Publications by authors named "Xin-Dong Fan"

36 Publications

Epigenetic regulation of VENTXP1 suppresses tumor proliferation via miR-205-5p/ANKRD2/NF-kB signaling in head and neck squamous cell carcinoma.

Cell Death Dis 2020 10 9;11(10):838. Epub 2020 Oct 9.

Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

An increasing number of studies have shown that long noncoding RNAs (lncRNAs) play important roles in tumor development and progression. However, their involvement in head and neck squamous cell carcinoma (HNSCC) remains largely unknown. Epigenetic regulation is one major mechanism utilized by cancer cells to control lncRNA expression. We identified that lncRNA VENTXP1 was epigenetically silenced in multiple cancer types, and its lower expression was correlated with poorer survival in HNSCC patients. Through in silico analysis and experimental validation, we identified miR-205-5p and its direct interacting partner of VENTXP1, which regulates HNSCC cell proliferation and tumorigenicity. Using RNA-seq and differential gene expression analysis, we further identified ANKRD2 as a miR-205-5p target, which plays an essential role in modulating NF-kB signaling. These findings suggest that VENTXP1 inhibits tumor growth via suppressing miR-205-5p/ANKRD2-mediated NF-kB signaling in HNSCC. Thus, pharmaceutical targeting of DNA methylation to restore VENTXP1 expression might constitute a therapeutic strategy for HNSCC.
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http://dx.doi.org/10.1038/s41419-020-03057-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547684PMC
October 2020

Standards of care for Kasabach-Merritt phenomenon in China.

World J Pediatr 2021 Apr 26;17(2):123-130. Epub 2020 Aug 26.

Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.

Kasabach-Merritt phenomenon (KMP) is a rare disease that is characterized by severe thrombocytopenia and consumptive coagulation dysfunction caused by kaposiform hemangioendothelioma or tufted hemangioma. This condition primarily occurs in infants and young children, usually with acute onset and rapid progression. This review article introduced standardized recommendations for the pathogenesis, clinical manifestation, diagnostic methods and treatment process of KMP in China, which can be used as a reference for clinical practice.
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http://dx.doi.org/10.1007/s12519-020-00379-9DOI Listing
April 2021

Effect of combined low-dose oral prednisone with beta-adrenergic receptor antagonists for refractory infantile hemangiomas: retrospective cohort study in 76 patients.

Ann Transl Med 2019 Dec;7(23):750

Department of Interventional Therapy, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.

Background: Beta-adrenergic receptor antagonists have been the first-line treatment for infantile hemangiomas (IHs); however, monotherapy may fail to achieve sufficient efficacy for certain patients, especially for refractory IHs. The aim of this study was to evaluate the efficacy and safety of the combination of prednisone and beta-adrenergic receptor antagonists for refractory IHs.

Methods: We studied 76 patients with refractory IHs. After more than one month of insufficient oral propranolol therapy, forty-four patients received additional treatment of prednisone, while thirty-two patients continued to receive beta-adrenergic receptor antagonists monotherapy. The response to treatment was assessed according to hemangioma score values.

Results: The outcomes of patients after combined treatment were significantly better than those with monotherapy of beta-adrenergic receptor antagonists. The age to initiate prednisone was significantly negatively correlated with the improvement in the combination treatment group. The age at initiate treatment showed significant correlation with score variation percentage in both groups. There was no significant difference in the treatment duration observed between the two groups. Multivariable logistic regression analysis for all patients showed prednisone administration was the most important factor to better overall outcomes.

Conclusions: Short-term addition of low-dose oral prednisone is an effective and safe adjunctive treatment for oral propranolol in contributing to refractory IH. Both early administration and long enough duration would be necessary.
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http://dx.doi.org/10.21037/atm.2019.11.94DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989970PMC
December 2019

Intraosseous Arteriovenous Malformations in the Extremities Managed with Coils and Absolute Ethanol Treatment.

Ann Vasc Surg 2020 May 16;65:152-159. Epub 2019 Nov 16.

Department of Interventional Radiotherapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address:

Background: The extremity intraosseous arteriovenous malformations (AVMs) are rare high flow vascular lesions for which the treatment remains challenging. The aim of the study wasto assess treatment methods, interim results, and complications of coils and absolute ethanol in managing extremity intraosseous AVMs via direct puncture approach.

Methods: From 2009 to 2017, 12 patients (mean age, 27.5 years; range, 3-54 years) with extremity intraosseous AVMs underwent staged coils and absolute ethanol treatment via the direct puncture approach. All patients were symptomatic before the procedure as per the Schobinger staging system. The mechanical detachable coils and undetachable coils were used first followed by the injection of absolute ethanol used as a sclerosant agent via a direct puncture approach. Follow-up evaluation (6 to 72 months; mean, 23.5 months), including imaging and symptoms and signs, was performed in all patients.

Results: Twenty-seven absolute alcohol procedures were performed for patients with intravascular sclerosis (range: 1-3, mean: 2) with one procedure required per patient (n = 2), 2 per patient (n = 5), or 3 per patient (n = 5). The average stretched length of the total coils per patient was 843.33 cm. The amount of absolute ethanol used ranged from 10 mL to 45 mL (mean, 25.69 mL) in a single session. Nine of twelve patients (75%) exhibited complete responses, and 3 patients (25%) exhibited partial responses. One patient experienced minor complication of transient motor nerve injury and completely recovered half a month later. No major complications occurred.

