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Puzderova B, Belvoncikova P, Grossmannova K, Csaderova L, Labudova M, Fecikova S, Pastorek J, Barathova M. Propranolol, Promising Chemosensitizer and Candidate for the Combined Therapy through Disruption of Tumor Microenvironment Homeostasis by Decreasing the Level of Carbonic Anhydrase IX. Int J Mol Sci 2023; 24:11094. [PMID: 37446271 DOI: 10.3390/ijms241311094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Resistance to chemotherapy represents a persisting medical problem, ranking among main causes of chemotherapy failure and cancer mortality. There is a possibility to utilize and repurpose already existing therapeutics which were not primarily intended for oncological treatment. Overactivation of adrenergic receptors and signaling dysregulation promotes tumor progression, metastatic potential, immune system evasion, tumor angiogenesis and drug resistance. The non-selective beta-blocker propranolol, approved in infantile haemangioma treatment, has a high potential for use in cancer therapy. We analyzed the effects of propranolol and 5-fluorouracil combination on sensitive and resistant cells derived from colorectal carcinoma in monolayers, single-component and co-culture spheroids and in vivo mouse models. Our results revealed that propranolol is able to exert its effect not only in chemosensitive colorectal cells, but also in 5-fluorouracil resistant cells. Propranolol disrupts the hypoxic adaptation machinery by inhibiting HIF1α, carbonic anhydrase IX, and activates apoptosis, which may be important in the management of chemo-resistant patients. We showed that propranolol slows down the growth of xenografts formed from colorectal cancer cells, even from cells already adapted to the β-blocker. We provide clear evidence that blockade of β-adrenergic receptors affects essential signaling pathways modulating tumor microenvironment and thus the response to anticancer therapy. Our findings indicate that propranolol could be repurposed to serve as chemosensitizer in combined therapy aimed at disrupting homeostasis of tumor microenvironment.
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Affiliation(s)
- Barbora Puzderova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Petra Belvoncikova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Katarina Grossmannova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Lucia Csaderova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Martina Labudova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Silvia Fecikova
- National Institute of Lung Disaeses, Thorax Surgery and Tuberculosis, Vyšné Hágy 1, 059 84 Vysoké Tatry, Slovakia
| | | | - Monika Barathova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
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Fu R, Zou Y, Wu Z, Jin P, Cheng J, Bai H, Huang M, Huan X, Yuan H. Safety of oral propranolol for neonates with problematic infantile hemangioma: a retrospective study in an Asian population. Sci Rep 2023; 13:5956. [PMID: 37046020 PMCID: PMC10097822 DOI: 10.1038/s41598-023-33105-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/07/2023] [Indexed: 04/14/2023] Open
Abstract
Although the efficacy of propranolol in the treatment of infantile hemangioma (IH) has been well established, clinical data on the safety and tolerability of propranolol in neonates are still lacking. In this work, clinical data of 112 neonates with IH were analyzed retrospectively. All of the patients were evaluated in the hospital at the beginning of the treatment and later in outpatient settings during the treatment. Each time, the following monitoring methods were applied: physical examination, ultrasound echocardiography (UCG), electrocardiography (ECG), blood pressure (BP), heart rate (HR), and basic laboratory tests including blood glucose (BG), liver function, blood potassium, thyroid function. There was a significant reduction in BP and HR at the initiation of treatment. The incidences of bradycardia and hypoglycemia were observed to be increased with the prolong duration of treatment, but not prolonged PR interval. During the course of the therapy, the risk of hyperkalemia and hypothyroidism was reached maximum at the 2 months and 3 months, respectively. Physical growth index including average height, weight and head circumference was not influenced by the treatment. The observed adverse effects were majority mild and only 3 patients needed to rest for 7 days due to severe diarrhea before restarting treatment. This study demonstrated that propranolol is safe and well-tolerated by properly selected young infants with IH. No serious adverse events were observed.
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Affiliation(s)
- Ronghua Fu
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Yun Zou
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Zhiping Wu
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Pingliang Jin
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Jun Cheng
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Hanxiang Bai
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Mengyu Huang
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Xiangquan Huan
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Hua Yuan
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China.
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Xu W, Zhao H. Management of infantile hemangiomas: Recent advances. Front Oncol 2022; 12:1064048. [PMID: 36523969 PMCID: PMC9745076 DOI: 10.3389/fonc.2022.1064048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
Infantile hemangiomas (IHs) are benign vascular tumors commonly observed in children. A small number of cases can manifest as organ or system dysfunction, permanent scarring, or even disfigurement. Currently, diagnosis is mainly based on clinical history, physical examination, and auxiliary inspection. In the treatment of a hemangioma, the functional damage caused by the lesion and complications that may endanger the patient’s life should be given priority. This suggests that identification, diagnosis, and referral to specialists during the early stages of IHs are important factors in preventing related complications and obtaining a better prognosis. During the past few decades, researchers have explored different treatments according to the condition, including oral or topical drugs, topical drug injections, laser surgery, and surgical treatment. However, oral propranolol remains a well-accepted first-line treatment. This article will primarily focus on the recent advances in the clinical diagnosis and treatment of hemangiomas, along with a literature review on the subject.
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Chen W, Zhu P, Xu M, Chen S, Wang Y, Shen C, Xu H, Chen J, Li X. Diagnosis of infantile subglottic hemangioma and the effect of oral propranolol. Am J Otolaryngol 2022; 43:103610. [PMID: 35988523 DOI: 10.1016/j.amjoto.2022.103610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To investigate the clinical characteristics of infantile subglottic hemangioma (SGH), and to observe the safety and efficacy of propranolol in the treatment of SGH. METHODS The data of 21 children diagnosed with SGH and treated with propranolol in our hospital from March 2013 to January 2021 were retrospectively analyzed and followed up. RESULTS Among the 21 cases, there were 7 males and 14 females. SGH was found 11 left-sided, 9 right-sided and 1 bilateral-sided. The clinical manifestations included stridor (13/21), respiratory distress (6/21), barking cough (5/21), feeding difficulty (4/21), three concave sign (4/21), cyanosis (2/21) and hoarseness (1/21). 8 patients had multiple cutaneous hemangiomas. The age of presentation ranged from 1 to 8 months, with a median of 1.1 months. 18 cases (85.7 %) had a history of misdiagnosis, 14 bronchitis/pneumonia, 5 laryngomalacia, 2 laryngeal obstruction and 1 asthma. The median ages at diagnosis were 3 months, with a range of 1.2-28 months. The treatment duration ranged from 6 to 25.6 months, with an average of (14.3 ± 4.9) months. Age at termination of treatment ranged from 9 to 38 months, with a median of 18.6 months, and only 2 cases were beyond 2 years old at that time. No adverse side effects from propranolol therapy occurred and all 21 cases were cured. CONCLUSIONS We advocate a strong index of suspicion for SGH presenting with respiratory symptoms under 2 years old who has poor effect or repeated condition after routine treatment. Laryngoscopy combined with contrast-enhanced CT can confirm the diagnosis of SGH. Oral propranolol is safe and effective, and that early diagnosis and intervention of propranolol without further delay are crucial to the successful management. We advocate continue propranolol treatment beyond 18 months of age, furthermore, 2 years old may be the best time for therapy termination.
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Affiliation(s)
- Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Peng Zhu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Mengrou Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Shumei Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Ying Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Chenling Shen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Jiarui Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China.
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China.
