Objective: To study the efficacy of 1 mg·kg^-1·d^-1 and 2.0 mg·kg^-1·d^-1 of propranolol in the treatment of infantile hemangiomas, so as to provide an ideal dosage for clinical treatment. Methods: From September 2015 to October 2016, there were 89 patients in accordance with the inclusion criteria of infantile hemangiomas. According to randomized and controlled principle, the patients were assigned to receive two propranolol regimens, Group A(n=45): propranolol at a dose of 1 mg·kg^-1·d^-1; Group B(n=44): propranolol at a dose of 2 mg·kg^-1·d^-1. 1 or 2 mg of propranolol base per kilogram per day, divided into two doses.The first dose was taken at 9, next at 15.The effective rate, cure rate and adverse effect rate were compared at the six months after treatment. The duration of the treatment was compared after 12 months′ treatment, and the recurrence rate was compared at the three months after being cured.The data were statistically processed with SPSS 22.0. The sample rate was compared with χ² test, and the data were compared with t test. P<0.05 was statistically significant difference. Results: Group A: Treatment for 6 months, 45 children were evaluated as follows: the effective rate was 91.1%(41/45), the cure rate was 60%(27/45). The incidence of adverse reactions was 13.3%(6/45). The cure rate of group A at 12 months was 86.7%(39/45). The duration of treatment was 7.6±2.7 months.The recurrence rate was 9.5%(4/42). Group B: Treatment for 6 months, 44 children were evaluated as follows: the effective rate was 90.9%(40/44), the cure rate was 72.7%(32/44). The incidence of adverse reactions was 15.9%(7/44). The cure rate of group B at 12 months was 88.6%(39/44). The duration of treatment was 6.2±1.9 months. The recurrence rate was 11.9%(5/42). The effective rate of the two groups at 6 months was not statistically significant(χ²=2.583, P=0.461). The cure rate of the two groups at 6 months was statistically significant(χ²=8.339, P=0.004). The incidence of adverse effects was not statistically significant(χ²=0.118, P=0.731). The cure rate of the two groups at 12 month was not statistically significant(χ²=0.080, P=0.778). The duration of treatment between the groups was statistically significant (t=0.290, P=0.009). The recurrence rate of the two groups after 3 months withdrawal was no statistical difference(χ²=0.124, P=0.724). Conclusions The propranolol doses at 1 mg·kg^-1·d^-1 and 2 mg·kg^-1·d^-1 in the treatment of infantile hemangiomas are safe and effective. The propranolol dose at 1 mg·kg^-1·d^-1 doesn′t decrease the effective and cure rate, not increase the recurrence rate in infantile hemangiomas. Low dose at 1 mg·kg^-1·d^-1 can be used as a common dose of propranolol in infantile hemangiomas.

Objective: To investigate whether N6-methyladenine DNA(6-mA DNA) modification is related to the occurrence of infantile hemangiomas (IH) at the epigenetic level. Methods: The genomic 6-mA DNA data were obtained by MeDIP and high-throughput sequencing. The 6-mA DNA methylation levels in 3 proliferative hemangioma specimens and adjacent skin tissues were compared by u-test. The functional differences of 6-mA modified genes were analyzed by GO analysis. Results: The level of 6-mA DNA modification in IH tissue was higher. The coverage of 6-mA Peaks in the genome was 0.037% in the tumor tissue, and the coverage of 6-mA Peaks in the surrounding skin tissue was 0.013% in the genome. The difference between the two groups was statistically significant (u=5999.87, P=0.00). The gene functions of differentially 6-mA modified genes in tumors were enriched in mesoderm development, stem cell differentiation, mesenchymal development, and cell cycle. These gene functions were closely related to the pathogenesis of IH. Conclusion Abnormal 6-mA DNA modification may be one of the pathogenesis of infantile hemangioma.

