Adjuvant analgesics refer to a group of drugs that are used not only to treat certain diseases but also to induce analge-sia. Such drugs demonstrate different mechanisms based on the complexity of cancer pain. Thus, opioids, nonsteroidal drugs, and adju-vant analgesics are often combined to control cancer pain. According to the WHO three-step analgesic ladder, adjuvant analgesics can be used at any cancer stage, and the usage of these drugs combined with opioids can reduce the required dosages of these pain relievers, thereby alleviating the adverse reactions associated with opioid use. Moreover, these drugs are particularly suitable for neuropathic pain patients who are not fully sensitive to opioids. The commonly used adjuvant analgesics include antidepressants, anticonvulsants, local administration drugs, corticosteroids, and N-methyl-D-aspartate (NMDA) receptor antagonists. Various adjuvant analgesics also differ in usage and dosage based on primary disease treatment. Therefore, clinical doctors should determine the adverse reactions, proper dos-age, and subsequent amount of dosage to be added in a few days or weeks to achieve balance between the desired effect and adverse re-actions.

Neurolytic celiac plexus block (NCPB) is an effective method used to alleviate upper abdominal pain or back pain caused by pancreatic cancer and other malignancies. NCPB can relieve cancer pain to improve the quality of life and cause fewer side effects than conventional analgesic drugs. This article systemically reviewed NCPB methodology and research progress in clinical appli-cations.

To study the general characteristics of cancer pain and to improve cancer pain diagnosis and treatment lev-el by prospective and open cross-sectional assessment of the clinical characteristics of patients with moderate to severe cancer pain. Methods:Patients with moderate to severe cancer pain were observed upon initial admission to the hospital from December 2012 to De-cember 2013. We assessed pain intensity, location, characteristics, and predisposing and mitigating factors and classified the pain by pathophysiology. Results:A total of 310 patients with moderate (101 cases, 32.58%) and severe (209 cases, 67.42%) pains were as-sessed. The top five cancers identified were lung cancer (102 cases, 32.90%), colorectal cancer (30 cases, 9.68%), pancreatic cancer (27 cases, 8.71%), breast cancer (24 cases, 7.74%), and gastric cancer (20 cases, 6.54%). These patients reported 533 cancer pain locations, including waist (132 cases), abdominal (125 cases), chest (88 cases), lower limb (71 cases), shoulder, neck, and upper limb (47 cases), pelvis (33 cases), perineal area (23 cases), and head and face (14 cases). The pain location of the pancreatic cancer was 90.63%consis-tent with the primary tumor site. The pathophysiology of the pain was classified as follows:bone pain (145 cases, 27.20%), visceral pain (138 cases, 25.89%), soft tissue pain (126 cases, 23.64%), and neuropathic pain (124 cases, 23.27%). The incidence of visceral pain in pancreatic cancer was 92.59%. Conclusion:A variety of common malignancies could cause moderate to severe pain, especially lung cancer. The clinical manifestation of pancreatic cancer pain is visceral pain. The location of this cancer was consistent with the pri-mary tumor site. No apparent specificity was observed in other cancer types.

Neuropathic cancer pain (NCP) arises from physical or chemical damage to peripheral or central neurons or in the neural conduction system.The mechanisms of NCP include pain directly related to tumor involvement,pain associated with chemotherapy,radiotherapy and surgery,neuropathic syndromes associated with paraneoplastic syndromes,inflammation and other factors.A detailed history and careful physical examination are important means of diagnosis of NCP.The clinical evaluation of NCP should use standardized pain assessment scale.Till now,the treatments of NCP include opioid combined with auxiliary analgesic drugs,interventional treatment and gene treatment.Deciding treatment strategies according to the pathogenesis of NCP,multidisciplinary collaboration,combined therapy with different analgesic drugs and technologies are the therapeutic directions for NCP.

Cancer pain can seriously disturb patients′quality of life.Intractable cancer pain not ame-nable to standard analgesics is a horrifying truth in parts of the patients.Interventional pain management tech-niques can be an effective alternative for those patients.Based on the evidence of evidence-based medicine, celiac plexus block or splanchnic nerve block are recommended for the management of upper abdominal cancer pain,pelvic cancer pain can be managed with superior hypogastric plexus block,and back pain due to vertebral compression fractures with tumor invasion can be managed with percutaneous vertebroplasty or kyphoplasty. Intercostal nerve block for chest wall cancer pain,ganglion impar block and saddle block for perineal pain due to pelvic tumors should be used only in the context of an experimental study or in cases of compassionate use with no other available forms of effective pain relief.