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Amthaghri S, Amssayef A, Slaoui M, Eddouks M. Antihypertensive and Vasorelaxant Effects of Hibiscus rosa-sinensis through Angiotensin-Converting Enzyme-2 (ACE-2), and Ca2+ channels Pathways. Cardiovasc Hematol Disord Drug Targets 2022; 22:CHDDT-EPUB-122011. [PMID: 35352670 DOI: 10.2174/1871529x22666220329190331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/22/2021] [Accepted: 02/10/2022] [Indexed: 11/22/2022]
Abstract
AIMS The aim of the study was to assess the antihypertensive activity of Hibiscus rosa-sinensis. BACKGROUND Hibiscus rosa-sinensis is used traditionally to treat hypertension. OBJECTIVE The goal of the study was to investigate the effect of the aqueous extract of Hibiscus rosa-sinensis flowers (AEHRS) on resting blood pressure in rats. MATERIAL AND METHODS In the present study, AEHRS was prepared and its antihypertensive activity was evaluated using in vivo and in vitro studies. In the in vivo study, hypertensive and normotensive rats were treated by AEHRS (100 mg/kg) orally for 6 hours in the acute treatment and for 7 days in the subchronic treatment. Systolic, diastolic, and mean arterial blood pressure values and heart rate were then recorded using a tail cuff and a computer-assisted monitoring device. To assess the vasorelaxant activity of AEHRS, isolated thoracic aortic rings were suspended in a tissue bath and changes in tension were recorded using a data acquisition system. Potential pathways involved in the vasorelaxant activity were evaluated using several standard pharmacological agents. RESULTS The results indicated that repeated oral administration of AEHRS during 7 days lowered systolic, diastolic, and mean arterial blood pressure in hypertensive rats without affecting normotensive rats. Furthermore, the data revealed that AEHRS exerts vasorelaxant properties via an endothelium-independent pathway. More interestingly, the study demonstrates that the vasorelaxant capacity of AEHRS seems to be exerted through the stimulation of angiotensin-converting enzyme-2 (ACE-2) and the inhibition of Ca2+ channels pathway. CONCLUSION The present study revealed that aqueous extract of Hibiscus rosa-sinensis has a significant antihypertensive activity and that its vasorelaxant effect may be mediated through stimulation of ACE-2, and inhibition of the Ca2+ channels.
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Affiliation(s)
- Smail Amthaghri
- Team of Ethnopharmacology and Pharmacognosy, Faculty of Sciences and Techniques Errachidia, Moulay Ismail University of Meknes, Errachidia, Morocco. BP 509 Errachidia, Morocco
| | - Ayoub Amssayef
- Team of Ethnopharmacology and Pharmacognosy, Faculty of Sciences and Techniques Errachidia, Moulay Ismail University of Meknes, Errachidia, Morocco. BP 509 Errachidia, Morocco
| | - Miloudia Slaoui
- Team EMDD, Center of CERNE2D, Ecole Supérieure de Technologie, Boulevard Mohamed VI Salé, Université Mohammed V, Rabat, Morocco
| | - Mohamed Eddouks
- Team of Ethnopharmacology and Pharmacognosy, Faculty of Sciences and Techniques Errachidia, Moulay Ismail University of Meknes, Errachidia, Morocco. BP 509 Errachidia, Morocco
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Abstract
Infantile hemangiomas (IHs) are common vascular lesions which are benign but can cause significant functional and cosmetic morbidity. Since the fortuitous discovery of propranolol being effective to treat IH over a decade ago, the therapy and prognosis for children with IH have improved dramatically. Oral propranolol (as well as other oral beta-blockers and topical timolol) are safe and effective treatments, and have now supplanted other therapies. Making the correct diagnosis is crucial, because other vascular lesions can mimic IH. In addition, IH can be the first manifestation of an underlying syndrome. For IH requiring treatment, initiating treatment early is key to optimizing success. Therefore, early recognition and referral, if necessary, are important. Continued research on IH, both basic science and clinical, should result in continued advances.
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Affiliation(s)
- Kristy S Pahl
- Department of Pediatrics, Duke University School of Medicine, Durham
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Abstract
Infantile hemangioma (IH) is the most common benign vascular tumor of infancy, affecting about 5% of infants. It has a characteristic growth pattern of early rapid proliferation followed by progressive involution. Although most IH evolve favorably, complications are observed in 10-15% of cases, justifying treatment. For over 10 years now, propranolol has become the first-line therapy for complicated IH, revolutionizing their management and their prognosis. In this article, we review the clinical features, associations, complications/sequelae and therapeutic approaches for IH, focusing on current medical therapy. Indications for treatment and various treatment options, including propranolol and other oral β-blockers, topical timolol, and corticosteroids are presented. Current controversies regarding oral propranolol such as pre-treatment screening, in- vs out-patient initiation of treatment, early and potential long-term side effects and recommended monitoring are discussed.
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Affiliation(s)
- Caroline Colmant
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada.
| | - Julie Powell
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
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Abstract
The International Society for the Study of Vascular Anomalies classifies vascular anomalies into vascular tumors and vascular malformations. Vascular tumors are neoplasms of endothelial cells, among which infantile hemangiomas (IHs) are the most common, occurring in 5%-10% of infants. Glucose transporter-1 protein expression in IHs differs from that of other vascular tumors or vascular malformations. IHs are not present at birth but are usually diagnosed at 1 week to 1 month of age, rapidly proliferate between 1 and 3 months of age, mostly complete proliferation by 5 months of age, and then slowly involute to the adipose or fibrous tissue. Approximately 10% of IH cases require early treatment. The 2019 American Academy of Pediatrics clinical practice guideline for the management of IHs recommends that primary care clinicians frequently monitor infants with IHs, educate the parents about the clinical course, and refer infants with high-risk IH to IH specialists ideally at 1 month of age. High-risk IHs include those with life-threatening complications, functional impairment, ulceration, associated structural anomalies, or disfigurement. In Korea, IHs are usually treated by pediatric hematology-oncologists with the cooperation of pediatric cardiologists, radiologists, dermatologists, and plastic surgeons. Oral propranolol, a nonselective beta-adrenergic antagonist, is the first-line treatment for IHs at a dosage of 2-3 mg/kg/day divided into 2 daily doses maintained for at least 6 months and often continuing until 12 months of age. Topical timolol maleate solution, a topical nonselective beta-blocker, may be used for small superficial type IHs at a dosage of 1-2 drops of 0.5% gel-forming ophthalmic solution applied twice daily. Pulse-dye laser therapy or surgery is useful for the treatment of residual skin changes after IH involution.
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Affiliation(s)
- Hye Lim Jung
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Sebaratnam DF, Rodríguez Bandera AL, Wong LCF, Wargon O. Infantile hemangioma. Part 2: Management. J Am Acad Dermatol 2021; 85:1395-1404. [PMID: 34419523 DOI: 10.1016/j.jaad.2021.08.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/25/2021] [Accepted: 08/03/2021] [Indexed: 12/18/2022]
Abstract
The majority of infantile hemangiomas (IH) can be managed conservatively, but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol. Patients that may require active intervention should receive specialist review, ideally before 5 weeks of age to mitigate the risk of sequelae. Propranolol can commence for most infants in the outpatient setting and the most frequently employed dosing regimen is 1 mg/kg twice daily. In the future, β-blockers with a more-selective mechanism of action, such as atenolol, show some promise. In recalcitrant lesions, systemic corticosteroids or sirolimus may be considered. For small, superficial IHs, topical timolol maleate or pulsed dye laser may be considered. Where the IH involutes with cutaneous sequelae, a range of interventions have been reported, including surgery, laser, and embolization. IHs have a well-described clinical trajectory and are readily diagnosed and managed via telemedicine. Algorithms have been constructed to stratify those patients who can be managed remotely from those who warrant in-person review during the COVID-19 pandemic.
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Affiliation(s)
- Deshan F Sebaratnam
- The Children's Hospital at Westmead, Sydney, Australia; Liverpool Hospital, Sydney, Australia.
| | | | | | - Orli Wargon
- Sydney Children's Hospital, Sydney, Australia
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Yang W, Wolter NE, Cushing SL, Pope E, Wolter JK, Propst EJ. Propranolol versus nadolol for treatment of pediatric subglottic hemangioma. Int J Pediatr Otorhinolaryngol 2021; 144:110688. [PMID: 33773428 DOI: 10.1016/j.ijporl.2021.110688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/16/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The beta-blocker propranolol is the standard medical therapy for subglottic hemangioma (SGH), but side effects and incomplete response rates require close monitoring. Nadolol has been identified as a potential alternative but its use has not been examined for SGH. METHODS Single institution retrospective cohort study of pediatric SGH treated with propranolol or nadolol. RESULTS Thirteen children (1 male, 12 female) with SGH were included: 6 were treated with propranolol (2.0-3.5 mg/kg/d) and 7 with nadolol (2.0-4.0 mg/kg/d). The most common presenting symptom was stridor (85%) and mean (SD) symptom duration prior to diagnosis was 4.6 (3.8) weeks. Cutaneous vascular lesions were present in 54%. There were 7 right-sided, 5 left-sided and 1 bilateral SGH. The mean (SD) percentage of airway obstruction was 60.6% (27.4). The response rate was 100% (6/6) for propranolol and 85.7% (6/7) for nadolol (p = 0.36). Mean (SD) time to symptomatic improvement was 2.6 (2.2) days with no difference across groups (p = 0.71). There was no hypotension, hypoglycemia, weight loss, or sleep disturbances in either group. One patient in the propranolol group experienced vomiting. Two patients in the nadolol group required dosage reduction due to asymptomatic bradycardia. The mean (SD) duration of admission was 14.4 (12.6) days and duration of treatment was 13.8 (11.2) days with no difference across groups (p = 0.23; p = 0.31, respectively). All patients had treatment initiated as inpatients and completed as outpatients. CONCLUSION Children with SGH treated with propranolol or nadolol had similar response rates and side effect profiles.