Objective To evaluate the clinical efficacy and safety of recipient-site pre-expansion via tumescent anesthesia in facial fat grafting .Methods Facial fat grafting was operated through the technology of recipient-site pre-expansion via tumescent anesthesia .The high-frequency ultrasonography was used to record the changes of soft tissue thickness , blood flow signal and transplant area in certain-points.Theresult were analyzed by SPSS 11.5.The survival rates of fat grafting were compared by Kruskal-Wallis H test.The area of soft tissue blood flow signals were analyzed by variance analysis .The patients' postoperative satisfaction rates and pain were evaluated by mean value .Results 14 cases were treated , with obvious improvement .Results of high frequency ultrasonography showed the median and quartile spacing of the soft tissue thickness was 70.1％(53.85％), 56.4％(51.95％), and 16.7％in the first month, third month and the sixth month after operation , separately.The difference between the three groups was statistically significant (H=1.4 ×108, P<0.05).The area of soft tissue blood flow signals was(3.97 ±0.84)‰,(2.21 ±0.55)‰,(6.89 ±2.39)‰,(14.61 ±4.66)‰,(9.39 ±3.94)‰, (15.87 ±3.02)‰before the operation, 24 hours, the first month, third month and the sixth month after operation,separately.The difference between the six groups were statistically significant (F=3.471, P <0.05).No complication occurred in the following-up period.Patients were satisfied with the pain relief. Conclusions It is safe and effective to apply recipient-site pre-expansion via tumescent anesthesia in fat grafting.

Objective:To assess the efficacy and safety of common medication treatments on Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA).Methods:PubMed, Embase, Web of Science, CNKI and Wanfang database were searched to find out the observational studies on medication treatment of KHE and TA. R-3.6.2 was used for calculate the pooled response rate and pooled adverse events rate. Meta analyses were performed according to KHE and TA with and without Kasabach-Merritt phenomenon (KMP) respectively. SPSS 22.0 was used to compare the pooled rates among each therapy.Results:A total of 30 studies regarding the medication treatment of KHE and TA were identified in this meta-analysis. Analyzed medicines included glucocorticoid, vincristine, sirolimus, propranolol, combination therapy of vincristine and glucocorticoid. The pooled results indicated that when referring therapy on KHE and TA with KMP, the pooled response rate of combination therapy (98.34%) and sirolimus (96.43%) was higher than that of other therapies, and the difference was statistically significant. The pooled adverse events rate of sirolimus (5.53%) was relatively higher than other modalities, with no statistically significance. As for therapy on KHE and TA without KMP, sirolimus (94.23%) had higher pooled response rate than glucocorticoid (31.25%), vincristine (46.15%) and propranolol (22.86%), with statistically significant differences. The pooled adverse events rate of sirolimus was 23.81%.Conclusions:Our findings indicate that for KHE and TA with KMP, combination therapy (sirolimus + glucocorticoid) and vincristine have the best efficacy, while the adverse events rate of sirolimus is relatively high. For KHE and TA without KMP, sirolimus has the highest response rate, but there is also a risk of serious adverse events. Glucocorticoid and vincristine have comparable response rate, which both inferior to sirolimus.

Objective:To explore the application and choice of trunk perforator flaps in chest wound repair.Methods:From May 2015 to December 2019, clinical data of 14 patients using trunk perforator flap for chest soft tissue defect repair were reviewed. They were 8 males and 6 females, aged from 17 to 74 years. 5 patients had wound after scar surgery. 6 patients had benign lesions, and 3 patients had malignant tumors. The size of tissue defects ranged from 6.0 cm×8.0 cm-20.0 cm×21.0 cm. The perforator flaps were designed to repair different wounds. Preoperatively, the perforators are identified by ultrasound or CTA, and the flap scope and surgical approach are designed according to the perforator alignment and the perforated muscle point. Postoperatively, the survival of the flap was observed and followed up for at least 6 months.Results:All 17 flaps of 14 patients survived. The flap area was 7.0 cm × 8.0 cm-22.0 cm × 22.0 cm, and the length of the pedicle was 2.0-6.0 cm. All patients were followed up for 6 to 26 months with satisfied result . Recurrence occurred in one of the patients with thoracic dermatofibrosarcoma protuberans.Conclusions:The perforator artery of the trunk is densely and easy to obtain. The combined flaps could be used to repair large chest defects. The first-stage suture of the donor area, so it meets the organization transplantation principle of "the repair is perfect, the damage is small" .

