端粒酶hTERT基因反义核酸对TNF-α诱导前列腺癌PC3细胞凋亡的影响

目的:探讨hTERT基因的两端部分硫代修饰反义寡核苷酸(AS PS-ODN)抑制前列腺癌细胞PC3端粒酶活性后,肿瘤坏死因子α(TNF-α)对PC3凋亡的增敏作用。方法:采用端粒重复序列扩增法及TRAP-PCR-ELISA法检测前列腺癌细胞的端粒酶活性;采用MTT比色试验观察hTERTAS PS-ODN与TNF-α共同作用对前列腺癌细胞PC3生长活力的影响;倒置显微镜观察凋亡细胞的形态变化;通过流式细胞仪测定凋亡细胞的百分率。结果:hTERTAS PS-ODN作用于PC3细胞48h,其端粒酶活性下降,作用72h,其端粒酶活性受到抑制,与正义寡核苷酸组及空白对照组相比差异有显著性(P<0.05)。hTERTAS PS-ODN作用于PC3细胞后加入TNF-α作用48h,PC3细胞的抑制率与对照组、S PS-ODN组、AS PS-ODN组、TNF-α组及S PS-ODN+TNF-α组相比有统计学差异(P<0.01)。hTERTAS PS-ODN作用于PC3细胞后加入TNF-α作用48h,细胞出现典型的凋亡形态变化。hTERT ASPS-ODN作用于PC3细胞后加入4μg/ml TNF-α作用48h,凋亡细胞的百分率分别与对照组、S PS-ODN组、AS PS-ODN组、TNF-α组及S PS-ODN+TNF-α组相比差异有显著性(P<0.05)。结论:hTERTAS PS-ODN能降低前列腺癌细胞PC3端粒酶活性;hTERT基因反义核酸对TNF-α诱导前列腺癌细胞PC3凋亡有增敏作用。     

端粒酶hTERT反义核酸对TFOF诱导的氟他胺耐受型前列腺癌细胞LNCaP-flu凋亡影响机制研究

目的探讨hTERT基因全硫代修饰反义寡核苷酸(AS PS-ODN)抑制氟他胺耐受型前列腺癌细胞LNCaP-flu端粒酶活性后,藏药镰状棘豆总黄体酮(TFOF)对LNCaP-flu细胞凋亡的影响。方法采用TRAP-PCRELISA法检测氟他胺耐受型前列腺癌细胞LNCaP-flu端粒酶活性;采用台盼蓝观察hTERT AS PS-ODN与TFOF共同作用对氟他胺耐受型前列腺癌细胞LNCaP-flu生长活力的影响;通过双标流式细胞仪测定凋亡细胞的百分率。结果hTERTAS PS-ODN作用于LNCaP-flu细胞48h,端粒酶活性明显下降;hTERTAS PS-ODN作用于LNCaP-flu细胞后加入TFOF 0.1g/L作用48h,LNCaP-flu细胞的抑制率与对照组、S PS-ODN组、AS PS-ODN组、TFOF组及S PS-ODN+TFOF组相比有统计学差异(P0.01)。hTERTAS PS-ODN作用于LNCaP-flu细胞后加入0.1g/L TFOF作用48h,凋亡细胞的百分率分别与对照组、S PS-ODN组、AS PS-ODN组、TFOF组及S PS-ODN+TFOF组相比有显著性差异(P0.05)。结论hTER7基因反义核酸对TFOF诱导的氟他胺耐受型前列腺癌细胞LNCaP-flu凋亡有增敏作用。     

膀胱肿瘤端粒酶活性及细胞凋亡的研究

目的　探讨端粒酶活性及细胞凋亡与膀胱癌临床生物学行为及预后的关系。　方法　分别采用端粒酶活性试剂盒和末端脱氧核苷酸转移酶介导缺口末端标记 (TUNEL)法对 5 6例膀胱癌标本进行端粒酶活性和细胞凋亡的检测 ,并结合临床资料进行分析。　结果　 5 6例膀胱癌标本端粒酶活性阳性率为 89 3 % (5 0 / 5 6 ) ,细胞凋亡指数为 (4 5 2± 14 4) % ;端粒酶活性强度及细胞凋亡指数与年龄、性别、肿瘤大小、数目等无关 (P >0 0 5 ) ;与肿瘤分级、分期及预后有关 (P <0 0 1) ,即端粒酶活性越高或 (和 )细胞凋亡越少 ,则肿瘤“瘤级”、“瘤期”高者预后较差。端粒酶活性强度与细胞凋亡指数呈明显的负相关 (r=- 0 6 9,P <0 0 1)。　结论　膀胱癌端粒酶活性及细胞凋亡与肿瘤分级、分期及预后有关 ,端粒酶活性及细胞凋亡的检测有助于膀胱癌的临床分析及预后的评估     

