Low-dose sclerotherapy with lauromacrogol in the treatment of infantile hemangiomas: A retrospective analysis of 368 cases

Recent updates in laryngeal hemangioma management: a scoping review

PURPOSE

To provide a comprehensive review of the current strategies in the management of laryngeal hemangiomas, with an aim to introduce a management algorithm that aligns with the variable clinical presentations and anatomical complexities of these lesions.

METHODS

We conducted an extensive literature search across major databases using specific and general terms, combined with Boolean operators, to ensure comprehensiveness. Articles from January 2004 to August 2023 were included, with findings categorized by management approach.

RESULTS

Laryngeal hemangiomas exhibit a spectrum of manifestations, ranging from asymptomatic lesions to those causing severe airway obstruction. Optimal management demands an individualized approach tailored to the patient's unique presentation and anatomical considerations. Diverse treatment modalities, each with distinct indications, advantages, and limitations, are explored. Notable highlights encompass the prominent role of Beta-blockers, notably Propranolol, in addressing problematic infantile hemangiomas, the nuanced efficacy of laser therapies contingent upon hemangioma type and depth, and the critical relevance of tracheotomy in emergencies. Novel approaches like transoral robotic surgery and transoral ultrasonic surgery, demonstrate promise in specific scenarios. We propose a management algorithm based on the complexity and presentation of laryngeal hemangiomas, emphasizing individualized treatment strategies, thereby addressing the unique challenges and nuances of each case.

CONCLUSION

Laryngeal hemangioma management requires personalized approaches informed by diverse therapies, clinical expertise, and collaboration. The review introduces an algorithm spanning observation to advanced interventions, adapting to each case's complexity. Ongoing research promises innovative treatments.

MicroRNA‑203a‑3p improves bleomycin and pingyangmycin sensitivity by inactivating the PI3K/AKT pathway in hemangioma

MicroRNAs (miRs) have been found to play a fundamental role in the pathology and progression of hemangioma. Of note, miR-203a-3p prevents hemangioma progression via inactivation of the PI3K/AKT pathway. Bleomycin and pingyangmycin are drugs used in sclerotherapy, but certain hemangioma patients experience drug resistance, leading to poor clinical outcomes. The present study aimed to explore the impact of miR-203a-3p on bleomycin and pingyangmycin sensitivity in hemangioma, as well as the involvement of the PI3K/AKT pathway. miR-203a-3p or negative control mimics were transfected into human hemangioma endothelial cells, which were treated with 0-20 µM bleomycin or pingyangmycin. Subsequently, 740 Y-P, a PI3K/AKT pathway agonist, was added. Cell viability, rate of apoptosis and the expression levels of proteins involved in the PI3K/AKT pathway, including phosphorylated (p)-PI3K, PI3K, p-AKT and AKT, were detected. miR-203a-3p overexpression significantly decreased the half-maximal inhibitory concentration (IC50) values of bleomycin (5.84±0.87 vs. 14.23±2.17 µM; P<0.01) and pingyangmycin (5.13±0.55 vs. 12.04±1.86 µM; P<0.01), compared with untreated cells. In addition, under bleomycin or pingyangmycin treatment, miR-203a-3p overexpression significantly reduced the proportion of EdU positive cells (both P<0.05) and B-cell leukemia/lymphoma-2 (BCL2) protein expression levels (both P<0.05), whilst increasing cell apoptosis rate (both P<0.05) and cleaved caspase 3 protein expression levels (both P<0.05) compared with untreated controls. Furthermore, miR-203a-3p overexpression significantly inhibited the phosphorylation of PI3K and AKT (both P<0.05), an effect that was significantly diminished by 740 Y-P treatment (both P<0.01). In addition, 740 Y-P significantly increased IC50 values of bleomycin (P<0.01) and pingyangmycin (P<0.001) and also significantly increased the proportion of EdU-positive cells and BCL2 protein expression levels, while decreasing the apoptosis rate and cleaved caspase 3 protein expression levels in cells treated with bleomycin or pingyangmycin (all P<0.05). Of note, 740 Y-P weakened the effect of miR-203a-3p overexpression on the aforementioned cellular characteristics. The present study demonstrated that miR-203a-3p improved the sensitivity of cells to bleomycin and pingyangmycin treatment by inhibiting PI3K/AKT signaling in hemangioma.

Efficacy and preliminary dose studies of ultrasound-guided sclerotherapy with lauromacrogol for the treatment of implanted hepatic tumors in rabbits

Background

To study the curative effect of sclerotherapy with lauromacrogol on a rabbit VX2 implanted liver tumor model, the effect of ultrasound-guided sclerotherapy with different doses of lauromacrogol in the treatment of the rabbit VX2 implanted liver tumor model and the degree of damage to the surrounding liver tissue was compared and observed. The relationship between the sclerosing effect and drug dose of lauromacrogol in the treatment of liver cancer is preliminarily discussed.

Methods

Thirty rabbit models of liver cancer were randomly divided into 5 groups. Control Group A was injected with normal saline, control Group B was injected with absolute ethanol, experimental Group C was injected with lauromacrogol (Z =2.885D); the injection volume in experimental Group D was 1.5-fold higher than that in Group C; and the injection volume in experimental Group E was 2-fold higher than that in Group C. Changes in tumor volume were followed up by ultrasound before and 7 and 14 days after the operation; contrast-enhanced ultrasonography was used to measure the volume of the ablation area and volume rate. For pathological anatomy, hematoxylin and eosin (H&E) staining were used to observe tumor cell necrosis and the degree of damage to surrounding normal liver cells. The expression levels of the apoptosis-related protein cleaved-caspase 3 and the cell proliferation antigen Ki67 were examined by immunohistochemistry.

Results

The volumes in Groups A and C increased significantly. The volumes in Groups B, D, and E remained the same or slightly expanded, tumor growth in the three groups was significantly inhibited after sclerotherapy. Contrast-enhanced ultrasonography showed that the ablation volume and ablation volume rate in Groups B, D, and E were similar. Group C were smaller than those in the other treatment groups. Large coagulative necrotic foci were observed in the central area of tumors in Groups B, D, and E.

Conclusions

The experiment demonstrates that lauromacrogol can inhibit tumor growth in the rabbit VX2 tumor model and cause VX2 tumor cell apoptosis. The sclerosing effect of the 1.5-fold amount of lauromacrogol is equivalent to that of absolute ethanol, with little effect on normal liver tissue.