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Affiliation(s)
- Weining Yang
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Sharon L Cushing
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Elena Pope
- Department of Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jennifer K Wolter
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
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Kim JH, Lam JM. Paediatrics: how to manage infantile haemangioma. Drugs Context 2021; 10:dic-2020-12-6. [PMID: 33889196 PMCID: PMC8029639 DOI: 10.7573/dic.2020-12-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2021] [Indexed: 11/21/2022] Open
Abstract
Infantile haemangiomas (IHs) are relatively common benign vascular tumours found in the paediatric population. They have varying sizes and involve different depths in the skin leading to various colours, shapes and textures. Although considered harmless in most cases, they may lead to life-threatening complications or cause permanent disfigurations and organ dysfunction. For problematic IHs, the treatment options include oral and topical beta-blockers, systemic corticosteroids, laser treatment, and surgery. In this narrative review, the treatment options for problematic IH are compared and delivered concisely to facilitate the clinical decisions from practitioners, including those in primary care settings. Oral propranolol is currently considered the first-line intervention for problematic IHs. For superficial lesions, there is robust evidence for the use of topical timolol maleate. Systemic corticosteroids are sometimes used in specific situations such as resistance or contraindications to beta-blockers. Surgical excision can be considered in cases requiring urgent intervention such as airway obstruction; this can be done alongside laser therapies for the removal of residual tissue or when reconstructing areas of deformity. The combination of multiple treatment modalities may lead to a more rapid clinical response.
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Affiliation(s)
- Jason Hs Kim
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Vascular tumors are a part of the vascular anomalies spectrum. Vascular malformations are congenital vascular lesions, originating from a mesenchymal stem cell defect and distinguished from vascular tumors by their low cell turnover and lack of invasiveness. They tend to grow in proportion to the child. Vascular tumors are proliferative and range from benign proliferation to malignant tumors. The appropriate differential diagnosis is imperative. Infantile hemangioma can be diagnosed clinically and rarely requires therapy; more rare tumors are difficult to diagnose and treat. This review provides an overview of vascular tumors seen in the neonatal period and summarizes treatment options.
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Affiliation(s)
- Michael Briones
- Pediatric Hematology and Oncology, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA.
| | - Denise Adams
- Complex Vascular Anomalies Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Leung AKC, Lam JM, Leong KF, Hon KL. Infantile Hemangioma: An Updated Review. Curr Pediatr Rev 2021; 17:55-69. [PMID: 32384034 DOI: 10.2174/1573396316666200508100038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life. OBJECTIVE To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas. METHODS A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50% of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement. CONCLUSION Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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Tiwari P, Kumar R, Pandey V, Kar A, Tiwary N, Sharma S. A clinicopathological study to assess the role of intralesional sclerotherapy following propranolol treatment in infantile hemangioma. J Cutan Aesthet Surg 2021; 14:409-415. [PMID: 35283595 PMCID: PMC8906266 DOI: 10.4103/jcas.jcas_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Qiao J, Lin J, Zhang D, Li J, Chen C, Yu H, Li X, Fang B. Efficacy of Combined Topical Timolol and Oral Propranolol for Treating Infantile Hemangioma: A Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2020; 11:554847. [PMID: 33132908 PMCID: PMC7578425 DOI: 10.3389/fphar.2020.554847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022] Open
Abstract
Background Oral propranolol has become the first-line treatment for infantile hemangioma (IH). However, combined therapy with topical timolol and oral propranolol has been proposed as a more effective IH treatment strategy. We aimed to compare the safety and efficacy of topical timolol, oral propranolol, and their combination for treating IH in a meta-analysis. Methods Relevant randomized controlled trials (RCTs) were obtained after searching the PubMed, Embase, Cochrane’s Library, China National Knowledge Infrastructure, and WanFang databases. A random-effect model was used to pool the results. Results Eight RCTs with 759 patients with IH were included in this meta-analysis. Treatment with topical timolol alone showed a similar response rate compared to oral propranolol (risk ratio [RR] = 0.97, p = 0.63), but resulted in fewer adverse events (RR = 0.36, p = 0.002). Combined treatment with topical timolol and oral propranolol showed a favorable response rate compared to treatment with oral propranolol (RR = 1.14, p = 0.03) or topical timolol (RR = 1.36, p = 0.01) alone. Moreover, combined treatment showed similar risks of adverse events compared to oral propranolol (RR = 0.80, p = 0.24) or topical timolol (RR = 1.31, p = 0.25) alone. Conclusions Combined treatment with topical timolol and oral propranolol may be more effective than either single treatment strategy in patients with IH. Topical timolol alone conferred similar efficacy for IH compared to oral propranolol, but with less incidence of adverse events.
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Affiliation(s)
- Junbo Qiao
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junjie Lin
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dexin Zhang
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junhua Li
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changkuan Chen
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongye Yu
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaodi Li
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bin Fang
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Tiemann L, Hein S. Infantile Hemangioma: A Review of Current Pharmacotherapy Treatment and Practice Pearls. J Pediatr Pharmacol Ther 2020; 25:586-599. [PMID: 33041713 DOI: 10.5863/1551-6776-25.7.586] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Infantile hemangioma (IH) is the most common vascular tumor of infancy, affecting as many as 5% to 10% of all infants. The exact cause is unclear, but specific risk factors, such as low birth weight, prematurity, female sex, white race, and family history are associated with IH development. Most IHs are benign and self-resolving, but a small subset of patients with IHs are at risk of severe or life-threatening outcomes. Systemic and topical β-blockers are effective and safe for use in pediatric patients and considered first-line treatment for both complicated and uncomplicated IHs. Recently published guidelines provide a thorough review of IH and management. This article focuses on IH pharmacotherapy and provides practice pearls to support health care providers in IH medication management.
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Huang Z, Zhang N, Cai H, Luo K. Efficacy of propranolol and pingyangmycin, respectively, combined with pulsed dye laser on children with hemangioma. Exp Ther Med 2020; 19:1197-1202. [PMID: 32010289 PMCID: PMC6966208 DOI: 10.3892/etm.2019.8314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023] Open
Abstract
Clinical efficacy of propranolol and pingyangmycin, respectively, combined with pulsed dye laser in the treatment of children with hemangioma was analyzed, to provide a new therapeutic idea for their clinical treatment. A total of 120 children with hemangioma were selected into the study. Children treated with propranolol combined with pulsed dye laser were in group A, those treated with pingyangmycin combined with pulsed dye laser were in group B, and 60 healthy children were selected as control group (group C). Blood samples of children were taken before and after treatment for miR-4295 detection. The expression of miR-4295 was observed after treatment, and the total clinical remission rate and adverse reactions after treatment were compared between the two groups. The tumor volume of the two groups was significantly reduced after treatment, with statistically significant difference (P<0.05); miR-4295 expression was reduced in the two groups (P<0.05); adverse reactions in propranolol group were less than pingyangmycin group during treatment (P<0.05). Propranolol and pingyangmycin, respectively, combined with pulsed dye laser had ideal efficacy on hemangioma in children. Moreover, miR-4295 was highly expressed in children with hemangioma, and the expression level reduced after two methods of treatment. However, adverse reactions in propranolol group were less and its safety was higher.