Conclusions: The study provides strong evidence, suggesting that direct puncture and coils with absolute ethanol approach is an effective and safe treatment in patients with extremity intraosseous AVMs, yielding minor complications and good results.
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http://dx.doi.org/10.1016/j.avsg.2019.11.022DOI Listing
May 2020

Local suture ligation-assisted percutaneous sclerotherapy for Kasabach-Merritt phenomenon-associated kaposiform haemangioendothelioma.

Oncol Lett 2019 Jan 2;17(1):981-989. Epub 2018 Nov 2.

Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai 200011, P.R. China.

Kaposiform haemangioendotheliomas (KHEs) complicated by the Kasabach-Merritt phenomenon (KMP) are rare and severe neoplastic lesions often associated with locally aggressive disease, consumption coagulopathy and high mortality rates. Current regimens have yet to achieve a satisfactory therapeutic effect. Thus, an effective and minimally invasive approach for treating complex KHE/KMP cases is necessary for clinical management. The present case series describes patients with KHE/KMP who underwent local suture ligation-assisted percutaneous sclerotherapy to minimise surgical trauma and ensure effective treatment. Between September 2015 and September 2017, 3 consecutive patients with KHE/KMP underwent staged local suture ligation-assisted percutaneous sclerotherapy. Of these patients, 2 presented with medical histories of corticosteroid treatment with unsatisfactory outcomes. The patients underwent a stepwise synthetic serial therapy programme consisting of percutaneous sclerotherapy and adjunctive pharmacotherapy accompanied by a suture ligation procedure. Clinical, radiological, pathological and laboratory data were analysed to evaluate the outcomes of the therapy. All patients were successfully managed with the proposed procedure. Significant relief of clinical symptoms and improvements in haematological indicators were achieved. No recurrence or complications were observed during regular follow-up (4, 19 and 28 months). In conclusion, local suture ligation-assisted percutaneous sclerotherapy was demonstrated to be a safe and effective treatment for KHE/KMP, being minimally invasive, involving simple manipulation and providing a clear treatment benefit in certain cases. Further studies involving larger sample sizes are required to thoroughly evaluate the procedure, which can potentially be used as a novel therapeutic option for KHE/KMP treatment.
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http://dx.doi.org/10.3892/ol.2018.9661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313080PMC
January 2019

A Novel Anisotropic Hydrogel with Integrated Self-Deformation and Controllable Shape Memory Effect.

Macromol Rapid Commun 2018 May 13;39(9):e1800019. Epub 2018 Mar 13.

Key Laboratory of Marine Materials and Related Technologies, Zhejiang Key Laboratory of Marine Materials and Protective Technologies, Ningbo Institute of Material Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, China.

Although shape memory polymers have been highlighted widely and developed rapidly, it is still a challenging task to realize complex temporary shapes automatically in practical applications. Herein, a novel shape memory hydrogel with the ability of self-deformation is presented. Through constructing an anisotropic poly(acrylic acid)-polyacrylamide (PAAc-PAAm) structure, the obtained hydrogel exhibits stable self-deformation behavior in response to pH stimulus, and the shapes that formed automatically can be fixed by the coordination between carboxylic groups and Fe ; therefore, self-deformation and shape memory behaviors are integrated in one system. Moreover, the magnitude of auto-deformation and shape memory could be adjusted with the concentration of corresponding ions, leading to programmable shape memory and shape recovery processes.
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http://dx.doi.org/10.1002/marc.201800019DOI Listing
May 2018

Topical Application of 0.5% Timolol Maleate Hydrogel for the Treatment of Superficial Infantile Hemangioma.

Front Oncol 2017 27;7:137. Epub 2017 Jun 27.

Department of Interventional Therapy, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

The therapeutic options for infantile hemangiomas (IHs) have been greatly altered since the introduction of oral propranolol for successful treatments of IHs. Recently, there is an increase in the application of topical timolol maleate for treating superficial IHs. In the present study, we developed a new formulation of timolol maleate 0.5% hydrogel and treated 321 patients with superficial IHs to evaluate its efficacy and safety in the treatment of superficial IHs. This new timolol hydrogel was applied three times daily with a mean duration of 7.1 months. Response to treatment was assessed according to cosmetic improvement by using visual analog scale (VAS). The average VAS improvement after treatment was 76.4, with 126 patients (39.3%) achieving excellent responses, 159 patients (49.5%) achieving good responses, 33 patients (10.3%) achieving fair responses, and three patients (0.9%) achieving poor responses. Age at treatment initiation ( = 0.0349) and lesion thickness ( = 0.0147) were significantly associated with therapeutic efficacy. No severe side effects were observed in all patients. In conclusion, this new topical timolol maleate 0.5% hydrogel appears to be a proper candidate for treating superficial IHs, and our study provides supportive evidence and experience of topical timolol maleate in treating superficial IHs.
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http://dx.doi.org/10.3389/fonc.2017.00137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484769PMC
June 2017

[Chinese expert consensus on the use of topical timolol maleate treatment of infantile hemangiomas].

