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 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" .

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 evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for circular superficial esophageal cancer.Methods:A retrospective analysis was conducted on 74 consecutive cases of circular superficial esophageal squamous cell carcinoma treated with ESD at Nanjing Drum Tower Hospital from January 2015 to December 2019. The success rate of ESD, curative resection rate, incidence of complications, and additional treatment were mainly observed.Results:One case was transferred to surgery, and the remaining 73 cases successfully completed ESD treatment. The success rate of ESD was 98.6%. Postoperative pathology of ESD revealed that 39 cases achieved curative resection, with a curative resection rate of 53.4% (39/73). Intraoperative muscle layer injury occurred in 15 cases (20.5%), and intraoperative perforation occurred in 1 case (1.4%). Two cases (2.7%) experienced delayed bleeding, and one case (1.4%) experienced delayed perforation. Eleven cases were lost to follow-up, and the remaining 62 cases received follow-up for 36.4±19.0 months. Among the follow-up cases, 12 underwent additional surgery and 5 cases additional chemotherapy and radiotherapy. Among the 57 patients with follow-up data who did not underwent surgery, 49 developed esophageal stenosis after ESD, with an incidence rate of 86.0%.Conclusion:ESD for circular superficial esophageal cancer is generally safe, but it is prone to muscle layer injury during the operation, with a low curative resection rate, a high incidence of postoperative esophageal stenosis, and a high proportion of additional surgical procedures.