Background: Vascular malformations (VAMs) impose multifaceted burdens extending beyond physical impairments to psychosocial dysfunction. While prior studies predominantly utilized generic quality-of-life instruments, disease-specific tools are critical for addressing heterogeneous symptom profiles and sociocultural variability, particularly in understudied Asian populations. This study investigated psychosocial impacts across pediatric and adult VAM patients via validated, condition-specific measures. Methods: A prospective cohort of 233 hospitalized VAM patients (114 pediatric patients, 119 adult patients) completed the OVAMA questionnaire, and 114 adult, 68 pediatric patients, and 115 parent-proxies completed corresponding PROMIS questionnaires. The subtypes included arteriovenous malformations (AVMs), venous/lymphatic/lymphovenous malformations (VMs/LMs/LVMs), port-wine stains (PWSs), and other vascular malformations. Statistical analyses (Mann-Whitney U test, Kruskal-Wallis test, linear regression) were used to evaluate associations between demographics, clinical characteristics, and psychosocial outcomes. Results: Compared with children, adults reported significantly greater distress related to general (p = 0.004) and appearance (p = 0.003) problems. Compared with AVM (p = 0.01) and PWS (p = 0.041) patients, VM/LM/LVM patients presented elevated general problem scores. Pain and bleeding were related to general problems, whereas temporary enlargement was related togeneral and appearance problems. The PROMIS results revealed that 42.1% of adults had below-normal psychosocial-positive scores, whereas 33% demonstrated abnormal psychosocial-negative scores. Pediatric self-reports were associated with higher anxiety and depression rates than parent proxies were, with the VM/LM/LVM subgroups reporting poorer family relationships (p = 0.0062) and life purposes (p = 0.0075). Treatment frequency was correlated with increased psychological stress in children (p = 0.007). Conclusion: VAMs significantly impair psychosocial functioning across all ages, with adults experiencing heightened distress and social role deficits. Pediatric patients with low-flow malformations (VMs/LMs/LVMs) face compound depressive symptoms and familial strain. Disease-specific tools such as OVAMA and PROMIS are essential for comprehensive assessments, guiding tailored interventions to address both physical and psychosocial burdens.

Background Photodynamic therapy (PDT), an emerging treatment modality for port-wine stains (PWS) alongside pulsed dye laser (PDL) therapy, currently lacks clear guidelines regarding the optimal number of treatment sessions. In recent clinical practice, we found that for patients presented poor efficacy to initial PDT sessions, subsequent session exhibited significantly better efficacy than preceding ones. We termed this phenomenon "delayed cumulative response" (DCR). This study was to introduce and summarize the DCR for the first time, and to provide evidence for its existence, explore potential mechanisms. Methods We conducted a retrospective study based on clinical data analysis of 80 PWS patients, comparing the efficacies between the session that performed DCR and the session before DCR, identifying influencing factors, and analyzing related pathological results. Results All lesions were located on the head, face, and neck. Patients typically experience DCR at the 2.79th ± 0.74th PDT session. The clearance rate of DCR session markedly increased from 21.71% in the previous session to 59.43%, while the VAS score rose from 1.27 to 2.75. Patients with PWS lesions involving single site were more prone to experiencing DCR. Conclusion DCR phenomenon was observed in the PDT treatment of PWS. We defined DCR as a situation where the initial PDT sessions show limited efficacy (less than 25% improvement), followed by a subsequent session with significant efficacy (greater than 50% improvement). For patients with poor initial responses to PDT, we recommended scheduling at least 3 treatment sessions to achieve 60% clinical improvement.

Background: Vascular-targeted photodynamic therapy (PDT) is an effective alternative treatment choice for port-wine stains (PWSs). The histological characteristics of PWSs after PDT treatment have not yet been reported. Objective: To investigate the morphological features of PWSs treated by PDT and define the histopathological characteristics of PWS that achieve clinical cure. Methods: Thirteen patients with facial PWSs, who presented with complete regressive PWS lesions after a mean of 4.38 (standard deviation = 4.907) sessions of PDT. Post-treatment biopsy samples were obtained from each patient. The number of blood vessels, vascular diameter, and depth were measured and compared in all samples of PDT-regressive sites, PDT-resistant sites, and normal skin. Results: Within the 7-year follow-up after PDT, there was no recurrence in the regression area of PDT. In the PDT-regressive sites, within 800 μm of the dermal-epidermal junction, the dilated vessels were occluded and remained fissure-like after PDT. Conclusions: When the vascular lesions within 800 μm of the dermal-epidermal junction were closed after PDT, a stable clinical cure (no recurrence) was achieved.