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Affiliation(s)
- Zhiyong Huang
- Department of Vascular Surgery, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518000, P.R. China
| | - Ning Zhang
- Department of Vascular Surgery, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518000, P.R. China
| | - Hanxin Cai
- Department of Vascular Surgery, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518000, P.R. China
| | - Kunhui Luo
- Department of Vascular Surgery, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518000, P.R. China
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Helal AA, Daboos MA. Five years’ experience of combined intralesional therapy in infantile hemangioma. ANNALS OF PEDIATRIC SURGERY 2019. [DOI: 10.1186/s43159-019-0008-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Infantile hemangiomas (IHs) are common vascular tumors. Although it involutes spontaneously, outcomes are unpredictable. Intralesional therapy is one of its treatment modality. We present our experience with combined intralesional therapy for IHs over a 5-year duration. A total of 427 patients were treated and followed at Al-Azhar University Hospitals during the study period of 5 years. All patients were treated by intralesional therapy in the form of combined injection of triamcinolone and bleomycin. All patients were followed for the response. Response to the treatment was graded as marked, partial, and poor improvement.
Results
IHs were noticed within the first month of life in 90.2% of patients. The commonest site of involvement was head and neck in 90% of patients. The commonest clinical presentation was swelling with discoloration. Mean age was 7.43 ± 6.04 months and mean IHs size was 15.54 ± 11.13 cm2. The response to the treatment was highest for patients below 1 year of age. The reported complications were ulceration, scarring, and subcutaneous atrophy in some cases.
Conclusion
Combined intralesional therapy in IHs showed good efficacy in most patients. It is a reliable and safe treatment modality with clear curative effects and minimal complications. If IHs treatment is indicated, combined intralesional therapy should be considered as an alternative effective treatment modality.
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Yang H, Hu DL, Shu Q, Guo XD. Efficacy and adverse effects of oral propranolol in infantile hemangioma: a meta-analysis of comparative studies. World J Pediatr 2019; 15:546-558. [PMID: 31342465 DOI: 10.1007/s12519-019-00285-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND A number of clinical trials evaluated the efficacy and adverse effects of oral propranolol in the treatment of infantile hemangioma (IH), but the treatment has not yet been standardized. This meta-analysis aims to reevaluate the efficacy and adverse effects of oral propranolol in comparative studies and to provide a reliable basis for clinical administration in the therapy for IH. METHODS Data were obtained from PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang database, from inception to December 1st, 2018. The pooled risk ratios (RR) with 95% confidence intervals (95% CI) were calculated and used to evaluate the effect size. The meta-analysis was performed using the random-effects model due to heterogeneity between the studies. The Cochrane Collaboration 6 aspects of bias, methodological index for non-randomized studies and the Newcastle-Ottawa Scale were used to assess the risk for bias. Sensitivity analysis, publication bias and subgroup analysis were performed. RESULTS Eighteen unique studies involving 2701 unique children were included in the analysis. The response rate was reported in 18 trials, which compared oral propranolol with other treatments. The heterogeneity was statistically significant (P < 0.00001, I2 = 95%). The difference in the response rate was statistically significant (RR = 1.40, 95% CI 1.13-1.75) while compared with the controls. However, no significant difference in the adverse events rate (RR = 0.78, 95% CI 0.45-1.34) and relapse rate (RR = 1.45, 95% CI 0.66-3.16) were found. Otherwise, the subgroup analysis indicated that the RR was 1.64 (95% CI 0.24-11.36) for low-dose propranolol (1 mg/kg/day), 1.42 (95% CI 1.12-1.80) for medium dose (2 mg/kg/day) and 1.46 (95% CI 1.17-1.82) for high dose (3 mg/kg/day), but the high dose had higher adverse events rate than medium dose, with 3.60% and 86.22%, respectively. The effectiveness of propranolol therapy among cases of treatment duration less than 6 months (RR = 1.24, 95% CI 1.05-1.47) was inferior to that of treatment duration greater than or equal to 6 months (RR = 1.46, 95% CI 1.11-1.92). CONCLUSIONS This meta-analysis reveals that oral propranolol is superior to other treatments in improving response rate of IH and can be used as the first-line therapy for IH children. A dosage of 2 mg/kg/day propranolol orally may be a good choice for IH. However, further studies are essential.
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Affiliation(s)
- Hao Yang
- Department of Pediatrics Surgery, Jinhua Central Hospital, No. 365 Renmindong Road, Wucheng District, Jinhua, 321000, China.,Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Dong-Lai Hu
- Department of Pediatrics Surgery, Jinhua Central Hospital, No. 365 Renmindong Road, Wucheng District, Jinhua, 321000, China
| | - Qiang Shu
- Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Xiao-Dong Guo
- Department of Pediatrics Surgery, Jinhua Central Hospital, No. 365 Renmindong Road, Wucheng District, Jinhua, 321000, China.
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Chen ZY, Wang QN, Zhu YH, Zhou LY, Xu T, He ZY, Yang Y. Progress in the treatment of infantile hemangioma. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:692. [PMID: 31930093 PMCID: PMC6944559 DOI: 10.21037/atm.2019.10.47] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023]
Abstract
Infantile hemangioma (IH) is a common benign tumor, which mostly resolves spontaneously; however, children with high-risk IH need treatment. Currently, the recognized first-line treatment regimen for IH is oral propranolol, but research on the pathogenesis of IH has led to the identification of new therapeutic targets, which have shown good curative effects, providing more options for disease treatment. This article summarizes the applications of different medications, dosages, and routes of administration for the treatment of IH. In addition to drug therapy, this article also reviews current therapeutic options for IH such as laser therapy, surgical treatment, and observation. To provide the best treatment, therapeutic regimens for IH should be selected based on the child's age, the size and location of the lesion, the presence of complications, the implementation conditions, and the potential outcomes of the treatment.
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Affiliation(s)
- Zhao-Yang Chen
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Qing-Nan Wang
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yang-Hui Zhu
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Ling-Yan Zhou
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Ting Xu
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Zhi-Yao He
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yang Yang
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
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Infantile Hemangiomas of the Lip: Complications and Need for Surgical Intervention. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2308. [PMID: 31624693 PMCID: PMC6635212 DOI: 10.1097/gox.0000000000002308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
Abstract
Background: Infantile lip hemangiomas are challenging to manage due to the functional and aesthetic importance of the lips. Hemangiomas in this region may lead to significant complications including ulceration, feeding difficulties, and lip contour distortion requiring surgical intervention. Methods: A retrospective chart review of children with focal lip hemangiomas treated at our institution between January 2000 and December 2016 was conducted. Patient demographics, lesion characteristics, complications, treatments, and outcomes were collected. Lesions were classified based on depth (superficial, deep, or mixed depth), vermillion border involvement, and location. Results: One hundred and two patients with focal lip hemangiomas were identified; 45.1% were managed expectantly, 43.1% were treated medically, and 18.6% required surgery. Residual lip contour deformity following involution was the most common complication (26.5% of patients). Ulceration during the proliferation phase was reported in 14.7% of patients, leading to significant feeding difficulties in 9.8% of patients. All ulcerations occurred in lesions with a superficial component. None of the patients with superficial lesions underwent surgery; 27.1% of patients with deep or mixed depth hemangiomas required surgical treatment to restore lip contour. Conclusions: Lip hemangiomas have high rates of complications that seem to be related to lesion morphology and phase of growth. Ulceration occurs during the early proliferative phase and is most frequently associated with mixed depth hemangiomas. Residual lip contour deformities are identified in the involution phase; presence of a deep component is the primary factor in predicting the need for surgical intervention in these patients.
