利用cDNA微列阵技术分析胰腺癌相关基因表达谱

目的：利用cDNA微列阵技术分析胰腺癌相关基因表达谱来寻找下一步研究的目标基因。方法：利用含有18000个cDNA克隆的微列阵，对2例正常胰腺组织和4例中分化胰腺癌标本行基因表达谱分析。结果：2份混合癌组织样品分别有1484和1353条差异表达基因，表达趋势相同的有455条，上调基因102条，下调基因353条，已知基因274条，未知功能EST181条，差异2倍以上的基因各占27．8％和52．0％，已知差异基因中包括抑癌基因、生长因子及其受体基因、信号传导相关基因、转寻调节因子等。结论：cDNA微列阵技术为分析胰腺癌相关基因表达谱提供了有力的工具,MBD1、EDG1等基因和过甲基化表达调控可能在胰腺癌发病机制中起着关键作用。     

甲基化CpG结合域蛋白1在胰腺癌组织中的表达和意义

目的：检测甲基化CpG结合域蛋白I（MBD1）蛋白在胰腺癌组织中的表达，并探讨其临床意义。方法：应用S-P免疫组织化学法检测38例胰腺癌、17例胰腺癌旁组织、8例胰腺良性肿瘤、3例慢性胰腺炎和6例正常胰腺组织中MBD1蛋白的表达。结果：MBD1在胰腺癌组织、正常胰腺组织、胰腺良性肿瘤、胰腺癌旁组织中的表达阳性率分别是76．32％（29/38）、16．67％（1／6）、25．0％（2／8）、29．41％（5／17），3例慢性胰腺炎标本中未见表达；胰腺癌阳性表达率明显高于正常胰腺、慢性炎症、良性肿瘤和癌旁对照组织（P〈0．05）。MBD1表达水平的高低与病人的性别、年龄、肿瘤部位、肿瘤大小、分化程度和TNM分期无显著性差异（P〉0．05）；而与淋巴结转移密切相关，有淋巴结转移者胰腺癌组织MBD1的表达阳性率为92．31％（24／26），高于无淋巴结转移者的41．67％（5／12）（P〈0．01）。结论：胰腺癌中MBD1呈高水平表达，并与胰腺癌的高转移侵袭活性有关，其机制可能与MBD1介导抑制多个甲基化相关抑癌基因的表达有关。MBD1的转录调控机制有待进一步研究。     

Affymetrix基因表达谱芯片技术筛选胰腺癌异常表达基因的研究

目的:利用基因表达谱芯片筛选出胰腺癌组织与癌旁正常组织的差异表达基因。方法:收集新疆医科大学第三附属医院2014年1月—2016年6月间手术切除的10例胰腺导管细胞癌组织及其相应癌旁正常组织,用TRIzol法提取总RNA后采用含49395个基因探针的Affymetrix基因表达谱芯片筛选出差异表达基因,并行GO分析和pathway分析,对部分差异表达基因行实时定量PCR法验证表达情况。结果:样本总RNA检测合格,基因芯片质量评估良好,检测结果可靠且可重复性高。经芯片降噪处理后共检测38079个基因,其中存在差异表达的基因共512个,表达上调的基因419个,表达下调的基因93个;共287个差异表达基因编码与3个GO分类(生物学过程、分子功能、细胞组分)相关的蛋白;共29条信号通路存在明显基因差异表达,涉及126个基因。经PCR验证,差异表达基因CPB1、CELA3B、CPA1、POSTN、PLA2G1B、CTRC及SPINK1的表达情况与基因芯片检测结果吻合。结论:胰腺导管细胞癌组织与癌旁正常组织间存在大量差异表达的基因,这些基因主要与生物学过程、分子功能及细胞组分相关,且参与了多个细胞信号通路的调控。     

MBD1 RNA干扰对胰腺癌细胞VIMENTIN、GRP78表达影响的实验研究

目的：观察下调甲基化CpG结合域蛋白1（MBD1）表达后对胰腺癌细胞甲基化相关基因VIMENTIN、GRP78表达的影响,探讨MBD1介导的甲基化调控网络在胰腺癌发生、发展中的重要作用。方法：人工设计合成针对MBD1基因的小分子干扰RNA,构建MBD1-siRNA重组质粒,脂质体法转染人胰腺癌细胞株BxPC-3,RT-PCR和Western印迹法检测转染前后MBD1、VIMENTIN和GRP78 mRNA与蛋白表达的变化。结果：MBD1-siRNA重组质粒成功转染胰腺癌细胞系BxPC-3,并筛选得到稳定表达的细胞株。转染后胰腺癌BxPC-3细胞株MBD1、VIMENTIN和GRP78的mRNA与蛋白表达水平均明显降低。结论：MBD1下调可使胰腺癌细胞VIMENTIN和GRP78表达下降：MBD1可能通过调控甲基化相关基因的表达,在胰腺癌的发生、发展过程中起重要的作用。     

MBD1甲基化调控胰腺癌BxPC-3细胞株mdr1转录及其表达的研究

目的 观察MBD1通过对mdr1转录区域结合位点甲基化影响,在转录水平间接调控胰腺癌mdr1基因表达.方法 应用RNA干扰技术对人胰腺癌细胞株BxPC-3中MBD1基因进行抑制;应用定量荧光聚合酶链式反应(FQ-PCR)技术、MSP(甲基化专用聚合酶链式反应)方法分别检测转染前后细胞株中的mdr1 mRNA的表达差异和转录区域结合位点甲基化变化.结果 成功构建并转染MBDI siRNAs至人原位胰腺腺癌细胞BxPC-3(BxPC-3)细胞中,证实MBDI mRNA水平明显下调(下调幅度为93.19%).MBD1下调后,mdr1 DNA转录区域(-110GC和-50GC)甲基化分别上调(上调幅度分别为181.98%和409.57%);mdr1 mRNA表达明显下调(下调幅度为97.79%).结论 MBD1可通过对mdr1转录区域结合位点甲基化的影响,在转录水平间接调控胰腺癌mdr1基因表达.     