Shanghai Kou Qiang Yi Xue 2016 Dec;25(6):744-747

Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China.

Non-selective β-blocker propranolol has been proved by FDA as the first-line agent for infantile hemangioma (IH) with dramatic response. To reduce the side effects caused by systemic administration of propranolol, timolol maleate treatment has been increasingly used as an alternative to systemic β-blockers and watchful waiting for many IH patients in recent years. However, the appropriate indications, drug dosage, dosing regimen, time for initiation, optimal duration, monitoring for side effects still remains controversial. To standardize the use of topical timolol in treating IH, avoid overtreatment or under-treatment, as well as minimize complications, a Chinese expert consensus on the use of topical timolol treatment of IH has been approved and written by a multidisciplinary experts group based on an up-to-date literature review and repeated discussion, which can be used to reduce inappropriate variations in clinical practice and to promote the delivery of high quality, evidence-based health care for IH patients.
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December 2016

Interferon-alpha therapy for refractory kaposiform hemangioendothelioma: a single-center experience.

Sci Rep 2016 10 31;6:36261. Epub 2016 Oct 31.

Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.

Kaposiform hemangioendothelioma (KHE) is a relatively rare vascular tumor with an aggressive and infiltrating nature. Previous studies have revealed an exclusive relationship between KHE and Kasabach-Merritt Phenomenon (KMP), which is associated with high morbidity and mortality. No universally accepted treatment modality exists for refractory KHE with or without KMP. The aim of this study was to evaluate the safety and efficacy of interferon-alpha (IFN-α) therapy for treatment of refractory KHE. Twelve consecutive patients with KHE were treated with subcutaneous injections of IFN-α after other treatments had failed. Eleven patients exhibited a reduction in tumor size of more than 50%, and the platelet count for all five patients with KMP returned to normal level after IFN-α therapy. The duration of IFN-α treatment ranged from 3 months to 9 months (mean: 6.3 months). The response time for IFN-α treatment ranged from 10 days to 5 weeks (mean: 3.6 weeks). Additionally, no severe complications, such as neurological damage or spastic diplegia, were observed in these patients. In conclusion, our study suggested that IFN-α therapy is effective and safe for refractory KHE, and IFN-α may be used as an alternative after other treatments have failed.
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http://dx.doi.org/10.1038/srep36261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087085PMC
October 2016

Treatment of deep-seated facial microcystic lymphatic malformations with intralesional injection of pingyangmycin.

Medicine (Baltimore) 2016 Sep;95(37):e4790

Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China Department of General Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,China Department of Interventional Radiotherapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,China.

Treatment of microcystic lymphatic malformations (LMs) is still a great challenge to physicians in the field of managing vascular anomalies. Several kinds of treatment have been proposed for microcystic LMs, but the responses to these treatment modalities vary considerably among individuals. The aim of the study was to investigate the safety and efficacy of intralesional injection of pingyangmycin for microcystic LMs located in the deep facial region.Twenty-one consecutive patients with deep-seated facial microcystic LMs were treated with intralesional injection of pingyangmycin between March 2010 and April 2015. The patients received 2 to 8 injections, and the average session was 3.7. The therapeutic efficacy was accessed on the basis of the imaging findings and clinical measurements.Among the 21 patients, the clinical responses were excellent in 7 patients (33.33%), good in 9 patients (42.86%), fair in 3 patients (14.29%), and poor in 2 patients (9.52%). No severe side effects were encountered. Furthermore, therapeutic outcomes were significantly associated with lesion location (P = 0.006) and number of injections (P = 0.003).Our study supports that sclerotherapy with pingyangmycin is safe and effective for the treatment of deep-seated facial microcystic LMs.
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http://dx.doi.org/10.1097/MD.0000000000004790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402574PMC
September 2016

[Chinese experts consensus on the use of oral propranolol for treatment of infantile hemangiomas].

Shanghai Kou Qiang Yi Xue 2016 Jun;25(3):257-60

Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China.

Infantile hemangioma (IH) is one of the most common benign vascular tumors in children. A variety of treatment methods have been documented for the management of IH over the past years, including pharmacotherapy via oral administration or injection of corticosteroids, vincristine, alpha interferon and bleomycin; laser therapy, radionuclide therapy, cryotherapy and excisional surgery. The therapeutic efficacy of each treatment modality is variable, while adverse effects or complications are common and sometimes serious. Since the serendipitous discovery of propranolol, a nonselective beta-adrenergic receptor blocker, being very efficacious in treating IH in 2008, oral propranolol has earned a role as a first-line medical therapy for complicated IH. However, the appropriate drug dosage, dosing regimen, time for initiation, optimal duration, monitoring for side effects remains controversial. To standardize the use of propranolol in treating IH, avoid overtreatment or under-treatment, as well as minimize complications, a Chinese experts consensus on the use of oral propranolol for treatment of IH has been approved and written by a multidisciplinary experts group based on an up-to-date literature review and repeated discussion.
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June 2016

Functional surgery for the treatment of dentigerous cyst in the maxillary sinus.

J Craniofac Surg 2015 Mar;26(2):e84-6

From the Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.