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El-Ouady F, Eddouks M. Warionia saharae induces antihypertensive and vasorelaxant activities through nitric oxide and KATP channels pathways in rats. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 17:/j/jcim.ahead-of-print/jcim-2019-0024/jcim-2019-0024.xml. [PMID: 31348761 DOI: 10.1515/jcim-2019-0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/24/2019] [Indexed: 11/15/2022]
Abstract
Background Warionia saharae Bentham & Cosson. is used in traditional medicine to treat many diseases including hypertension. Method The present study was designed to investigate the antihypertensive activity of aqueous extract of Warionia saharae (WSLAE) in anesthetized L-NAME (Nω-L-arginine methyl ester)-induced rats. The acute and sub-chronic effects of WSLAE on systolic, diastolic, mean arterial blood pressure and heart rate (HR) were investigated after oral administration of the extract (100 mg/kg body weight of WSLAE) during 6 h for the acute experiment and during 7 days for the sub-chronic test. In addition the effect of WSLAE on the contractile response of isolated rat aortic rings was tested and the role of the vascular receptors was evaluated using several drugs. Results The results showed that WSLAE induced a significant decrease in the systolic, diastolic, mean arterial blood pressure and HR in both normotensive and hypertensive rats. Furthermore, this extract induced relaxation in rings pre-contracted with Epinephrine (10 µM) or with KCl (100 mM). This vasorelaxant capacity seems to be mediated through inhibition of KATP channels and nitric oxide (NO) synthase pathways. Conclusion This study supports the use of Warionia saharae in the management of hypertension in Moroccan traditional medicine.
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Affiliation(s)
- Fadwa El-Ouady
- Faculty of Sciences and Techniques Errachidia, Moulay Ismail University, BP 509, Boutalamine, BP 21, Errachidia, 52000, Morocco
| | - Mohamed Eddouks
- Faculty of Sciences and Techniques Errachidia, Moulay Ismail University, BP 509, Boutalamine, BP 21, Errachidia, 52000, Morocco
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Mannschreck DB, Huang AH, Lie E, Psoter K, Puttgen K. Topical timolol as adjunct therapy to shorten oral propranolol therapy for infantile hemangiomas. Pediatr Dermatol 2019; 36:283-289. [PMID: 30968438 DOI: 10.1111/pde.13816] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND/OBJECTIVES First-line therapy for infantile hemangiomas (IH) is oral propranolol, a systemic beta-blocker with the risk of rare but serious adverse effects. Topical timolol presents an attractive off-label alternative with good tolerability, but sequential therapy with propranolol followed by timolol is not well studied. Here, we report effects of topical timolol preceding or following oral propranolol as adjunct therapy for IH. METHODS A retrospective chart review of 559 patients with IH seen at the pediatric dermatology clinic of a tertiary care center between December 2008 and January 2018. Children were grouped by treatment received: propranolol only, timolol only, propranolol to timolol, timolol to propranolol to timolol, and timolol to propranolol. Patient demographics, clinical/treatment characteristics, and pairwise differences were explored between groups. RESULTS Among all patients treated with propranolol, those who received propranolol followed by timolol received the shortest duration of oral propranolol and were the youngest at the time of propranolol completion. These patients received propranolol for a median of 2.2 months duration (P = 0.006) and were a median of 1.7 months younger (P = 0.007) compared with patients who received oral propranolol only. None had treatment failure defined as requiring propranolol reinitiation, compared with 13% of patients in the propranolol only group (P = 0.036). CONCLUSIONS Sequential therapy with oral propranolol followed by topical timolol for IH may help minimize potential adverse effects of systemic beta-blockers by reducing the duration of propranolol therapy and facilitating successful taper at a younger age without an increase in treatment failures.
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Affiliation(s)
| | - Amy H Huang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erina Lie
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin Psoter
- Division of Biostatistics, Epidemiology, & Data Management, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine Puttgen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Düzenli Kar Y, Özdemir ZC, Acu B, Bör Ö. Infantile hemangioma: Efficacy of low-dose propranolol and of intralesional bleomycin injection for propranolol non-response. Pediatr Int 2019; 61:459-464. [PMID: 30861274 DOI: 10.1111/ped.13830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/26/2019] [Accepted: 03/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infantile hemangioma (IH) is the most common form of benign childhood vascular tumor. Most resolve spontaneously, but treatment is recommended in patients who develop complication. Propranolol is recommended as the first-line therapy, while the treatment in the case of non-response to first-line therapy depends on the clinical experiences of each center. The aim of this study was to investigate the efficacy of low-dose propranolol in the treatment of IH, and the outcomes of percutaneous intralesional bleomycin injection (IBI) in patients unresponsive to propranolol. METHODS Medical records of 104 children diagnosed with IH between June 2014 and June 2017 were reviewed retrospectively. RESULTS Median patient age was 6 months (range, 3-12 months). Forty-five patients (43.3%) received therapy: 18 (40%) for cosmetic problems and 27 (60%) for lesion-related complications. The most common complications were hemorrhage (15.6%) and impairment in visual function (15.6%). All of the patients received propranolol 1 mg/kg/day as the first-line therapy. Response to treatment was excellent in 35 patients, good in four and poor in one, while five patients did not respond to therapy. The five unresponsive patients received percutaneous IBI at 0.3-0.5 mg/kg/dose as second-line therapy. The response to treatment was excellent in four patients, good in one. CONCLUSIONS The majority of IH resolved spontaneously. In the patients who required treatment, low-dose propranolol was successful in most, and IBI was effective and safe in the remaining five patients who did not respond to propranolol.
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Affiliation(s)
- Yeter Düzenli Kar
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Zeynep Canan Özdemir
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Berat Acu
- Division of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Kola B, Mehrafza M, Kane A. Phacomatosis Pigmentovascularis: Simple Presentation of a Not So Simple Dermatological Condition. Clin Pediatr (Phila) 2019; 58:485-487. [PMID: 29067825 DOI: 10.1177/0009922817737088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cutaneous vascular malformations are rare disorders that are often confused with more common infantile hemangiomas. We report the case of a female infant who presented with phacomatosis pigmentovascularis type IIA with features of Klippel-Trenaunay-Weber syndrome.
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Affiliation(s)
- Bhargavi Kola
- 1 Texas Tech University Health Sciences Center, Odessa, TX, USA
| | | | - Alex Kane
- 3 University of Texas Southwestern Medical Center at Dallas, TX, USA
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Zhu YL, Peng ZB, Chen ZP, Wang JK, Shi CX, Chen Y, Yu RQ. Quantification of enantiomers by mass spectrometry based on chemical derivatization and spectral shape deformation quantitative theory. JOURNAL OF MASS SPECTROMETRY : JMS 2019; 54:250-257. [PMID: 30672064 DOI: 10.1002/jms.4334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
A facile mass spectrometric kinetic method for quantitative analysis of chiral compounds was developed by integrating mass spectrometry based on chemical derivatization and the spectral shape deformation quantitative theory. Chemical derivatization was employed to introduce diastereomeric environments to the chiral compounds of interest, resulting in different abundance distribution patterns of fragment ions of the derivatization products of enantiomers in mass spectrometry. The quantitative information of the chiral compounds of interest was extracted from complex mass spectral data by an advanced calibration model derived based on the spectral shape deformation quantitative theory. The performance of the proposed method was tested on the quantitative analysis of R-propranolol in propranolol tablets. Experimental results demonstrated that it could achieve accurate and precise concentration ratio predictions for R-propranolol with an average relative predictive error (ARPE) of about 4%, considerably better than the corresponding results of the mass spectrometric method based on chemical derivatization and the univariate ratiometric model (ARPE: about 12%). The limit of detection (LOD) and limit of quantification (LOQ) of the proposed method for the concentration ratio of R-propranolol were estimated to be 1.5% and 6.0%, respectively. The proposed method is complementary to the existing methods designed for the quantification of enantiomers such as the Cooks kinetic method.
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Affiliation(s)
- Yan-Li Zhu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Zu-Bin Peng
- Forensic Science Branch of Changsha Railway Public Security Bureau, No. 19, Shuguang North Road, Furong District, Changsha, Hunan, 410001, China
| | - Zeng-Ping Chen
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Ji-Kai Wang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Cai-Xia Shi
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Yao Chen
- Hunan Key Lab of Biomedical Materials and Devices, College of Life Sciences and Chemistry, Hunan University of Technology, Zhuzhou, Hunan, 412008, China
| | - Ru-Qin Yu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
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Abstract
OBJECTIVE To quantify complications and rates of adverse events associated with surgical excision of hemangiomas in children using a national surgical database. DATA SOURCE Pediatric American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® -pediatric), years 2012-2016. METHODS Subjects included children under 18 years with a postoperative diagnosis of International Classification of Diseases (ICD), 9th revision code: 228.00 and 228.01, or ICD 10 codes D18.00 and D18.01-hemangioma, any site and hemangioma, of skin and subcutaneous tissue. RESULTS A total of 1180 patients were included. The median age was 3.2 years (interquartile range [IQR] 1.2 to 6.4 years old). No occurrences of deep incisional surgical site infection, nerve injury, mortality, sepsis, septic shock, or blood stream infections were noted. In multivariate analysis, age ≤ 3 years and advanced American Society of Anesthesiologists class were significant predictors of adverse events (P = 0.035 and 0.001, respectively). CONCLUSIONS For children with infantile hemangioma who fail to respond or have an incomplete response to medical therapy, surgical resection may be a relatively safe treatment alternative. Children older than 3 years of age with hemangiomas had less surgical adverse events than younger children. Overall, however, the surgical complications rates were low and deemed relatively minor.