MBD1甲基化调控胰腺癌BxPC-3细胞株mdr1转录及其表达的研究

目的 观察MBD1通过对mdr1转录区域结合位点甲基化影响,在转录水平间接调控胰腺癌mdr1基因表达.方法 应用RNA干扰技术对人胰腺癌细胞株BxPC-3中MBD1基因进行抑制;应用定量荧光聚合酶链式反应(FQ-PCR)技术、MSP(甲基化专用聚合酶链式反应)方法分别检测转染前后细胞株中的mdr1 mRNA的表达差异和转录区域结合位点甲基化变化.结果 成功构建并转染MBDI siRNAs至人原位胰腺腺癌细胞BxPC-3(BxPC-3)细胞中,证实MBDI mRNA水平明显下调(下调幅度为93.19%).MBD1下调后,mdr1 DNA转录区域(-110GC和-50GC)甲基化分别上调(上调幅度分别为181.98%和409.57%);mdr1 mRNA表达明显下调(下调幅度为97.79%).结论 MBD1可通过对mdr1转录区域结合位点甲基化的影响,在转录水平间接调控胰腺癌mdr1基因表达.     

MBD1甲基化调控胰腺癌BxPC-3细胞株mdr1转录及其表达的研究

目的 观察MBD1通过对mdr1转录区域结合位点甲基化影响,在转录水平间接调控胰腺癌mdr1基因表达.方法 应用RNA干扰技术对人胰腺癌细胞株BxPC-3中MBD1基因进行抑制;应用定量荧光聚合酶链式反应(FQ-PCR)技术、MSP(甲基化专用聚合酶链式反应)方法分别检测转染前后细胞株中的mdr1 mRNA的表达差异和转录区域结合位点甲基化变化.结果 成功构建并转染MBDI siRNAs至人原位胰腺腺癌细胞BxPC-3(BxPC-3)细胞中,证实MBDI mRNA水平明显下调(下调幅度为93.19%).MBD1下调后,mdr1 DNA转录区域(-110GC和-50GC)甲基化分别上调(上调幅度分别为181.98%和409.57%);mdr1 mRNA表达明显下调(下调幅度为97.79%).结论 MBD1可通过对mdr1转录区域结合位点甲基化的影响,在转录水平间接调控胰腺癌mdr1基因表达.     

胰腺癌中p16基因甲基化改变及其蛋白表达分析

目的:探讨胰腺癌与癌旁组织中p16基因启动子区异常甲基化的改变及其蛋白表达的特点,以及其与胰腺癌发生发展的关系。方法:分别采用免疫组化SP法及甲基化特异PCR(MSP)检测46例人胰腺癌和癌旁组织中p16基因表达及其甲基化的水平,并结合临床资料进行分析。结果:胰腺癌中p16蛋白表达率为41.3%(19/46),而癌旁组织表达率为95.7%(44/46),两者有差异显著性(P<0.01)。p16蛋白阳性的19例胰腺癌标本中均未检出基因甲基化;p16蛋白缺失的27例标本中有18例检出基因甲基化,甲基化率为39.1%。p16基因甲基化与蛋白缺失有明显关系(P<0.05)。p16基因表达及其启动子区甲基化的发生率与胰腺癌的大小,患者性别﹑年龄的差异无显著意义(P>0.05),但与组织分化程度﹑淋巴结转移﹑PTNM分期有显著意义(P<0.05)。结论:p16基因启动子的异常甲基化可影响p16蛋白的表达,它们与胰腺癌的发生发展有关;p16甲基化和蛋白表达可能成为胰腺癌诊断及预后的候选标志物之一。     

胰腺癌中p16基因甲基化改变及其蛋白表达分析

目的研究p16基因启动子区异常甲基化改变和p16蛋白表达在胰腺癌与癌旁组织中的表达特点,探讨其与胰腺癌发生发展与临床的关系。方法分别以免疫组化法(SP法)及甲基化特异PCR(MSP)检测46例胰腺癌及其癌旁组织中p16基因表达及其甲基化的水平,并结合临床资料进行分析。结果胰腺癌中p16蛋白表达率为41.3%(19/46),而癌旁组织表达率为95.7%(44/46),两者相比差异有统计学意义(P<0.01)。p16蛋白阳性的19例胰腺癌标本,均未检出基因甲基化;p16蛋白缺失的27例标本,有18例检出基因甲基化,甲基化率为39.1%。基因甲基化与p16蛋白缺失明显相关(P<0.05),p16基因表达及p16基因启动子区甲基化的发生率与胰腺癌的大小、患者性别、年龄的差异无统计学意义(P>0.05),但在组织分化程度、有无淋巴结转移、PTNM分期上有统计学意义(P<0.05)。结论p16基因启动子异常甲基化改变可能影响p16蛋白的表达;p16甲基化、蛋白表达与胰腺癌的发生发展密切相关,p16甲基化和蛋白表达是胰腺癌患者诊断及预后的候选标志物之一。     

基于在线数据库分析E2F转录因子家族成员信使RNA在胰腺癌组织中表达水平及其在胰腺癌患者中的预后意义

目的:基于在线数据库分析阐明E2F转录因子家族成员mRNA在胰腺癌组织中的表达水平及其在胰腺癌患者中的预后意义。方法:利用基因表达谱交互式分析(GEPIA)在线分析数据库,采用Mann-Whitney U检验及Kaplan-Meier生存分析的统计学方法分别分析E2F转录因子家族成员mRNA在179例胰腺...     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.