Background: Dentigerous cyst (DC) in the maxillary sinus is rarely seen. Several complications are observed after the Caldwell-Luc operation, which is combined with endoscopy. Still, a more perfect treatment method is yet to be discovered.

Objectives: The purpose of this study was to explore and assess a new functional surgical treatment with fewer complications, which not only insured normal maxillary sinus cilia restoration and bony integrity but also did little damage to maxillary sinus natural ostium.

Methods: Dentigerous cyst in the maxillary sinuses of 20 patients had conditions diagnosed through radiographic imaging and the locating of bone windows' positions according to preoperative 3-dimensional computed tomography (CT) (3D CT). All the patients underwent a functional surgery in which a bony lid was created anteriolaterally of maxillary sinus with piezosurgery and reimplanted by titanium plates after enucleating the cyst, leaving the maxillary sinus mucosa in place with or without endoscope's assistance. Therapeutic efficacy was evaluated by clinical examination and radiographic imaging at regular intervals; the longest follow-up was 24 months.

Results: All the patients recovered except for one, who underwent plate removal and radical maxillary sinusotomy owing to infection. Patients were asymptomatic, and CT images showed integrated maxillary bone. Extrusion deformation of the sinus was improved to different extents after 6 to 24 months of follow-up.

Conclusions: Functional surgery for the treatment of DC in the maxillary sinus is a new approach and has the advantages of less surgical trauma, restoration of mucosa and bony wall, and more satisfactory results.
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http://dx.doi.org/10.1097/SCS.0000000000001287DOI Listing
March 2015

Percutaneous sclerotherapy with absolute alcohol to treat aneurysmal bone cyst of the frontal bone.

J Craniofac Surg 2015 Mar;26(2):456-8

From the Departments of *Radiology and †Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.

Aneurysmal bone cysts (ABCs) rarely occur in the cranial bone. Surgical resection can lead to bone defects, deformities, functional abnormalities, and so on. This article describes a frontal ABC in a 73-year-old man who has a rapidly increasing swelling in the frontal bone preceded by an accidental trauma. In this case, we use percutaneous sclerotherapy with absolute alcohol under the guidance of fluoroscopy to treat the ABC instead of traditional surgical resection. When analyzed the follow-up imaging, bone reconstruction happened after using absolute alcohol. It is a feasible alternative treatment for ABC arising from the cranial bone.
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http://dx.doi.org/10.1097/SCS.0000000000001378DOI Listing
March 2015

A practical guide for diagnosis and treatment of arteriovenous malformations in the oral and maxillofacial region.

Chin J Dent Res 2014 ;17(2):85-9

Arteriovenous malformations (AVMs) are congenital vascular malformations (CVMs) resulting from birth defects of the vasculature. It is rarely seen, only accounting for 1.5% of all vascular anomalies, and 50% of the lesions are located in the oral and maxillofacial region. Regardless of the type, AVMs may ultimately lead to significant anatomical, pathophysiological and hemodynamic consequences. Therefore, despite their relative rarity, AVMs still remain the most challenging and/or life-threatening form of vascular anomalies. Transarterial coil embolisation or ligation of feeding arteries are incorrect approaches and may result in progress of the lesion. Furthermore, such procedures would prevent future endovascular access to the lesions via the arterial route, and should be abandoned. Interventional embolisation using various sclerosants is currently the mainstay of treatment for AVMs, and elimination of the nidus (if present) is the key to success. Among various embolosclerotherapy agents, ethanol sclerotherapy produces the best long-term outcomes, with minimal complications. For more complex cases, multidisciplinary approaches and interventions may provide an excellent potential for a curative result. Based on the published literature and clinical experiences, a practical treatment guideline was established in order to provide a criterion for the management of oral and maxillofacial AVMs. This protocol will be renewed and updated to reflect cutting edge knowledge, and provide the newest treatment modalities for oral and maxillofacial AVMs.
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March 2015

Absolute ethanol embolization of arteriovenous malformations in the periorbital region.

Cardiovasc Intervent Radiol 2015 Jun 24;38(3):632-41. Epub 2014 Oct 24.

Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China,

Objective: Arteriovenous malformations (AVMs) involving the periorbital region are technically challenging clinical entities to manage. The purpose of the present study was to present our initial experience of ethanol embolization in a series of 16 patients with auricular AVMs and assess the outcomes of this treatment.

Methods: Transcatheter arterial embolization and/or direct percutaneous puncture embolization were performed in the 16 patients. Pure or diluted ethanol was manually injected. The follow-up evaluations included physical examination and angiography at 1- to 6-month intervals.

Results: During the 28 ethanol embolization sessions, the amount of ethanol used ranged from 2 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all the 16 patients, with down-staging of the Schobinger status for each patient. AVMs were devascularized 100 % in 3 patients, 76-99 % in 7 patients, and 50-75 % in 6 patients, according to the angiographic findings. The most common complications were necrosis and reversible blister. No permanent visual abnormality was found in any of the cases.

Conclusion: Ethanol embolization is efficacious and safe in the treatment of AVMs in the periorbital region and has the potential to be accepted as the primary mode of therapy in the management of these lesions.
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http://dx.doi.org/10.1007/s00270-014-0993-zDOI Listing
June 2015

A practical guide to treatment of infantile hemangiomas of the head and neck.