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Affiliation(s)
- Jeffrey Cheng
- Pediatric Otolaryngology, Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Beiyu Liu
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - Hui-Jie Lee
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
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Central Nervous System Effects of Oral Propranolol for Infantile Hemangioma: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8020268. [PMID: 30813242 PMCID: PMC6406625 DOI: 10.3390/jcm8020268] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/16/2019] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
Concerns about the effects of propranolol on the central nervous system (CNS) in the infantile hemangioma (IH) population have been raised. We conducted a meta-analysis of the CNS and sleep-related effects of oral propranolol in IH patients. PubMed, Embase, Cochrance, Web of Science, and Clinicaltrials.gov were searched for relevant studies. We included clinical trials that compared oral propranolol with other treatments among IH patients under 6 years old and monitored and reported any adverse events. Study characteristics, types and number of adverse events were abstracted. Cochrane Collaboration Risk of Bias Tool was used to assess risk of bias. Our main outcomes were CNS and sleep-related effects. Random-effects models were used to estimate the pooled risk ratio. We did not observe statistically significant associations between oral propranolol and CNS or sleep-related effects. Oral propranolol appeared to have a safer profile of CNS effects than corticosteroids (RR = 0.27, 95% CI 0.02⁻3.00), but had an increased risk versus non-corticosteroids (for CNS effect, RR = 1.40, 95% CI 0.86⁻2.27; for sleep-related effects, RR = 1.63, 95% CI 0.88⁻3.03). Despite no statistically significant associations, there were suggestive findings of increased CNS effects and sleep-related risk of propranolol versus non-corticosteroids. In practice, CNS and sleep-related events should be monitored more closely among IH patients treated with oral propranolol.
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Satterfield KR, Chambers CB. Current treatment and management of infantile hemangiomas. Surv Ophthalmol 2019; 64:608-618. [PMID: 30772366 DOI: 10.1016/j.survophthal.2019.02.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 12/19/2022]
Abstract
Infantile hemangiomas, otherwise known as infantile capillary hemangiomas, strawberry hemangiomas, or strawberry nevi, are nonmalignant vascular tumors that commonly affect children. The natural disease course typically involves growth for up to a year, followed by regression without treatment over a period of years with no cosmetic or functional sequelae. Less commonly, however, infantile hemangiomas can become a threat to vision or even life depending on location and size of the lesion. In addition, infantile hemangiomas, particularly those involving the face, may be disfiguring and result in lifelong sequelae. β-blockers have become a mainstay of therapy given their relatively low-risk profile and efficacy. Other treatment modalities previously described in the literature include corticosteroids (both intralesional and systemic), imiquimod, vincristine, bleomycin A5, and interferon α. More recently, angiotensin-converting enzyme inhibitors such as captopril have been used. Laser therapy and, less commonly, surgical excision are also available treatment options. We review current recommended management and treatment of capillary hemangiomas and discuss the benefits and risks of all previously reported treatment modalities.
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Affiliation(s)
- Kellie R Satterfield
- Department of Medicine, Scripps Mercy Hospital, San Diego, California, USA; Department of Ophthalmology, University of Washington, Seattle, Washington DC, USA
| | - Christopher B Chambers
- Department of Ophthalmology, University of Washington, Seattle, Washington DC, USA; Department of Oculoplastic and Reconstructive Surgery, University of Washington, Seattle, Washington DC, USA.
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Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene AK, Annam A, Baker CN, Frommelt PC, Hodak A, Pate BM, Pelletier JL, Sandrock D, Weinberg ST, Whelan MA. Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics 2019; 143:peds.2018-3475. [PMID: 30584062 DOI: 10.1542/peds.2018-3475] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs.
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Affiliation(s)
- Daniel P Krowchuk
- Departments of Pediatrics and Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina;
| | - Ilona J Frieden
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Anthony J Mancini
- Departments of Pediatrics and Dermatology, Feinberg School of Medicine, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David H Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School and Children's Hospital of the King's Daughters, Norfolk, Virginia
| | - Francine Blei
- Donald and Barbara Zucker School of Medicine, Northwell Health, New York City, New York
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Aparna Annam
- Department of Radiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Cynthia N Baker
- Department of Pediatrics, Kaiser Permanente Medical Center, Los Angeles, California
| | - Peter C Frommelt
- Department of Pediatrics, Cardiology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Amy Hodak
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Brian M Pate
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | | | - Deborah Sandrock
- St Christopher's Hospital for Children and College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Stuart T Weinberg
- Departments of Biomedical Informatics and Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Mary Anne Whelan
- College of Physicians and Surgeons, Columbia University, New York City, New York
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Zhao F, Yang X, Xu G, Bi J, Lv R, Huo R. Propranolol suppresses HUVEC viability, migration, VEGF expression, and promotes apoptosis by downregulation of miR-4295. J Cell Biochem 2018; 120:6614-6623. [PMID: 30368887 DOI: 10.1002/jcb.27957] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 10/02/2018] [Indexed: 01/18/2023]
Abstract
Infantile hemangioma (IH) is a common benign tumor. Human umbilical vein endothelial cells (HUVECs) have the potential of stem cells, which has been widely used in vascular endothelial cell experiments. Oral propranolol was first reported to treat hemangioma in 2008. However, the role of propranolol in IH remains unclear. Therefore, in this study, we investigated the effects of propranolol on HUVECs in vitro, to explore the underlying mechanism of propranolol in IH. HUVECs were treated with 0.15, 1.5, and 15 μM of propranolol, and transfected with microRNA-4295 (miR-4295) mimic. Cell viability, migration, and apoptosis were examined using Cell Counting Kit-8, transwell assay, and flow cytometry analysis, respectively. In addition, the expressions and concentrations of miR-4295, vascular endothelial growth factor (VEGF), VEGF-A, FLT1, FLT2, and FOXF1 were assessed using real-time polymerase chain reaction, Western blot assay, and enzyme-linked immunosorbent assay. We found that 15 μM of propranolol decreased HUVEC viability the most. Then, cell migration and the concentrations of VEGF and VEGF-A were reduced, and apoptosis was increased when treated with propranolol. Meanwhile, the expressions of VEGF, VEGF-A, FLT1, FLT2, and FOXF1 were downregulated by propranolol exposure. Further study showed that miR-4295 expression was upregulated in IH tissues, and propranolol treatment downregulated miR-4295 expression in HUVECs. MiR-4295 overexpression alleviated the reductions of viability, migration, and factors expression, as well as the increase of apoptosis. Propranolol suppressed HUVEC viability, migration, the expression of VEGF, VEGF-A, FLT1/2, FOXF1, and promoted apoptosis via downregulation of miR-4295. This study lays a foundation for further study of the effect of propranolol on IH.
