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Infantile hemangioma, a common benign tumor of infancy, grows quickly in six months to one year after birth, then slowly involutes into fibrofatty tissue childhood. In this study, we observed the adipogenesis in hemangioma and investigated the expression of adipogenic differentiation-related genes. 33 fresh resected hemangioma samples were collected, including 18 proliferating cases (less than one year old), 9 involuting cases (from one to five years old), and 6 involuted cases (more than five years old). The pathological evolution of hemangioma was observed by H-E staining. The expression of Perilipin A was showed by immunohistochemistry staining. The expression and location of PPAR-γ (a key transcription factor in adipogenesis) was displayed by Immunofluorescence staining, with the co-staining of α-SMA and CD31. The expression of adipose differentiation-related genes including PPAR-γ2, LPL, CEBPA, and Perilipin A was detected by Quantitative real time PCR. The results of H-E and Immunohistochemical staining showed the increase of adipose cells as hemangioma developed from the proliferative phase to involuting phase and later to involuted phase. Immunofluorescence staining showed that PPAR-γ wa expressed in the perivascular cells in hemangioma. Quantitative PCR analysis showed a significant increase of PPAR-γ2, LPL, CEBPA and Perilipin A genes' expression in the involuting and involuted heangioma. In conclusion, the PPAR-γ(+) perivascular cells (specific mesenchymal stem cells or pericytes) contribute to the adipogenesis in hemangioma. The siginificantly increased expression of adipogenic differentiation-related genes in the involuting and involuted phase suggested that they played a role in the adipogenesis in hemangioma., Competing Interests: None., (IJCEP Copyright © 2017.)

Kasabach-Merritt phenomenon (KMP) is life-threatening, charactered by the profound thrombocytopenia and consumptive coagulopathy associated with vascular tumors. The therapy of KMP still remains challenging. In this study, we retrospectively analyzed the clinical data of KMP treated in Nanjing Children's Hospital and Jinling Hospital, China, and brief reviewed the literature on KMP. From Jan. 2005 to Dec. 2014, a total of 19 cases of KMP were enrolled into this study. Laboratory results showed that seven patients had typical disseminated intravascular coagulation (DIC), and others were atypical DIC. CT scanning showed the low-density tumor with obvious intensification in enhanced scanning, and the large distorted arteries in association with the tumor. After the admission, the patients received the infusion of platelets and the applying of dipyridamole, steroids, and other necessary drugs. Eight patients underwent complete surgical removal of the tumor, or partial removal with subsequent chemotherapy of vincristine. Three patients underwent only the chemotherapy of vincristine. Eight patients underwent the intralesional injection of absolute ethanol. Pathological examination showed eighteen samples were kaposiform hemangioendothelioma, and one tufted agioma. In our cases, six patients died from extensive hemorrhage and subsequent multiple organ failure. The others survived. In conclusion, KMP in Chinese children has typical symptoms. Kaposiform hemangioendothelioma is the most frequent vascular tumor associated with KMP. The individual treatments with surgical management, chemotherapy with vincristine, and intralesional injection of absolute ethanol can achieve good results in most of the patients with KMP.

Objective: This study aims to learn about the current situation of surgical massive blood transfusion of different surgical departments in China's Tertiary hospitals, which could provide the basis for the formulation of guidelines on massive blood transfusion., Method: A multicenter retrospective research on the application status of blood constituents during massive blood transfusion was conducted and a comparative analyses of survival and length of hospitalization in patients from different departments (trauma, cardiac surgery, obstetric conditions, or other common surgeries), were performed., Result: In China, during massive blood transfusion the ratio of the dosage of fresh frozen plasma to the dosage of red blood cell suspension reached 1:1-2, while the dosage of platelet and cryoprecipitate appeared to be very small. The risk of in-hospital death were associated with the primary disease in patients receiving massive blood transfusion (Log-Rank P = 0.000), cardiac surgery and trauma patients who received massive blood transfusion have a higher risk of death rate., Conclusions: Patients undergoing massive blood transfusion among different surgical departments have a certain difference in use of blood transfusion, mortality rate and the time of death. Our findings suggested that we should set up an independent transfusion program in cardiac surgery and trauma patients of massive blood transfusion.

