Pain permeates the entire process of cancer,and its mechanism is complex,involving tumor microenvironment,cancer-related bone pain,cancer-related visceral pain,cancer-related neuro-pathic pain,and surgery and radiotherapy-related factors.Studies have indicated that lidocaine can al-leviate intractable cancer pain for opioids,and its mechanism of action in treating various types of cancer pain may also be different,involving the regulation of acid-sensing ion channels(ASICS),transient receptor potential channels(TRP),voltage-gated sodium channels(VGSCs),nerve growth factor(NGF),glutamate and its receptors,inflammatory cells and cytokines,microglia,astrocytes,and high mobility group box 1 protein(HMGB1).This paper reviewed the mechanisms of cancer pain,the mechanisms of lidocaine in treating different types of cancer pain as well as its clinical appli-cations.

Pain permeates the entire process of cancer,and its mechanism is complex,involving tumor microenvironment,cancer-related bone pain,cancer-related visceral pain,cancer-related neuro-pathic pain,and surgery and radiotherapy-related factors.Studies have indicated that lidocaine can al-leviate intractable cancer pain for opioids,and its mechanism of action in treating various types of cancer pain may also be different,involving the regulation of acid-sensing ion channels(ASICS),transient receptor potential channels(TRP),voltage-gated sodium channels(VGSCs),nerve growth factor(NGF),glutamate and its receptors,inflammatory cells and cytokines,microglia,astrocytes,and high mobility group box 1 protein(HMGB1).This paper reviewed the mechanisms of cancer pain,the mechanisms of lidocaine in treating different types of cancer pain as well as its clinical appli-cations.

Objective To investigate the impact of thoracic epidural anesthesia on stress hyper-glycemia in patients undergoing major abdominal operations.Methods Forty patients were divided in-to two groups:general anesthesia (group I)and thoracic epidural and general anesthesia (group E). The venous samples were collected for the measurements of blood glucose (Glu),nitric oxide (NO), malonadialdehyde (MDA),glutathione (GSH)and the activities of aldose reductase (AR),glucose-6-phasphate dehydrogenase (G-6PD), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD),catalase(CAT)in red blood cells at 30 min before induction (T0 ),90 min after incision (T1 ),60 min after surgery (T2 )and on the 1st,2nd postoperative day (T3 and T4 ).Results The lev-el of Glu was increased from T1 to T3 in two groups compared with T0 .The activities of AR,G-6PD and CAT in RBC and plasma MDA were increased markedly at T3 while plasma levels of GSH and NO were decreased significantly in group I (P<0.05).Above parameters,except Glu,changed slightly and did not reach significance in group E.Compared to group I,the level of Glu and the activities of AR,G-6PD,CAT in group E were decreased and NO level was increased significantly at T3 (P <0.05).SOD and GSH-Px activity changed slightly within and between two groups.Conclusion Tho-racic epidural anesthesia can effectively attenuate stress hyperglycemia in patients undergoing major abdominal surgery.

Objective To explore the correlation between Th1,Th2,Th17,and Treg cells differentiation and related cytokines in patients with rheumatoid arthritis (RA).Methods Seventy-one patients with active RA were enrolled in this study.They were divided into low,moderate and high disease activity groups according to disease activity score (DAS28).The frequencies of Th1,Th2,Th17,and Treg cells in the peripheral blood of RA patients group (n=71) and healthy conlrol group (n=18) were determined by flow cytometry.T test was used for statistical analysis.Results Significant difference could be detected between the proportions of Th1 [ (6.2±4.5)％],Th17 [ (1.1±0.9)％] and Treg [(1.8±1.2)％] cells in the peripheral blood of RA patients and the control group (P＜0.05),and there was correlation between proportions of these three kinds of cell and the DAS28.Conclusion Th1 and Th 17 cells may promote the development of RA disease,but Th2 and Treg cells could prevent further development of RA disease.

Objective To study the changes in the polyol pathway of glucose metabolism and oxidative stress responses induced by general thoracic surgery by measuring erythrocyte aldose reductase (AR), phosphofructokinase (PFK) and glucose-6 phospate dehydrogenase (G-6PD) activities and plasma MDA and GSH levels before and after surgery performed under different anesthetic techniques. Methods Thirty-two ASA Ⅰ-Ⅱ patients aged 45-71 yrs weighing 55-70 kg were randomly allocated to one of two groups with 16 patients in each group : group Ⅰ received isoflurane inhalation for maintenance of anesthesia and group Ⅱ isoflurane inhalation combined with epidural block. Patients with endocrine and glucose metabolism-related diseases were excluded. The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Anesthesia was induced with intravenous midazolam 0.1 mg?kg-1 , propofol 1.0-1.5 mg?kg-1 , fentanyl 0.1-0.15 mg, droperidol 1-2 mg and vecuronium 0.1 mg?kg-1 in both groups. The patients were mechanically ventilated (VT 8-10 ml?kg-1, RR 10-12 bpm) after tracheal intubation. Anesthesia was maintained with isoflurane inhalation at 1.2-1.6 MAC in group Ⅰ or isoflurane inhalation (0.6-0.8 MAC) combined with epidural block (T9-10) with 1 % lidocaine in group Ⅱ supplemented with fentanyl 5-10 ?g?kg-1 and droperidol 0.1-0.2 mg?kg-1 in divided doses and vecuronium infusion at 1-2 ?g? kg?min-1 . Venous blood samples were obtained before anesthesia (baseline, T0), 90 min after skin incision (T1), 60 min after surgery (T2 ) and on the 1 st and 2nd postoperative days (T3 , T4 ) for determination of erythrocyte AR, PFK and G-6PD activities and plasma glucose, MDA and GSH levels. Results In group Ⅰ plasma MDA level and AR and G-6PD activities in erythrocyte were significantly increased, while plasma GSH level and PFK activity in erythrocyte were significantly decreased on the 1st postoperative day compared to the baseline values before anesthesia (T0) (P 0.05). Conclusion Isoflurane inhalation combined with epidural block can effectively attenuate the effects of surgical trauma on glucose metabolism in theerythrocyte and the oxidative stress responses of the body.