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Affiliation(s)
- Feng Zhao
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.,Department of Burn and Plastic Surgery, Linyi People's Hospital, Linyi, Shandong, China
| | - Xiaoliang Yang
- Department of Burn and Plastic Surgery, The Affiliated Central Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangqi Xu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jianhai Bi
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Renrong Lv
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Ran Huo
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Ceasrine AM, Lin EE, Lumelsky DN, Iyer R, Kuruvilla R. Adrb2 controls glucose homeostasis by developmental regulation of pancreatic islet vasculature. eLife 2018; 7:39689. [PMID: 30303066 PMCID: PMC6200393 DOI: 10.7554/elife.39689] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/07/2018] [Indexed: 12/12/2022] Open
Abstract
A better understanding of processes controlling the development and function of pancreatic islets is critical for diabetes prevention and treatment. Here, we reveal a previously unappreciated function for pancreatic β2-adrenergic receptors (Adrb2) in controlling glucose homeostasis by restricting islet vascular growth during development. Pancreas-specific deletion of Adrb2 results in glucose intolerance and impaired insulin secretion in mice, and unexpectedly, specifically in females. The metabolic phenotypes were recapitulated by Adrb2 deletion from neonatal, but not adult, β-cells. Mechanistically, Adrb2 loss increases production of Vascular Endothelial Growth Factor-A (VEGF-A) in female neonatal β-cells and results in hyper-vascularized islets during development, which in turn, disrupts insulin production and exocytosis. Neonatal correction of islet hyper-vascularization, via VEGF-A receptor blockade, fully rescues functional deficits in glucose homeostasis in adult mutant mice. These findings uncover a regulatory pathway that functions in a sex-specific manner to control glucose metabolism by restraining excessive vascular growth during islet development.
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Affiliation(s)
- Alexis M Ceasrine
- Department of Biology, Johns Hopkins University, Baltimore, United States
| | - Eugene E Lin
- Department of Biology, Johns Hopkins University, Baltimore, United States
| | - David N Lumelsky
- Department of Biology, Johns Hopkins University, Baltimore, United States
| | - Radhika Iyer
- Department of Biology, Johns Hopkins University, Baltimore, United States
| | - Rejji Kuruvilla
- Department of Biology, Johns Hopkins University, Baltimore, United States
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Polites SF, Rodrigue BB, Chute C, Hammill A, Dasgupta R. Propranolol versus steroids for the treatment of ulcerated infantile hemangiomas. Pediatr Blood Cancer 2018; 65:e27280. [PMID: 29932302 DOI: 10.1002/pbc.27280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND There has been a paradigm shift from steroids to propranolol for the pharmacologic treatment of infantile hemangiomas (IH); however, the outcomes for ulcerated IH are not well studied. The purpose of this study was to compare the efficacy of steroids and propranolol specifically for ulcerated IH. METHODS A retrospective review was conducted on patients with ulcerated IH treated with propranolol or steroids at a single tertiary care institution between 2007 and 2014. Patient characteristics, hemangioma features, and outcomes, including time to heal and medication complications, were compared between propranolol and steroid patients. RESULTS There were 29 patients treated with propranolol and 23 with steroids. There were no significant differences in the two treatment groups including age, race, sex, size, or insurance status. There were more head/neck IH in the steroid group. There was no significant difference in the percentage of healed lesions (93 vs. 74%, P = 0.12) or the median time to heal (80 vs. 126 days, p = 0.21) between groups. Overall complication rates also did not vary between medications (24 vs. 44%, P = 0.14). CONCLUSION Propranolol is noninferior to steroids for the treatment of ulcerated IH; however, healing time is lengthy regardless of treatment. While side effect profiles differed between medications, the overall complication rate was similar.
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Affiliation(s)
- Stephanie F Polites
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bentley B Rodrigue
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Carol Chute
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adrienne Hammill
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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El-Abasawi NM, Attia KAM, Abo-Serie AAM, Morshedy S, Abdel-Fattah A. Simultaneous determination of rosuvastatin and propranolol in their binary mixture by synchronous spectrofluorimetry. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2018; 198:322-330. [PMID: 29567601 DOI: 10.1016/j.saa.2018.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Simultaneous determination of rosuvastatin calcium and propranolol hydrochloride using the first derivative synchronous spectrofluorimetry was described. This method involves measuring the synchronous fluorescence of both drugs in ethanol using, ∆ λ = 60 nm then the first derivative was recorded and the peak amplitudes were measured at 350 and 374 nm for rosuvastatin calcium and propranolol hydrochloride, respectively. Under the optimum conditions, the linear ranges of rosuvastatin calcium and propranolol hydrochloride were 0.2-2 μg/mL and 0.1-1 μg/mL, respectively. The method was used for quantitative analysis of the drugs in raw materials and pharmaceutical dosage form. The validity of the proposed method was assessed according to an international conference on harmonization (ICH) guidelines.
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Affiliation(s)
- Nasr M El-Abasawi
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, 11751 Nasr City, Cairo, Egypt
| | - Khalid A M Attia
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, 11751 Nasr City, Cairo, Egypt
| | - Ahmad A M Abo-Serie
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, 11751 Nasr City, Cairo, Egypt
| | - Samir Morshedy
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, 11751 Nasr City, Cairo, Egypt
| | - Ashraf Abdel-Fattah
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, 11751 Nasr City, Cairo, Egypt.
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Al Khalifah R, Florez ID, Guyatt G, Thabane L. Network meta-analysis: users' guide for pediatricians. BMC Pediatr 2018; 18:180. [PMID: 29843665 PMCID: PMC5975630 DOI: 10.1186/s12887-018-1132-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/30/2018] [Indexed: 11/23/2022] Open
Abstract
Background Network meta-analysis (NMA) is a powerful analytic tool that allows simultaneous comparison between several management/treatment alternatives even when direct comparisons of the alternatives (such as the case in which treatments are compared against placebo and have not been compared against each other) are unavailable. Though there are still a limited number of pediatric NMAs published, the rapid increase in NMAs in other areas suggests pediatricians will soon be frequently facing this new form of evidence summary. Discussion Evaluating the NMA evidence requires serial judgments on the creditability of the process of NMA conduct, and evidence quality assessment. First clinicians need to evaluate the basic standards applicable to any meta-analysis (e.g. comprehensive search, duplicate assessment of eligibility, risk of bias, and data abstraction). Then evaluate specific issues related to NMA including precision, transitivity, coherence, and rankings. Conclusions In this article we discuss how clinicians can evaluate the credibility of NMA methods, and how they can make judgments regarding the quality (certainty) of the evidence. We illustrate the concepts using recent pediatric NMA publications.
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Affiliation(s)
- Reem Al Khalifah
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada. .,Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism King Saud University, Riyadh, Saudi Arabia.
| | - Ivan D Florez
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia
| | - Gordon Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada
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Zhou C, Fang F, Cheng Y, Li Y, Liu H, Zhou Y. Rhodium(III)-Catalyzed C-H Activation of Benzoylacetonitriles and Cyclization with Sulfoxonium Ylides to Naphthols. Adv Synth Catal 2018. [DOI: 10.1002/adsc.201800362] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Chaofan Zhou
- Nano Science and Technology Institute; University of Science and Technology of China; 166 Ren Ai Road Suzhou 215123 People's Republic of China
- Key Laboratory of Receptor Research, S; hanghai Institute of Materia Medica; Chinese Academy of Sciences; 555 Zu Chong Zhi Road Shanghai 201203 People's Republic of China
| | - Feifei Fang
- Key Laboratory of Receptor Research, S; hanghai Institute of Materia Medica; Chinese Academy of Sciences; 555 Zu Chong Zhi Road Shanghai 201203 People's Republic of China
| | - Yilang Cheng
- Key Laboratory of Receptor Research, S; hanghai Institute of Materia Medica; Chinese Academy of Sciences; 555 Zu Chong Zhi Road Shanghai 201203 People's Republic of China
| | - Yazhou Li
- Key Laboratory of Receptor Research, S; hanghai Institute of Materia Medica; Chinese Academy of Sciences; 555 Zu Chong Zhi Road Shanghai 201203 People's Republic of China
| | - Hong Liu
- Key Laboratory of Receptor Research, S; hanghai Institute of Materia Medica; Chinese Academy of Sciences; 555 Zu Chong Zhi Road Shanghai 201203 People's Republic of China
| | - Yu Zhou
- Key Laboratory of Receptor Research, S; hanghai Institute of Materia Medica; Chinese Academy of Sciences; 555 Zu Chong Zhi Road Shanghai 201203 People's Republic of China
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Zheng L, Li Y. Effect of topical timolol on response rate and adverse events in infantile hemangioma: a meta-analysis. Arch Dermatol Res 2018; 310:261-269. [PMID: 29362868 DOI: 10.1007/s00403-018-1815-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/19/2017] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
Abstract
A number of clinical trials evaluated the effect of topical timolol in the treatment of infantile hemangioma and provided inconsistent results. The present study assessed the response rate and adverse events of topical timolol in the treatment of infantile hemangioma. Pubmed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, and Cochrane library were searched until October 2016. Specific inclusion criteria were used to evaluate articles. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. The meta-analysis was performed using a random effect model. A total of 10 studies, comprising 887 infants with hemangioma, were included. The response rate was reported in eight trials; these studies compared the topical timolol to laser, observation, placebo, or propranolol. The heterogeneity was statistically significant (P < 0.00001, I2 = 83%). The difference in the response rate was significant (RR = 2.86, 95% CI 1.31-6.24) while comparing the topical timolol to the controls. However, no significant difference in the response rate was observed while comparing the topical timolol to propranolol (RR = 0.99, 95% CI 0.70-1.42). The difference in the adverse events was found to be significant (RR = 0.21, 95% CI 0.05-0.97) when the timolol group was compared to the control group. This meta-analysis confirmed that the topical timolol alone was more beneficial on response rate and adverse event than laser, placebo, and observation. The response rate did not differ significantly when comparing the topical timolol to propranolol. However, further studies are essential using an improved design of the study.