目的 探讨光动力治疗(photodynamic therapy,PDT)葡萄酒色斑(port-wine stain,PWS)的组织学特征,明确PWS达到临床治愈的组织病理学深度.方法 回顾性分析自2012年1月至2019年10月于上海交通大学医学院附属第九人民医院整复外科血管瘤与脉管畸形诊疗中心就诊的面部PWS并接受过PDT治疗11例患者的临床资料,所有面部PWS患者在平均(4.91±5.41)次PDT治疗后病灶呈现红斑消退的痊愈病灶及对治疗抵抗的残留病灶.患者均进行组织活检.在痊愈部位、残留部位和正常皮肤样本中比较血管数量、直径和深度.结果 11例患者PDT术后平均随访6年,痊愈部位800μm深度范围内的扩张血管均已闭塞并呈裂隙状.残留病灶与痊愈病灶的血管数量、血管深度无差异(P>0.05),而血管直径(39.76±15.30)μm显著大于痊愈部位(27.82±12.38)μm(P=0.001).结论 PDT破坏PWS血管深度可达800μm.血管直径的差异可能是影响PDT治疗PWS疗效的重要原因之一.

Background Ethanol embolotherapy is considered an optimal choice for the treatment of arteriovenous malformations（AVMs）; however, there are some complications associated with this treatment. This study aimed to prospectively investigate systemic hemodynamic changes in high-flow AVMs using ethanol embolotherapy.Methods From September 2012 to September 2014, 34 male patients and 26 female patients with AVMs who underwent embolotherapy（100 sessions in total） with absolute ethanol were included in this study. Invasive systolic blood pressure（SBP） and heart rate（HR） were recorded before and after each injection and throughout the procedure. Differences between the initial and highest SBP（?maxSP） and HR values（?maxHR）, as well as the initial and final SBP（?SP） and HR（?HR） values, were analyzed. We aimed to explore the potential association between these values and the amount of ethanol that was used.Results The total ethanol used was variable（0.01–0.40 mL/kg; mean, 0.20 mL/kg）. SBP and HR increased after ethanol injection in most sessions（91 in 100 sessions）. SBP decreased in 9 sessions（9 in 100 sessions）, while HR, oxygen saturation, and end-tidal CO 2 decreased in one of the 9 sessions. ?maxSP and ?maxHR averaged 38.4 mmHg and 27.8 bpm, respectively（both P＜0.05）, while ?SP and ?HR averaged 3.4 mmHg and 4.0 bpm, respectively（both P＜0.05）. ?maxSP and ?maxHR were positively correlated with the total dose of ethanol injected.Conclusions Elevations in SBP and HR during ethanol embolotherapy are common, temporary, and most likely pain-mediated; these increases tend to be positively correlated with ethanol dose. Hypotension may be regarded as an acute complication of ethanol embolotherapy. Hypotension combined with bradycardia, oxygen desaturation, and decreased end-tidal CO 2 may be a potential predictor of cardiovascular collapse.

Background and ObjectivesMany types of lasers have been used to treat café‐au‐lait macules (CALMs) since the introduction of the selective photothermolysis theory. However, the efficacy and safety of picosecond lasers, compared with those of nanosecond lasers, have not been researched. To compare the efficacy and safety of 755 nm picosecond laser (PS‐755 nm), Q‐switched (QS) Alexandrite 755 nm nanosecond laser (QS‐755 nm), and QS Nd:YAG 532 nm nanosecond laser (QS‐532 nm) for treating CALMs.Study Design/Materials and MethodsForty‐one patients received several treatments at 3‐month intervals. Lesions were divided into two or three approximately equal parts, which were randomly treated with PS‐755 nm, QS‐755 nm, and QS‐532 nm. The safety and efficacy of three lasers were determined based on blinded visual assessments and self‐reports of patients three months after the comparative trial.ResultsVisual assessment 3 months after the comparative trial revealed that there was no statistically significant difference among the sites treated by QS‐755 nm (2.84 ± 1.11), QS‐532 nm (2.63 ± 1.06), and PS‐755 nm (2.74 ± 1.05) lasers. Five (26.32%) of 19 patients showed lesion recurrence. Adverse effects included acneiform miliaris, hypopigmentation, and hyperpigmentation, which were resolved within 12 months. Five (26.32%) of 19 patients who showed lesion recurrence 1–5 months after laser treatment had lightened or cleared at least 50% of the lesion. 46.67% of patients were satisfied or very satisfied with the outcome of the overall treatment.ConclusionsPS‐755 nm, QS‐755 nm, and QS‐532 nm laser treatments were equally effective in treating and improving CALMs. PS‐755 nm caused fewer adverse effects. Individuals can react differently to different types of lasers. Patch tests should be conducted before the treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC

Uptake and degradation of chylomicron remnants by the human hepatoma cell line Hep G2 was studied. Mesenteric lymph was collected from rats and injected into hepatectomized rats to obtain chylomicron remnants. This remnant preparation was taken up and catabolized by Hep G2 cells. The uptake process was dependent on cell growth and was regulated by compactin (a HMG-CoA reductase inhibitor) which suppresses cholesterol synthesis and by mevalonolactone, which enhances cholesterol synthesis. A monoclonal anti LDL receptor antibody blocked binding of chylomicron remnants to Hep G2 cells to a degree, which was comparable to but generally lower than the suppression of low-density lipoprotein binding. The results thus indicate that in Hep G2 cells, chylomicron remnant uptake is regulated, similarly to low-density lipoprotein uptake and that a significant part of the remnant uptake is mediated through the LDL receptor.