Intrathecal morphine delivery at prepontine cistern to control refractory cancer-related pain: a case report of extensive metastatic and refractory cancer pain.

BACKGROUND: Extensive metastatic and refractory cancer pain is common, and exhibits a dissatisfactory response to the conventional intrathecal infusion of opioid analgesics. CASE PRESENTATION: The present study reports a case of an extensive metastatic esophageal cancer patient with severe intractable pain, who underwent translumbar subarachnoid puncture with intrathecal catheterization to the prepontine cistern. After continuous infusion of low-dose morphine, the pain was well-controlled with a decrease in the numeric rating scale (NRS) of pain score from 9 to 0, and the few adverse reactions to the treatment disappeared at a low dose of morphine. CONCLUSIONS: The patient achieved a good quality of life during the one-month follow-up period.

Andrographolide ameliorates hepatic steatosis by suppressing FATP2-mediated fatty acid uptake in mice with nonalcoholic fatty liver disease.

Excessive intrahepatocellular lipid accumulation or steatosis is caused by abnormal lipid metabolism and a common character of nonalcoholic fatty liver disease (NAFLD), which may progress into cirrhosis and hepatocellular cancer. Andrographolide (Andro) is the primary active ingredient extracted from Andrographis paniculata, showing a protective role against dietary steatosis with the mechanism not fully understood. In this study, we showed that administration of Andro (50, 100, and 200 mg/kg/day for 8 weeks, respectively) attenuated obesity and metabolic syndrome in high-fat diet (HFD)-fed mice with improved glucose tolerance, insulin sensitivity, and reduced hyperinsulinemia, hyperglycemia, and hyperlipidemia. HFD-fed mice presented hepatic steatosis, which was significantly prevented by Andro. In vitro, Andro decreased the intracellular lipid droplets in oleic acid-treated LO2 cells. The selected RT-PCR array revealed a robust expression suppression of the fatty acid transport proteins (FATPs) by Andro treatment. Most importantly, we found that Andro consistently reduced the expression of FATP2 in both the oleic acid-treated LO2 cells and liver tissues of HFD-fed mice. Overexpression of FATP2 abolished the lipid-lowering effect of Andro in oleic acid-treated LO2 cells. Andro treatment also reduced the fatty acid uptake in oleic acid-treated LO2 cells, which was blunted by FATP2 overexpression. Collectively, our findings reveal a novel mechanism underlying the anti-steatosis effect of Andro by suppressing FATP2-mediated fatty acid uptake, suggesting the potential therapeutic application of Andro in the treatment of NAFLD.

Medullary thyroid carcinoma combined with papillary thyroid carcinoma: case report and literature review.

We investigated the clinicopathologic features, immunophenotype, (differential) diagnosis, pathogenesis, treatment, and follow-up of medullary thyroid carcinoma (MTC) combined with papillary thyroid carcinoma (PTC). A retrospective analysis of the clinical and pathologic features and immunophenotype was conducted in a patient with MTC and PTC. Relevant literature was also reviewed. Results of thyroid fine needle aspiration indicated malignant tumor in the right lobe of the thyroid, suggesting PTC; further analysis by biopsy confirmed this diagnosis. The left lobe exhibited MTC. Tumor metastases were absent from the lymph nodes of the left central area (0/2), and no tumor was present in the thymic tissue. In the right lobe and isthmus, PTC was observed, with a maximum infiltration diameter of 0.8 cm, and tumor metastases were absent from lymph nodes of the right central area (0/3). Immunohistochemistry of the left lobe was positive for calcitonin, CK, TTF-1, CD56, CgA, and Congo red, but negative for CK19, thyroglobulin, galectin-3, MC, and CEA, with a Ki-67 proliferation index of 1%. The right lobe was positive for CK19, galectin-3, and MC, but negative for CD56. The V600E mutation was detected in BRAF. MTC combined with PTC is a rare thyroid tumor. This condition is diagnosed mainly based on morphology, immunophenotyping, and molecular detection. It must be distinguished from other malignancies, such as thyroid follicular tumors, undifferentiated carcinoma, poorly differentiated carcinoma, transparent stellate tumor, and mixed PTC/MTC. Surgery and post-operative drug administration currently constitute the preferred treatments.

Topically administered rhGM-CSF affects PPARß expression in the stasis zone.

Using a rat comb thermal damage model, we investigated the effects of topically administered recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on peroxisome proliferator-activated receptor PPARß expression. We created bilateral comb scald models on the backs of fifty Sprague-Dawley rats. The left sides of the backs served as the experimental group and the right sides served as the control group. The experimental group received topically applied rhGM-CSF hydrogel and the control group did not. The survival situations of the stasis zones were compared between the experimental and control groups on the 1st, 3rd, 7th, 14th and 21st post-burn days. Tissues from the surviving stasis zones of both groups were collected at different time-points. Reverse transcriptase-polymerase chain reaction (RT-PCR) and western blotting were used to detect the PPARß mRNA and protein expression levels. Immunohistochemical methods were applied to detect the localization of PPARß protein expression. The results showed that, first, the tissue viability numbers for the stasis zones of the experimental group were significantly increased compared with those of the control group. Second, RT-PCR revealed that the PPARß mRNA expression first increased and then gradually declined in both groups. At all time-points, the expression level in the experimental group was increased compared with that in the control group and the highest expression levels were observed in both groups on the 3rd post-burn day. Third, western blot analysis revealed that the PPARß protein expression in both groups increased after thermal damage and then gradually decreased. PPARß protein expression in the experimental group was greater than that in the control group, and the highest expression quantities in both groups were observed on the 3rd post-burn day. In conclusion, rhGM-CSF hydrogel effectively promotes the expression of PPARß, and the hydrogel had a specific protective effect for the stasis zone.