Int J Clin Exp Med 2013 25;6(10):851-60. Epub 2013 Oct 25.

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine No. 639, Zhi Zao Ju Road, Shanghai 200011, China.

Infantile hemangiomas are the most common benign vascular tumors in infancy and childhood. As hemangioma could regress spontaneously, it generally does not require treatment unless proliferation interferes with normal function or gives rise to risk of serious disfigurement and complications unlikely to resolve without treatment. Various methods for treating infant hemangiomas have been documented, including wait and see policy, laser therapy, drug therapy, sclerotherapy, radiotherapy, surgery and so on, but none of these therapies can be used for all hemangiomas. To obtain the best treatment outcomes, the treatment protocol should be individualized and comprehensive as well as sequential. Based on published literature and clinical experiences, we established a treatment guideline in order to provide criteria for the management of head and neck hemangiomas. This protocol will be renewed and updated to include and reflect any cutting-edge medical knowledge, and provide the newest treatment modalities which will benefit our patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322PMC
November 2013

Guidelines for the treatment of head and neck venous malformations.

Int J Clin Exp Med 2013 22;6(5):377-89. Epub 2013 May 22.

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University Shanghai 200011, China.

Venous malformation is one of the most common benign vascular lesions, with approximately 40% of cases appearing in the head and neck. They can affect a patient's appearance and functionality and even cause life-threatening bleeding or respiratory tract obstruction. The current methods of treatment include surgery, laser therapy, sclerotherapy, or a combined. The treatment of small and superficial venous malformations is relatively simple and effective; however, the treatment of deep and extensive lesions involving multiple anatomical sites remains a challenge for the physicians. For complex cases, the outcomes achieved with one single treatment approach are poor; therefore, individualized treatment modalities must be formulated based on the patient's condition and the techniques available. Comprehensive multidisciplinary treatments have been adapted to achieve the most effective results. In this paper, based on the national and international literature, we formulated the treatment guidelines for head and neck venous malformations to standardize clinical practice. The guideline will be renewed and updated in a timely manner to reflect cutting-edge knowledge and to provide the best treatment modalities for patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664006PMC
June 2013

Is a swine model of arteriovenous malformation suitable for human extracranial arteriovenous malformation? A preliminary study.

Cardiovasc Intervent Radiol 2013 Oct 8;36(5):1364-70. Epub 2013 May 8.

Department of Oral & Maxillofacial Surgery, Shanghai Key Laboratory of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China,

Objective: A chronic arteriovenous malformation (AVM) model using the swine retia mirabilia (RMB) was developed and compared with the human extracranial AVM (EAVM) both in hemodynamics and pathology, to see if this brain AVM model can be used as an EAVM model.

Methods: We created an arteriovenous fistula between the common carotid artery and the external jugular vein in eight animals by using end-to-end anastomosis. All animals were sacrificed 1 month after surgery, and the bilateral retia were obtained at autopsy and performed hematoxylin and eosin staining and immunohistochemistry. Pre- and postsurgical hemodynamic evaluations also were conducted. Then, the blood flow and histological changes of the animal model were compared with human EAVM.

Results: The angiography after operation showed that the blood flow, like human EAVM, flowed from the feeding artery, via the nidus, drained to the draining vein. Microscopic examination showed dilated lumina and disrupted internal elastic lamina in both RMB of model and nidus of human EAVM, but the thickness of vessel wall had significant difference. Immunohistochemical reactivity for smooth muscle actin, angiopoietin 1, and angiopoietin 2 were similar in chronic model nidus microvessels and human EAVM, whereas vascular endothelial growth factor was significant difference between human EAVM and RMB of model.

Conclusions: The AVM model described here is similar to human EAVM in hemodynamics and immunohistochemical features, but there are still some differences in anatomy and pathogenetic mechanism. Further study is needed to evaluate the applicability and efficacy of this model.
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http://dx.doi.org/10.1007/s00270-013-0627-xDOI Listing
October 2013

Anatomic relationship between impacted third mandibular molar and the mandibular canal as the risk factor of inferior alveolar nerve injury.

Br J Oral Maxillofac Surg 2013 Dec 11;51(8):e215-9. Epub 2013 Feb 11.

Department of Oral and Maxillofacial Surgery, People's Republic of China.

Our aim was to explore the relation between the site of the mandibular canal and neurosensory impairment after extraction of impacted mandibular third molars. We organised a retrospective study of 537 extractions in 318 patients in which the affected tooth was intersected by the mandibular canal. This was verified by cone-beam computed tomography (CBCT), and we analysed the relation between the site of the canal and the likelihood of injury to the inferior alveolar nerve (IAN) after extraction of the third molar. The relation between the position of the root of the tooth and the mandibular canal was categorised into 4 groups: I=root above the canal; II=on the buccal side; III=on the lingual side; and IV=between the roots. The overall rate of neurosensory impairment after extraction was 6% (33/537). It occurred in 9/272 patients (3%) in group 1, 16/86 (19%) in group II, and in 8/172 (5%) in group III. There was no neurosensory impairment in group IV where the canal was between the roots. There were significant differences between group II and groups I and III (p<0.01), but not between groups I and III (p=0.32). The risk of damage to the inferior alveolar nerve is increased if third molars intersect with the mandibular canal, particularly on its buccal side.
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http://dx.doi.org/10.1016/j.bjoms.2013.01.011DOI Listing
December 2013

Randomized phase III trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma.