Objective To evaluate the clinical efficacy and safety of recipient-site pre-expansion via tumescent anesthesia in facial fat grafting .Methods Facial fat grafting was operated through the technology of recipient-site pre-expansion via tumescent anesthesia .The high-frequency ultrasonography was used to record the changes of soft tissue thickness , blood flow signal and transplant area in certain-points.Theresult were analyzed by SPSS 11.5.The survival rates of fat grafting were compared by Kruskal-Wallis H test.The area of soft tissue blood flow signals were analyzed by variance analysis .The patients' postoperative satisfaction rates and pain were evaluated by mean value .Results 14 cases were treated , with obvious improvement .Results of high frequency ultrasonography showed the median and quartile spacing of the soft tissue thickness was 70.1％(53.85％), 56.4％(51.95％), and 16.7％in the first month, third month and the sixth month after operation , separately.The difference between the three groups was statistically significant (H=1.4 ×108, P<0.05).The area of soft tissue blood flow signals was(3.97 ±0.84)‰,(2.21 ±0.55)‰,(6.89 ±2.39)‰,(14.61 ±4.66)‰,(9.39 ±3.94)‰, (15.87 ±3.02)‰before the operation, 24 hours, the first month, third month and the sixth month after operation,separately.The difference between the six groups were statistically significant (F=3.471, P <0.05).No complication occurred in the following-up period.Patients were satisfied with the pain relief. Conclusions It is safe and effective to apply recipient-site pre-expansion via tumescent anesthesia in fat grafting.

Objective:To assess the efficacy and safety of common medication treatments on Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA).Methods:PubMed, Embase, Web of Science, CNKI and Wanfang database were searched to find out the observational studies on medication treatment of KHE and TA. R-3.6.2 was used for calculate the pooled response rate and pooled adverse events rate. Meta analyses were performed according to KHE and TA with and without Kasabach-Merritt phenomenon (KMP) respectively. SPSS 22.0 was used to compare the pooled rates among each therapy.Results:A total of 30 studies regarding the medication treatment of KHE and TA were identified in this meta-analysis. Analyzed medicines included glucocorticoid, vincristine, sirolimus, propranolol, combination therapy of vincristine and glucocorticoid. The pooled results indicated that when referring therapy on KHE and TA with KMP, the pooled response rate of combination therapy (98.34%) and sirolimus (96.43%) was higher than that of other therapies, and the difference was statistically significant. The pooled adverse events rate of sirolimus (5.53%) was relatively higher than other modalities, with no statistically significance. As for therapy on KHE and TA without KMP, sirolimus (94.23%) had higher pooled response rate than glucocorticoid (31.25%), vincristine (46.15%) and propranolol (22.86%), with statistically significant differences. The pooled adverse events rate of sirolimus was 23.81%.Conclusions:Our findings indicate that for KHE and TA with KMP, combination therapy (sirolimus + glucocorticoid) and vincristine have the best efficacy, while the adverse events rate of sirolimus is relatively high. For KHE and TA without KMP, sirolimus has the highest response rate, but there is also a risk of serious adverse events. Glucocorticoid and vincristine have comparable response rate, which both inferior to sirolimus.

Objective:To explore the application and choice of trunk perforator flaps in chest wound repair.Methods:From May 2015 to December 2019, clinical data of 14 patients using trunk perforator flap for chest soft tissue defect repair were reviewed. They were 8 males and 6 females, aged from 17 to 74 years. 5 patients had wound after scar surgery. 6 patients had benign lesions, and 3 patients had malignant tumors. The size of tissue defects ranged from 6.0 cm×8.0 cm-20.0 cm×21.0 cm. The perforator flaps were designed to repair different wounds. Preoperatively, the perforators are identified by ultrasound or CTA, and the flap scope and surgical approach are designed according to the perforator alignment and the perforated muscle point. Postoperatively, the survival of the flap was observed and followed up for at least 6 months.Results:All 17 flaps of 14 patients survived. The flap area was 7.0 cm × 8.0 cm-22.0 cm × 22.0 cm, and the length of the pedicle was 2.0-6.0 cm. All patients were followed up for 6 to 26 months with satisfied result . Recurrence occurred in one of the patients with thoracic dermatofibrosarcoma protuberans.Conclusions:The perforator artery of the trunk is densely and easy to obtain. The combined flaps could be used to repair large chest defects. The first-stage suture of the donor area, so it meets the organization transplantation principle of "the repair is perfect, the damage is small" .