Downregulation of VEGFA inhibits proliferation, promotes apoptosis, and suppresses migration and invasion of renal clear cell carcinoma.

OBJECTIVE: The aim of this study was to investigate the effects of vascular endothelial growth factor A (VEGFA) on cell proliferation, apoptosis, migration, and invasion in renal clear cell carcinoma (RCCC). METHODS: Between June 2012 and June 2015, RCCC tissues were obtained for the experimental group, and RCCC adjacent tumor-free kidney parenchyma tissues were obtained for the control group. VEGFA mRNA and protein expressions and phosphoinositide 3-kinase, serine/threonine-specific protein kinase (AKT), and phosphorylated-AKT protein expressions were detected. The chemically synthesized specific siRNA using RNA interference technology was used to inhibit VEGFA gene expression in human RCCC 786-O cells. The negative control (NC) group was transfected with NC sequence, and the blank group was transfected with no sequence. Flow cytometry, scratch test, and cell-penetrating experiment were used to detect cell proliferation, apoptosis, migration, and invasion of 786-O cells. RESULTS: Positive expression of VEGFA protein was 60.62% in RCCC tissue and 18.34% in adjacent tissue with statistically significant difference (P<0.001). VEGFA protein and mRNA expressions were higher in RCCC tissue than those in adjacent tissue (both P<0.01). VEGF expression in RCCC tissue was associated with Fuhrman grading and American Joint Committee on Cancer staging (both P<0.05). After RCCC 786-O cells transfecting the VEGFA siRNA, the VEGFA mRNA and protein expressions and phosphoinositide 3-kinase and phosphorylated-AKT protein expressions were significantly decreased, cell proliferation was remarkably inhibited, cell apoptotic ratio was obviously increased, and migration distance and invasive cell number were markedly decreased compared to those in the NC group and the blank group (all P<0.05). CONCLUSION: Inhibition of VEGFA inhibited proliferation, promoted apoptosis, and suppressed migration and invasion of RCCC 786-O cells. VEGF has a potential role in diagnosis and therapy of RCCC.

[The gluteal perforator-based flap for repair of refractory wounds on different sites of buttocks].

OBJECTIVE: To discuss the application of perforator-based flap for repair of refractory sacral, ischial and trochanter wounds. METHODS: Vacuum sealing drainage (VSD) were applied for all the wounds for 6 - 21 days and cutaneous perforator was detected by Doppler before operation. According to the location of the perforator arteries, different types of perforator-based flaps were used to cover the wounds on the buttocks. RESULTS: Since 2005, 18 wounds in 14 patients were treated, including 11 sacral, 5 ischial and 2 trochanter defects. All flaps survived with primary healing.All the patients were followed up for 2 to 24 months with no ulcer relapse. The colour and texture of the flaps were excellent with satisfactory cosmetic results. CONCLUSION: The gluteal perforator-based flaps have reliable blood supply with less morbidity in donor sites. It is an optimal method in repairing refractory wounds of the gluteal region.

[Clinical efficacy of artery perforator-based flap in the repair of gluteal-sacral pressure sores].

OBJECTIVE: To investigate the clinical efficacy of artery perforator-based flap in the repair of gluteal-sacral pressure sores. METHODS: Gluteal artery perforator-based island flap and perforator-based flap were designed to repair the gluteal-sacral pressure sores of 26 patients according to the location and size of the wounds. The area of the biggest flap was 20 cm x 15 cm, the diameter of perforating vessel was above 1. 1 mm, with the length of free pedicle ranging from 2.0 - 3. 5 cm. RESULTS: All the flaps healed soon after operation, with no flap necrosis and postoperative complications, such as flap necrosis, wound infection and or formation. The color and texture of the flaps were good and the configuration was satisfactory. There was no recurrence of local bedsore in the follow-up period from 6 to 24 months. CONCLUSION: The artery perforator-based flaps have the advantages of delicate texture, easy dissection, reliable blood flow, preservation of the gluteus maximus muscle and no need of skin grafting for the donor defects in most cases. It is an optimal method in surgical treatment of gluteal-sacral pressure sores.

[Long-term in vitro culture of the fibroblasts from the deep partial thickness burn wound in burn patients].

OBJECTIVE: To establish a long-term in vitro culture of the fibroblasts obtained from burn wounds. METHODS: Skin samples were harvested from normal volunteers and the deep partial thickness burn wound in burn patients on the 5th, 10th, 21st, 28th and 35th postburn days (PBDs). The non-dermal tissue was removed from the samples and primed by chlorhexidine solution in concentration of 2.5 g/L. The skin sample was then digested by trypsin-EDTA in concentration of 1.25 g/L and was centrifuged before the cells were harvested and cultured. When the cells grew nearly to form sheet, multiple passage culture, freezing storage and revivification were carried out with routine methods. The cell morphology was continuously observed during the culture. And the cell doubling time was calculated. RESULTS: The wound-origin fibroblasts exhibited higher purity and better activity. The cellular growth features and gross morphology kept stable during primary and secondary culture, and during freezing storage and after revivification. The cells kept their activity above 80% of their original after many times of revivification. CONCLUSION: The establishment of the in vitro culture of fibroblasts from burn wounds might be useful in the exploration of the pathogenesis and therapeutic measures of scars.