J Clin Oncol 2013 Feb 5;31(6):744-51. Epub 2012 Nov 5.

Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Purpose: To evaluate induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF) followed by surgery and postoperative radiotherapy versus up-front surgery and postoperative radiotherapy in patients with locally advanced resectable oral squamous cell carcinoma (OSCC).

Patients And Methods: A prospective open-label phase III trial was conducted. Eligibility criteria included untreated stage III or IVA locally advanced resectable OSCC. Patients received two cycles of TPF induction chemotherapy (docetaxel 75 mg/m(2) on day 1, cisplatin 75 mg/m(2) on day 1, and fluorouracil 750 mg/m(2) on days 1 to 5) followed by radical surgery and postoperative radiotherapy (54 to 66 Gy) versus up-front radical surgery and postoperative radiotherapy. The primary end point was overall survival (OS). Secondary end points included local control and safety.

Results: Of the 256 patients enrolled onto this trial, 222 completed the full treatment protocol. There were no unexpected toxicities, and induction chemotherapy did not increase perioperative morbidity. The clinical response rate to induction chemotherapy was 80.6%. After a median follow-up of 30 months, there was no significant difference in OS (hazard ratio [HR], 0.977; 95% CI, 0.634 to 1.507; P = .918) or disease-free survival (HR, 0.974; 95% CI, 0.654 to 1.45; P = .897) between patients treated with and without TPF induction. Patients in the induction chemotherapy arm with a clinical response or favorable pathologic response (≤ 10% viable tumor cells) had superior OS and locoregional and distant control.

Conclusion: Our study failed to demonstrate that TPF induction chemotherapy improves survival compared with up-front surgery in patients with resectable stage III or IVA OSCC.
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http://dx.doi.org/10.1200/JCO.2012.43.8820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569675PMC
February 2013

Preoperative direct puncture embolization of advanced juvenile nasopharyngeal angiofibroma in combination with transarterial embolization: an analysis of 22 consecutive patients.

Cardiovasc Intervent Radiol 2013 Feb 8;36(1):111-7. Epub 2012 May 8.

Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, People's Republic of China.

Objective: This study was designed to evaluate the clinical application of preoperative auxiliary embolization for juvenile nasopharyngeal angiofibroma (JNA) by direct puncture embolization (DPE) of the tumor in combination with transarterial embolization (TAE).

Methods: The study included 22 patients. An 18-gauge needle was used to puncture directly into the tumor, and 20-25 % N-butyl cyanoacrylate was injected under the guidance of fluoroscopy after confirming the placement of the needle into the JNA and no leaking into the surrounding tissue. Tumors were obstructed later via TAE.

Results: The supplying arteries of JNA were from branches of the internal carotid and external carotid arteries. Control angiography showed the obliteration of contrast stain in the entire tumor mass and the distal supplying arteries disappeared after DPE in combination with TAE. Surgical resection was performed within 4 days after embolization and none of the patients required blood transfusion.

Conclusions: The use of DPE in combination with TAE was a safe, feasible, and efficacious method. It can devascularize effectively the JNAs and reduce intraoperative bleeding when JNAs are extirpated.
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http://dx.doi.org/10.1007/s00270-012-0404-2DOI Listing
February 2013

Propranolol for problematic head and neck hemangiomas: an analysis of 37 consecutive patients.

Int J Pediatr Otorhinolaryngol 2012 Apr 11;76(4):574-8. Epub 2012 Feb 11.

Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China.

Objective: Infantile hemangiomas (IHs) on head and neck are frequently encountered. Recently, propranolol was introduced as a novel pharmacologic treatment for IH. But the impact of propranolol for the treatment of IHs especially the side effects have not yet been well described. This article aimed to describe the effects and side effects of propranolol treatment in 37 children with problematic hemangiomas on head and neck.

Study Design: Data were collected from the medical charts of patients treated between October 2008 and November 2010. Serial examinations and photographs were obtained to evaluate perceived therapeutic response and complications of oral propranolol in the course of their therapy.

Results: Thirty-seven infants with propranolol-treated problematic head and neck hemangiomas were included and all patients had a good response. Most of patients were subjectively noticed an obvious improvement within one week from the onset of therapy. 29 patients endured the treatment of propranolol for 3 months with no recurrence, 6 patients endured prolonged course of treatment for 5/6 months. 2 patients who endured the treatment of propranolol for 3 months were found recurrence in two weeks. So the propranolol was given again for another 3 months. There were no severe adverse reactions. Minor side effects included diarrhea, light sleeping, and nausea.

Conclusion: Propranolol appears to be an effective and well-tolerated treatment for problematic IH on head and neck.
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http://dx.doi.org/10.1016/j.ijporl.2012.01.020DOI Listing
April 2012

Treatment guidelines of lymphatic malformations of the head and neck.

Oral Oncol 2011 Dec 8;47(12):1105-9. Epub 2011 Sep 8.

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Lab of Stomatology, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Road, Shanghai 200011, China.