Objective:To compare efficacy of percutaneous vertebroplasty (PVP) with radiotherapy and radiotherapy alone for bone me-tastasis pain. Methods:A total of 247 bone metastasis patients with pain were analyzed. The radiotherapy group comprised 158 cases, whereas the combination group comprised 89 cases. We mainly observed the effect of pain treatment, behavioral states, and im-proved emotional condition. The side effects and complications were also investigated. Daily medicine consumption of background pain treatment was observed between the two groups. Analysis was done by SPSS 17.0 statistical software. Numerical variables were analyzed using t test and comparisons between groups used chi-square test. Results:The VAS scores of radiotherapy group decreased from 8.12±1.45 to 3.06±1.68 after treatment (P<0.05), and combination group VAS scores from 8.46±1.73 to 2.45±1.47 (P<0.05). The time to pain relief following PVP and radiotherapy were 1.63±0.81 and 8.56±2.87 days, respectively (P<0.001). The breakthrough pain frequency was 4.56 ± 1.98 times/day, which decreased to 1.57 ± 0.98 times/day after PVP (P<0.05). By contrast, the breakthrough pain frequency was 4.73±2.24 times/day before treatment, which decreased to 3.56±1.56 times/day after radiotherapy. No serious compli-cations were observed in the two groups. The depression and anxiety mood in the combination group improved after treatment. Daily medicine consumption in radiotherapy group increased after therapy. However, daily medicine consumption in combination group was reduced after therapy. Conclusion:PVP with radiotherapy can effectively relieve bone metastasis pain and improve patients' quality of life and it is worthy of promotion in clinical practice.

Objective To determine the relationship between dietary fiber intake and risk of prostate cancer.Methods Electronic databases including PubMed,EMBase,Cochrane library,China National Knowledge Internet (CNKI),Wanfang and CBMwere searched to find eligible studies.Random-effects relative risk (RR)and its corresponding 95%CI were used.Besides,random-effects dose-response analyses were also performed to clarify the dose-response relations.Results Ten studies,including five cohort studies and five case-control studies,were eligible and included in this Meta-analysis.The pooled RR of prostate cancer for the highest compared with the lowest dietary fiber intake was 0.87 (95%CI:0.77-0.99,Z =2.10,P =0.035). In addition,pooled estimated data showed that risk of prostate cancer was significantly associated with soluble fiber (RR =0.78,95%CI:0.64-0.95,Z =2.45,P =0.014)and insoluble fiber (RR =0.65,95%CI:0.45-0.88,Z =2.79,P =0.005),but not with fruit,vegetable and cereal fiber intake.However,in dose-response analysis,no significant association was reported (RR =0.996,95%CI:0.989-1.002).Sensitivity analysis showed that the overall results were relatively stable,and omission of any single study had little effect on the combined results.Conclusion Dietary fiber intake is negative related to the risk of prostate cancer. Intake of dietary fiber is recommended to prevent prostate cancer.Considering the limitations of the included studies,more well-designed prospective studies will be needed to confirm our findings.

Objective To investigate the influence of immunosuppression strategy optimization on the outcomes of the renal transplant recipients in the last decades. Methods Data from 404 renal transplant recipients from Jan. 1st, 2001 to Dec. 31st, 2010 were analyzed retrospectively. The patients were divided into early transplant group (n = 260) and late transplant group (n= 144). The change of immunosuppression strategy included a low dose antithymoglobin (ATG) induction, a quick corticosteroid reduction and mycophenolate mofetil therapeutic monitoring with calcineurin inhibitor minimization. Recipients' gender,age, donor type, induction therapy, immunosuppression regime, occurrences of biopsy-proven acute rejection (BPAR), severe pulmonary infection and patient/allograft survival were compared between groups. A Cox regression model was used to investigate the factors that influenced the allograft survival. Results The follow-up rate was 98. 3 % in this study. The median follow-up period was 65 month (1-112 months). The proportion of ATG induction in late transplant group was significantly higher than in early transplant group (78. 5 % versus 31. 9 %, P<0. 01). The severe pulmonary infection rate was lower in late transplant group, while the BPAR rate was comparable between two groups. The allograft survival rate was significantly higher in late transplant group. Severe pulmonary infection was correlated with patient/allograft survival in Cox regression model. Conclusion The improvement of outcome in renal transplant recipients in our center is related to the optimization of immunosuppression strategy that reduces the severe pulmonary infection rate with no increase in BPAR.

