Infantile hemangiomas are common benign vascular tumors that exhibit a characteristic history of rapid proliferation in the first year of life and slow spontaneous involution during early childhood. The causative pathogenic event responsible for the abnormal endothelial proliferation remains elusive. The recent discovery of an immature phenotype of proliferating hemangioma endothelial cells due to the exclusive expression of the lymphatic endothelial hyaluronan receptor LYVE-1 led to the proposal that infantile hemangiomas are the result of a primary defect in endothelial cell maturation. To test this hypothesis, we looked for the expression of the lymphatic endothelial cell-specific markers LYVE-1, Prox-1, podoplanin and D2-40 in b4 integrin-negative proliferating and b4 integrin-positive involuting infantile hemangiomas. As b4 integrin proved to be a suitable marker for staging infantile hemangiomas, we used it in combination with clinical and histological criteria to objectively determine the proliferative and involutional phases. In immunohistochemical and immunofluorescent stains, hemangioma vessels were negative for all lymphatic endothelial cell-specific markers tested during both proliferation and involution. LYVE-1 immunoreactivity, however, was found in the dense network of perivascular HLA-DR-positive cells with dendritic cell morphology that are supposed to play a role in hemangiogenesis by releasing pro-and antiangiogenic factors. Notably, this LYVE-1 staining failed to correlate with the growth status of infantile hemangiomas. Our results do not support the notion that LYVE-1 expression was restricted to the proliferative phase and downregulated during involution. Thus, LYVE-1 does not seem to be a reliable marker for proliferating infantile hemangiomas. We conclude that the suggested intrinsic defect in endothelial cell maturation is unlikely the cause for the post-natal rapid growth in infantile hemangiomas. In addition, the lack of lymphatic endothelial cell-specific markers implies that infantile hemangiomas are tumors of blood vessels without lymphatic competence.
The application of robot-assisted laparoscopic techniques is new and generates numerous benefits for patients. Here, we summarise the experience of our first series through 52 cases of prostate cancer treated by robot-assisted radical prostatectomy (RARP) in the Department of Urology of Binh Dan Hospital, from December 2016 to September 2017, to study the learning curves of this procedure. In this clinical comparative study, 52 patients diagnosed with prostate cancer (clinical stage T1 to T3) received RARP with and without nerve sparing as well as standard pelvic lymphadenectomy. Patients were divided into 4 groups according to their surgeon (surgeons A, B, C, and D, with 22, 12, 10, and 8 patients, respectively) for comparison. Research variables were cancer stage, preand postoperative prostate-specific antigen (PSA) serum levels, Gleason scores, lymph node metastasis, estimated blood loss, surgery time, urinary incontinence, hospital stay, and complications. Mean age, PSA, and stage of cancer were statistically similar (p>0.3). Operative times were 194.55, 269.17, 236.00, and 306.88 min, respectively (p<0.01). Mean estimated blood losses were 363.64, 404.17, 322.22, and 253.75 ml, and were significantly different (p<0.01). Nine patients required blood transfusion. The lengths of hospital stay were 5.73, 12.92, 5.10, and 6.13 days, and were not similar among groups (p<0.05); however, drainage times and complication rates between groups (p<0.01) were statistically significant. The optimal learning curve for operative times was achieved after 20 cases. Our initial RARP results were relatively strong, suggesting that surgery could be safely performed with acceptable complications.
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