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Affiliation(s)
- Lei Zheng
- The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou, 310052, Zhejiang, China
| | - Yunling Li
- The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou, 310052, Zhejiang, China.
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Lee JH, Jo SH, Yang JW. Treatment of Periorbital Infantile Capillary Hemangioma with Propranolol. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.5.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Hoo Lee
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Hwan Jo
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Yang
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Taran K, Wnęk A, Kobos J, Andrzejewska E, Przewratil P. Tissue and serum mRNA profile of MMPs-2/9 as a potential novel biomarker for the most individual approach in infantile hemangiomas and cancer disease. Immunobiology 2017; 222:1035-1042. [DOI: 10.1016/j.imbio.2017.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/14/2017] [Accepted: 05/23/2017] [Indexed: 01/16/2023]
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Mei-Zahav M, Blau H, Hoshen M, Zvulunov A, Mussaffi H, Prais D, Stafler P, Steuer G, Lapidoth M, Amitai DB. Propranolol treatment for infantile hemangioma does not increase risk of childhood wheezing. Pediatr Pulmonol 2017; 52:1071-1075. [PMID: 28267266 DOI: 10.1002/ppul.23683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 01/25/2017] [Accepted: 02/08/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Propranolol is the treatment of choice for infantile hemangiomas requiring medical intervention. Although contraindicated in asthma, its bronchoconstrictive effect in infants and children has not been extensively studied. We aimed to assess the incidence of wheezing episodes in infants and children treated with propranolol for infantile hemangiomas. STUDY DESIGN A retrospective case-control study. SETTING a tertiary pediatric hospital. PATIENTS All Children followed for infantile hemangioma between 2009 and 2014. Children followed conservatively served as control group and were matched 1:1 for gender and month of birth by random matching to children treated with propranolol. INTERVENTIONS All respiratory episodes (asthma, wheezing, stridor, and pneumonia) and respiratory associated hospitalizations were recorded from hospital records, from the primary care physician visits records and pharmacy prescriptions. The main outcome measure was the incidence of respiratory episodes in the treatment and the control groups. RESULTS A total of 1828 clinic visits were reviewed for 683 children. In addition, primary care physician visits records were available in 80% of them. Two hundred and sixteen children were treated with propranolol. Incidence of respiratory episodes and recurrent respiratory episodes was similar in the propranolol and control groups (8.3% vs 12%, P = 0.265; 3.7% vs 6.5%, P = 0.274, respectively). Time to first episode was similar in the treatment and control groups (5.03 ± 3.32 vs 4.45 ± 3.21 months, respectively, P = 0.09). Respiratory hospital admission rate was similar in both groups. CONCLUSIONS Propranolol treatment does not exacerbate wheezing episodes in infants and children.
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Affiliation(s)
- Meir Mei-Zahav
- Kathy and Lee Graub Cystic Fibrosis Center Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Hannah Blau
- Kathy and Lee Graub Cystic Fibrosis Center Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Alex Zvulunov
- Pediatric Dermatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,Faculty of Health Sciences, Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Huda Mussaffi
- Kathy and Lee Graub Cystic Fibrosis Center Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Dario Prais
- Kathy and Lee Graub Cystic Fibrosis Center Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Patrick Stafler
- Kathy and Lee Graub Cystic Fibrosis Center Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Guy Steuer
- Kathy and Lee Graub Cystic Fibrosis Center Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Moshe Lapidoth
- Sackler School of Medicine, Tel Aviv University, Israel.,Laser Unit, Department of Dermatology, Rabin Medical Center, Petah Tikva, Israel
| | - Dan Ben Amitai
- Sackler School of Medicine, Tel Aviv University, Israel.,Pediatric Dermatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
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45
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Abstract
Perianal lesions in children are common reasons for dermatology clinic visits and a well-defined approach to diagnosis and management is helpful to the practicing clinician. In this article, we review and update various etiologies of perianal lesions in the pediatric population, including infectious, papulosquamous, vascular, and neoplastic. We provide a standard initial approach to diagnosis and updates on current management. Infectious etiologies of perianal lesions discussed in this article include fungal, bacterial, parasitic, and viral. Perianal papulosquamous lesions often encountered in children, and discussed in this article, include acrodermatitis enteropathica, psoriasis, contact dermatitis, and many others. We also discuss the diagnosis and management of other entities including infantile hemangiomas, Langerhans cell histiocytosis, and fibrous hamartoma of infancy.
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46
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Castillo SD, Vanhaesebroeck B, Sebire NJ. Phosphoinositide 3-kinase: a new kid on the block in vascular anomalies. J Pathol 2016; 240:387-396. [PMID: 27577520 DOI: 10.1002/path.4802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/17/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022]
Abstract
Vascular anomalies are broadly divided into vascular tumours and malformations. These lesions are composed of abnormal vascular elements of various types, and mainly affect infants, children, and young adults. Vascular anomalies may be painful, may be complicated by bleeding, infection, or organ dysfunction, and can have secondary effects on other tissues. Current treatment strategies include surgical excision, pulsed laser, and sclerotherapy, which are invasive, with risks of recurrence. There are growing pharmacological options for these vascular anomalies, but, to date, no specific targeted therapies have been developed. Phosphoinositide 3-kinases (PI3Ks) constitute a family of lipid kinases that are involved in signal transduction and vesicular traffic, and that modulate important cellular processes such as proliferation, growth, and migration. Recent findings have indicated that the PI3K signalling pathway is important in the pathogenesis of vascular anomalies. This provides an opportunity to use PI3K inhibitors, which are in clinical trials for cancer treatment, for such lesions. Here, we provide an update on the classification of vascular anomalies, with their major features, and discuss the role of the PI3K signalling pathway in the pathogenesis of vascular anomalies, and their clinical implications and therapeutic opportunities. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Neil J Sebire
- UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
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47
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Tran AQ, Choi CJ, Wester ST. Beta Blockers in the Treatment of Periocular Infantile Hemangiomas: A Review. INTERNAL MEDICINE REVIEW (WASHINGTON, D.C. : ONLINE) 2016; 2:221. [PMID: 32318646 PMCID: PMC7172575 DOI: 10.18103/imr.v2i9.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Infantile hemangiomas (IH) are the most common benign tumor of infancy, and in the periocular region can be associated with permanent visual impairment from amblyopia. Previous treatment options included systemic and local corticosteroids, surgical excision, laser therapy, and in rare cases immunomodulatory therapy, many of which had variable outcomes with undesirable side effect profiles. Since their initial use for IH in 2008, beta blockers have become the mainstay of therapy for periocular IH due to their excellent clinical efficacy and tolerability. While the exact mechanism of action of beta blockers in IH has not been fully elucidated, both oral and topical therapy have demonstrated low rates of adverse events and improved outcomes in the management of periocular IH. This review summarizes the most recent studies on the clinical outcomes, management, and guidelines for the treatment of periocular IH with topical and oral beta blockers.
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Affiliation(s)
- Ann Q Tran
- University of Miami – Bascom Palmer Eye Institute, Department of Ophthalmology
| | - Catherine J Choi
- University of Miami – Bascom Palmer Eye Institute, Department of Ophthalmology
| | - Sara T Wester
- University of Miami – Bascom Palmer Eye Institute, Department of Ophthalmology
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