Lymphatic malformations, traditionally called lymphangiomas, are diseases caused by development errors of the lymphatic system. About 90% of the cases occur within 2years of age, except a few cases which occur in adulthood, and approximately 75% of the lesions are located in the head and neck region. The lesions can grow rapidly with infection, trauma or bleeding, resulting in disfigurement as well as severe impairment of respiration, swallow and speech. Although lymphatic malformations are benign lesions, they rarely resolve spontaneously, their infiltrating nature coupled with the difficulty in distinguishing involved vital structures of head and neck from adjacent normal tissues makes complete surgical resection even more difficult. The likelihood of postsurgical recurrence and complications is thus higher than other vascular lesions. Surgical resection, sclerotherapy and laser therapy are currently the main treatment modes of lymphatic malformations. Various treatment options have their advantages and disadvantages, the selection of treatment modalities should depend on the patient's individual status and available technology and expertise. The treatment protocol should be individualized, comprehensive as well as sequential in order to obtain the best treatment outcome. Based on published literatures and clinical experiences, we devised the treatment guideline for management of head and neck lymphatic malformations. This protocol will be reviewed and updated periodically to include cutting edge knowledge to provide the best treatment options to benefit our patients.
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http://dx.doi.org/10.1016/j.oraloncology.2011.08.001DOI Listing
December 2011

[Superselective ethanol endovascular therapy under digital subtraction angiography for craniofacial arteriovenous malformations].

Zhonghua Zheng Xing Wai Ke Za Zhi 2009 Nov;25(6):406-11

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200011, China.

Objective: To introduce superselective endovascular therapy under digital subtraction angiography for craniofacial arteriovenous malformations using absolute ethanol, and to assess the efficacy and complications of the method.

Methods: A retrospective review of patient medical and imaging records was performed. 8 patients (7 male, 1 female, 11-50 years) with craniofacial arteriovenous malformations underwent staged selective ethanol endovascular therapy (1-4 times, median 2 times). Clinical follow-up (8-24 months, mean 12.1 months) was performed in all patients, and results from imaging follow-up (2-6 months, mean 4.3 months) were available in 4 patients. Therapeutic outcomes were established by evaluating the clinical outcome of symptoms, as well as the degree of devascularization at follow-up angiography.

Results: 16 sessions of selective ethanol endovascular therapy were performed in 8 patients. 5 of 8 patients were cured, 2 had improvement, 1 had no change. Selective ethanol endovascular therapy was considered effective in 7 patients (87.5%). 4 patients will need further treatment sessions for residual arteriovenous malformations. Blistering, superficial skin necrosis and transient hemolysis occurred in 4 of 8 patients. All the complications were healed with observation. No major complications occurred.

Conclusion: Superselective ethanol endovascular therapy under digital subtraction angiography has the potential for cure of craniofacial arteriovenous malformations and is able to obtain excellent cosmetic results, and with acceptable risk of complications.
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November 2009

Treatment guideline for hemangiomas and vascular malformations of the head and neck.

Head Neck 2010 Aug;32(8):1088-98

Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.

Vascular anomalies are among the most common congenital and neonatal dysmorphogenesis, which are separated into hemangiomas and vascular malformations. They can occur in various areas throughout the body, with 60% being located in the head and neck. The true mechanism of pathogenesis of vascular anomalies is still unclear. Various treatment methods have been reported, and there are still controversies over the selection of different treatment modalities. Based on the clinical and basic research and current literature, the Chinese Division of Oral and Maxillofacial Vascular Anomalies formulated a treatment guideline for hemangiomas and vascular malformations of the head and neck, which will be modified and updated periodically based on new medical evidence and research.
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http://dx.doi.org/10.1002/hed.21274DOI Listing
August 2010

[Non-involuting congenital hemangioma: a study for diagnosis and treatment].

Zhonghua Zheng Xing Wai Ke Za Zhi 2009 May;25(3):189-93

Department of Plastic and Reconstructive Surgery, Shanghai 9th People' s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200011, China.

Objective: To study the history, clinical symptoms, imaging and histology of a rare distinct infantile hemangioma.

Methods: 12 patients (5 female, 7 male; aged 18 months - 26 years) diagnosed as non-involuting congenital hemangioma were retrospectively analyzed. The history, imaging, histologic examination and the treatment were collected.

Results: Most of the patients had only one lesion which was round or ovoid, flat or plaque-like. The average size was about 5 cm x 6 cm. The overlying skin was usually had coarse telangiectasia with central or peripheral pallor. The skin has a high skin temperature. Magnetic resonance imaging, computed tomography angiography and digital subtraction angiography findings were similar to those of common infantile hemangioma. Histologic examination revealed lobular collections of small, thin-walled vessels with a large, often stellate, central vessel. "Hobnailed" endothelial cells lined along the intralobular vessels. Small arteries were observed "shunting" directly into lobular vessels or into abnormal extralobular veins. All lesions were easily excised without recurrence.

Conclusions: Non-involuting congenital hemangioma is a distinct infantile vascular tumor. It should be diagnose early and treated appropriately.
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May 2009

[Embolization of craniofacial arteriovenous malformations after the ligation of external carotid artery].