Aim To investigate the effect of paeoniflorin(PF)on TLR2/4 pathway in AGEs-induced RAW264.7 macrophages.Methods RAW264.7 macrophages were incubated at different time points in AGEs stimulation,as well as different concentrations of PF,to optimize experimental conditions.RAW264.7 macrophages were randomly divided into five groups: control group(DMEM),bull serum albumin(BSA)group(200 mg·L-1 BSA),AGEs group(200 mg·L-1 AGEs),paeoniflorin group(200 mg·L-1 AGEs+10-5 mol·L-1 PF)and TLR2/4 inhibitor group(200 mg·L-1 AGEs+30 mg·L-1 OxPAPC).The expression of Toll-like receptor 2(TLR2),Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),p-IRAK1,TIR-domain containing adaptor protein-inducing IFN-β(TRIF),interferon regulatory factor 3(IRF3),p-IRF3,NF-κB p-p65,NF-κB p65,inducible nitric oxide synthase(iNOS),tumor necrosis factor-α(TNF-α),interleukin-l β(IL-1β)and monocyte chemotactic protein-1(MCP-1)were measured by Western blot.Real-time PCR was used to detect the expression of TLR2 and TLR4 mRNA,while TNF-α,IL-1β and MCP-1 levels in cell supernatant were measured by ELISA.Results Compared with control group,AGEs significantly increased the expression of TLR2,TLR4,MyD88,p-IRAK1,TRIF,IRF3,p-IRF3,NF-κB p-p65,NF-κB p65,iNOS,TNF-α,IL-1β and MCP-1 proteins(P<0.01),as well as TLR2 and TLR4 mRNA(P<0.01).TNF-α,IL-1β and MCP-1 contents were also elevated in cell supernatant(P<0.01).The effects induced by AGEs were decreased significantly in PF and TLR2/4 inhibitor group(P<0.01).Conclusion PF plays an anti-inflammatory effect via inhibiting TLR2/4 pathway on macrophages,which may provide a new theoretical basis for the treatment of diabetic nephropathy.

Objective To evaluate the protective effect of sinomenine (SIN) on renal ischemia/reperfusion (I/R) in mice. Methods In the experiment one, 12 C57BL/6 mice were randomly divided into 2 groups: SIN group (mice were injected with 200 mg/kg SIN by tail vein) and control group (mice were injected with equal volume of saline). Six and 24 hs later, the serum was collected and the contents of alanine aminotransferase (ALT) and creatinine (SCr) were determined. In the experiment two, C57BL/6 mice were randomly divided into 3 groups: sham-operated (SO) group, SIN group (mice were injected with 200 mg/kg sinomenine just before ischemia induction) and saline group (mice were injected with equal volume of saline at the same time). At the 6th h after reperfusion, the sera and renal samples subject to IR injury were collected. The SCr and BUN levels in serum were determined and renal histological changes were also examined. The apoptosis of renal tubular epithelial cells was measured by using terminal deoxynucleotidyl transferase mediated dUTP nick end labeling assay. The infiltration of F4/80 positive macrophages was measured by using immunohistochemistry and that of neutrophils with myeloperoxidase (MPO) kits. The mRNA expression of tumor necrosis factor (TNF)-α, chemokine CXC ligand (CXCL)-10, intercellular adhesion molecule (ICAM)-1 and IL-17 was detected by using real-time reverse transcription PCR. The activation of transcription factor NF-κB was measured by using Western blotting. Results In the experiment one, there was no significant difference in ALT and SCr between the two groups at 6 or 24 h. In the experiment two,levels of SCr and BUN were lower in SIN group (P＜0. 05 or P＜0. 01 ), histological damage was milder (P＜0. 01 ), and apoptosis rate of renal tubular epithelial cells apoptosis was lower than in saline group (P＜0. 05). The infiltration of macrophages, neutrophils and the mRNA expression of TNF-α, CXCL-10, ICAM-1 and IL-17 in the renal tissue in SIN group were reduced as compared with saline group (P＜0. 05 or P＜0. 01 ). The activation of NF-κB in SIN group was significantly downregulated as compared with saline group. Conclusion SIN can ameliorate the renal IR injury without hepatic or renal toxicity, which is associated with inhibition of acute inflammatory response induced by reperfusion.