Objective: The aim of this study was to learn the current situation of surgical massive transfusion of death and survival groups in China, which could provide the basis for the formulation of guidelines on massive transfusion., Methods: A multicenter retrospective research for the application status of blood constituents during massive blood transfusion was conducted, the differences of fresh frozen plasma and platelet application between death group and survival group were compared, and the transfusion volume and the distribution of other blood constituents were analyses at different periods of time when red blood cells are infused between death group and survival group., Results: The patients with fresh frozen plasma compare the patients with red blood cell was 1:1-2 during massive transfusion, while the dosage of platelet and cryocepitate were transfused very small. Results showed that the average amount of platelet and plasma in death group was significantly lower than those in survival group., Conclusion: During massive transfusion, clinicians in 20 Chinese hospitals paid more attention to the infusion of fresh frozen plasma while making the infusion of red blood cells. However, they paid little attention to the supplement of platelet and cryocepitate. The average quantity of plasma and platelet in survival group were also higher than those in death group.

Hemangioma-derived mesenchymal stem cells (Hem-MSCs) expressed PPAR-γ, the key transcription factor in adipogenesis. We supposed that rosiglitazone, the agonist of PPAR-γ, may promote the adipogenesis of Hem-MSCs. In this study, MSCs were isolated from proliferating hemangioma. Four groups were set up, which were Group A (DMEM-LG/10% FBS), Group B (1 μM rosiglitazone + DMEM-LG/10% FBS), Group C (adipogenic media), and Group D (1 μM rosiglitazone + adipogenic media). Cells were cultured in the medium above. On the day 7 and 14, Oil Red "O" staining and Western blot were performed to detect the cytoplasmic lipid and perilipin A in the cells. The results showed that cytoplasmic lipid appeared in Group C and D, and no cytoplasmic lipid in Group A and B on the day 7 and 14. Analysis of Oil Red "O" staining showed the area of staining in Group D was significantly larger than that in Group C. Analysis of western blot showed no expression of perilipin A in Group A and B, and upregulated expression in Groups C and D, with the greater upregulation in Group D. In conclusion, our study demonstrated that rosiglitazone promoted the adipogenesis of Hem-MSCs initiated by adipogenic media via the activation of PPAR-γ pathway. The results may put forward the possibility of treating hemangioma via PPAR-γ pathway.

Infantile hemangioma, a common benign tumor of infancy, grows quickly in the first year of life, and then regresses slowly to fibrofatty tissue in childhood. The accumulation of fibrofatty tissue in hemangioma involution indicates adipogenesis during this period. Perivascular cells (PCs) from multiple organs display multi-lineage differentiation, including adipogenesis. So we supposed that PCs in hemangioma may contribute to the adipogenesis in the involution. In this study, PDGFR-β (+) PCs was isolated from hemangioma tissue (hemangioma-derived perivascular cells, Hem-PCs) by fluorescence-activated cell sorter. In vitro, Hem-PCs showed fibroblast-like morphology. Immunofluorescence staining and flow cytometry showed Hem-PCs expressed MSCs markers CD105, CD90, CD29 and vimentin, pericyte markers α-SMA and PDGFR-β, stem cell marker CD133, and the adipogenic transcription factor PPAR-γ, but not hematopoietic/endothelial markers CD45, CD34, CD31, and flt-1. In vitro inductions confirmed multi-lineage differentiation of Hem-PCs, especially strong adipogenic potential. Then a murine model was established to observe in vivo differentiation of Hem-PCs by subcutaneous injection of cells/Matrigel compound into nude mice. The results showed Hem-PCs differentiated into adipocytes in vivo. To the best of our knowledge, this is the first study reporting the isolation of multipotential PDGFR-β (+) PCs from hemangioma, and observing their adipogenic differentiation in vivo. PCs may be the cellular basis of adipogenesis in hemangioma involution, and may be the target cells of adipogenic induction to promote hemangioma involution.