Zhonghua Kou Qiang Yi Xue Za Zhi 2008 Jun;43(6):336-8

Department of Radiology, School of Stomatology, Shanghai Jiao Tong University, Shanghai 200011, China.

Objective: To introduce the method of retrograde embolization through the superficial temporal artery (STA) after the ligation of external carotid artery (ECA) for the treatment of craniofacial arterio-venous malformations (AVM).

Methods: Seven cases of craniofacial AVM were included in the study. After the ligation of ECA, the STA was surgically accessed and a 4F (1F = 0.333 mm) sheath introduced into the artery, and N-butyl-2-cyanoacrylate (NBCA) was selected as the permanent embolization material.

Results: The angiogram was successfully carried out in these cases, which showed that some collateral branches from the ophthalmic artery of left internal carotid artery, vertebral artery and thyrocervical trunk provided the blood supply to the AVM nidus. The retrograde embolization with NBCA was completed.

Conclusions: The vascular architecture of craniofacial AVM after the ligated ECA was better demonstrated in angiogram of vertebral artery. The retrograde embolization through STA was an effective method for the treatment of craniofacial AVM.
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June 2008

[Surgical ligation and occlusion of the feeding artery should not be used in management of arteriovenous malformations (AVMs) of the craniofacial regions].

Shanghai Kou Qiang Yi Xue 2008 Apr;17(2):113-7

Department of Radiology, College of Stomatology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Arteriovenous malformations (AVMs) are congenital vascular anomalies, which seldom occur in the craniofacial regions. The rarity of these lesions compounds their extreme management difficulty. The clinical manifestation, vascular architecture, natural progress history and therapeutic strategy on AVMs in the craniofacial regions were reviewed in this paper. It is concluded that surgical ligation or occlusion of feeding arteries proves totally futile as the phenomenon of neovascular recruitment reconstituted arterial inflow to the AVM nidus. The procedure should be prohibited to do because of the ineffectiveness and hindering further endovascular treatment.
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April 2008

[Surgery of the carotid artery: a retrospective study of 35 consecutive cases].

Zhonghua Kou Qiang Yi Xue Za Zhi 2006 Jan;41(1):25-8

Department of Oral and Maxillofacial Surgery, School of Stomatology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China.

Objective: To retrospectively analyze a single institution's experience with surgery of the carotid artery performed as part of an oncological procedure and emergency hemostasis, with the aim to determine the preoperative methods for evaluation of cerebral circulation, selection of surgical procedures and perioperative complications.

Methods: From January 1999 to December 2004, a total of 35 patients underwent carotid artery surgery including repair of carotid artery in 7 cases, ligation or resection of carotid artery in 17 cases, and reconstruction of carotid artery in 11 cases. All the patients were evaluated for blood flow in the circle of Willis with DSA, DSA plus TBO plus SPECT, and TCD and followed up from 4 months to 4 years. The perioperative complications and surgical outcomes were recorded and analyzed.

Results: There were 16 carotid body tumors, 1 malignant carotid body tumor, 17 malignant tumors involving the carotid artery and 1 traumatic arterio-venous fistula. Twenty-seven patients underwent carotid occlusion test, 10 were positive and 17 were negative (tolerable). Of 7 cases with repair of the carotid artery, 1 patient died of uncontrolled bleeding due to rupture of the anastomosis, and the remaining was uneventful. Of 17 cases with ligation or resection of the carotid artery, 4 developed neurologic deficit 2 weeks postoperatively. Three patients with malignant tumors died 1 month, 4 months, and 4 months postoperatively, respectively. One patient with carotid artery body tumor complained of inarticulate speech 4 months after operation; another patient complained of incapability and limited movement of the ipsilateral upper limbs; 5 patients complained of dizziness 4, 6, 12, 24 and 48 months postoperatively. Of 11 patients who underwent carotid reconstruction, no major cerebral complications were noted after operation. One patient died of recurrence, 1 patient with carotid body tumor complained inarticulate speech and incapability of the contralateral limbs, the remaining was uneventful. Color Doppler showed patent vascular graft 1 year postoperatively.

Conclusions: TBO plus SPECT is a reliable method for evaluation of the circle of Willis currently. The short term and long term complications of ligation of carotid artery are high, therefore, resection and revascularization of the carotid artery is advocated for carotid artery tumors when possible.
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January 2006

[Evaluation of the accuracy of 16 slices spiral CT in diagnosing maxillary sinus diseases].

Shanghai Kou Qiang Yi Xue 2006 Feb;15(1):11-4

Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China.

Purpose: To investigate the diagnostic value of 16 slices spiral CT in maxillary sinus diseases.

Methods: 16 slices spiral CT findings of 58 cases with maxillary sinus diseases confirmed clinically were analyzed, postprocessing of images was performed by using the software package at the workstation. All the cases were proved by surgery.

Results: Among 58 cases, there were 30 cases with inflammatory diseases; 6 cases with benign tumors; 8 cases with malignant tumors and 14 cases with fractures. The correct rate of CT diagnosis for location was 100%, and for the nature of the disease was 91.38%.

Conclusions: 16 slices spiral CT was proved to be a good way to show the range of maxillary sinus diseases, the degree of bony change and the relation to surrounding tissues, but determination of the nature of the diseases should be incorporated with clinical and pathological findings.
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February 2006