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Leptomeningeal metastasis (LM) is a serious late complication in patients with solid tumors, which is common in patients with lung cancer, breast cancer and melanoma. In recent years, due to the progress of diagnosis, the diagnosis rate of LM has gradually increased. The main goal of the therapy is to maintain neurological function, improve the quality of life and the overall survival rate, and prolong the progression-free survival time of patients. Intrathecal therapy is one of the main treatments for LM, which can deliver drugs directly to the subarachnoid space. The traditional intrathecal drugs are methotrexate, cytarabine and thiotepa. With the development of new research, a variety of chemotherapeutic drugs, targeted drugs and immune checkpoint inhibitors have also been used in intrathecal therapy. In addition, different ways of intrathecal administration also bring new hope to patients. This article reviewed the clinical research progress of intrathecal therapy in the treatment of LM. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies have indicated that lipoxin A4 has a neuroprotective effect against spinal cord injury in rats, but its mechanism of action in spinal cord ischemia-reperfusion injury is still unclear. OBJECTIVE: To investigate the neuroprotective effect of lipoxin A4 in rats with spinal cord ischemia-reperfusion injury. METHODS: Forty-eight Sprague-Dawley rats were randomized into three groups (n=16 per group): Spinal cord ischemia-reperfusion injury models were built in control and experimental groups followed by intrathecal injection of normal saline and lipoxin A4 respectively, and no treatment was given in blank control group. Basso-Beattie-Bresnahan (BBB) score was used to evaluate motor nerve function in rats at 6, 12, 24, and 48 hours after modeling. At 24 hours after reperfusion, TUNEL assay was used to detect cell apoptosis in the rat spinal cord; ELISA was used to detect the levels of Bcl-2 and Bax in the rat spinal cord, and western blot assay was used to detect the levels of cleaved-caspase-3, p-IKKβ and p-NF-κB proteins in the rat spinal cord. This experiment was approved by the Ethics Committee of the First Affiliated Hospital of Xinxiang Medical University (approval No. 2018038). RESULTS AND CONCLUSION: Compared with the blank control group, the BBB scores were lower in the control group at different observation time points (P < 0.05), while compared with the control group, the BBB score was higher in the experimental group at 12, 24, and 48 hours after modeling (P < 0.05). There were more apoptotic cells in the control group than the blank control group (P < 0.05), while the number of apoptotic cells in the experimental group was lower than that in the control group (P < 0.05). The levels of Bcl-2 and Bax in the spinal cord were significantly higher in the control group than the blank control group, while compared with the control group, the experimental group showed a higher Bcl-2 level and a lower Bax level (P < 0.05). Compared with the blank control group, the expressions of cleaved-caspase-3 and p-NF-κB proteins were strongly higher in the control group, while the protein expression of p-IKKβ was weaker in the control group. Compared with the control group, the expressions of cleaved-caspase-3 and p-NF-κB proteins were lower in the experimental group, while the protein expression of p-IKKβ was higher in the experimental group. These findings indicate that lipoxin A4, as a therapeutic agent for spinal cord ischemia-reperfusion injury, can inhibit cell apoptosis by activating the Caspase-3/IKKβ/NF-κB pathway in the cytoplasm. [ABSTRACT FROM AUTHOR]

Objective To observe the curative effect and life quality improvement in patients with intractable neuropathic pain (NP) after implanting a programmable continuous intrathecal infusion pump. Methods Three cases of intractable neuropathic pain with poor medicine efficacy or serious adverse drug reactions had been followed-up for 6-14 months after being implanted programmable intrathecal infusion pump. Pain relief, sleep quality improvement, dosage of oral analgesics and drug side effect were observed. Results After treatment the Visual Analogue Scale (VAS) of 3 patients decreased significantly, with pain releasing from preoperative moderate or severe pain to postoperative mild pain and decrease of fulminating pain frequency. Dosage of oral analgesics declined to 10% of its preoperative dose and sleep quality was improved obviously. Neither postoperative complications nor side effect of morphine was observed during the follow - up. Conclusion The treatment of implanting a totally programmable continuous intrathecal infusion pump is eutherapeutic to the patients with intractable neuropathic pain who have achieved satisfactory analgesic effect in experimental therapy. [ABSTRACT FROM AUTHOR]