端粒酶反义寡核苷酸对乳腺癌端粒酶活性及细胞生长的影响

目的　探讨端粒酶反义寡核苷酸对人乳腺癌细胞端粒酶活性的影响及抑制端粒酶活性以控制乳腺癌细胞生长的可能性。方法　采用 10 μmol/L与端粒酶催化亚基 (hTRT )mRNA互补的反义寡核苷酸处理乳腺癌细胞 ;于处理后 2 4、72h用端粒重复序列扩增及酶联免疫吸附方法检测细胞端粒酶活性 ;于处理后 72h以流式细胞术测定细胞周期 ;于处理后 12 0h采用原位末端标记法检测细胞凋亡。结果　经hTRT反义寡核苷酸作用后 ,细胞端粒酶活性明显受到抑制 ,至作用后 72h ,端粒酶活性较对照组降低 65 .6% (P <0 .0 5 ) ;细胞生长明显受到抑制 ;细胞周期发生显著变化 :G0 /G1期细胞数增多 ,S期及G2 /M期细胞数则减少 ;细胞增殖指数由 0 .46降低至 0 .2 5 ;并可观察到凋亡细胞的出现 ,凋亡发生率为 12 .5 % ;而无义组及空白对照组以上各指标均无明显变化 (P >0 .0 5 )。结论　端粒酶反义寡核苷酸可明显抑制乳腺癌细胞端粒酶活性 ,抑制细胞生长和增殖 ,诱导细胞凋亡 ;表明应用反义技术抑制端粒酶活性治疗乳腺癌具有广阔的前景。     

反义寡核苷酸对胆囊癌细胞端粒酶活性作用的实验研究

目的：探讨反义寡核苷酸对胆囊癌细咆端粒酶活性的影响及对胆囊癌细咆生长增殖的作用。方法：设计针对端粒酶RNA亚基模板序列并经硫代磷酸修饰的反义、正义和随机序列寡核苷酸，并以正常人成纤维细胞作对照，观察其对人胆囊癌细胞（GBC—SD）端粒酶活性和细胞生长增殖的影响作用以及对正常人成纤维细胞的作用。结果：反义寡核苷酸可有效地抑制胆囊癌细胞的端粒酶活性，呈剂量依赖性，并明显的抑制胆囊癌细胞的生长，对正常人成纤维细胞生长无明显作用。结论：硫代反义寡核苷酸（PS-ODN）对胆囊癌端粒酶活性有明显的抑制用并促进细胞凋亡。     

小RNA干扰对氟他胺耐受性前列腺癌细胞LNCaP端粒酶活性的影响机制研究

目的探讨hTERT基因的两端各三个碱基硫代修饰反义寡核苷酸(AS PS-ODN)对氟他胺耐受性前列腺癌细胞LNCaP端粒酶活性的影响机制。方法采用TRAP-PCR-ELISA法检测氟他胺耐受性前列腺癌细胞的端粒酶活性;采用RT-PCR方法检测hTERT基因mRNA的表达水平;以免疫组化通过流式细胞仪检测hTERT基因蛋白水平的变化。结果 hTERT基因的两端各三个碱基硫代修饰反义寡核苷酸(AS PS-ODN)作用于LNCaP细胞48h,其端粒酶活性下降,作用72h,其端粒酶活性受到抑制。结论通过hTERT基因的两端各三个碱基硫代修饰反义寡核苷酸(AS PS-ODN)特异性抑制hTERT基因mRNA的表达降低氟他胺耐受性前列腺癌细胞LNCaP端粒酶活性,为氟他胺耐受性前列腺肿瘤的基因治疗提供新思路。     

端粒酶抑制剂与阿霉素联合应用治疗小鼠膀胱癌

目的 观察端粒酶抑制剂与化疗药物阿霉素联用抑制小鼠膀胱癌的协同作用.方法 AZT(端粒酶抑制剂齐夫多啶)4.5 mg、阿霉素0.1 mg、AZT 4.5 mg+阿霉素0.1 mg分组治疗T24膀胱癌荷瘤小鼠,观察肿瘤生长、细胞凋亡情况.结果 治疗后15 d,AZT、阿霉素、AZT+阿霉素各治疗组抑瘤率分别为35.6%、18.5%和43.2%.TUNEL法检测各组肿瘤细胞凋亡指数为(18.16±0.78)、(9.23±0.22)和(25.15±1.65).肿瘤端粒酶活性检测示各组端粒酶阳性率分别为24.5%、47.2%和12.3%,AZT、阿霉素均有减少肿瘤端粒酶活性的作用,且联用效果明显优于两者单独应用(P＜0.05).结论 AZT及阿霉素均能抑制小鼠膀胱癌T24细胞的生长及降低其端粒酶活性、诱导细胞凋亡,两者联用有相加作用.     

端粒酶反义RNA基因转染抑制裸鼠人膀胱癌移植瘤生长的研究

目的　观察端粒酶反义RNA基因转染对裸鼠膀胱癌移植瘤细胞生长的影响。方法将脂质体介导的端粒酶反义RNA真核表达载体 (pBBS hTR)、空载体 ( pBBS 2 12 )及生理盐水注入移植瘤体内 (每天 3 0 0 μl,共 7d) ,应用端粒酶活性聚合酶链反应 酶联免疫吸附试验 (PCR ELISA)、苏木素 伊红 (HE)染色、透射电镜等连续观察 6周移植瘤组织细胞端粒酶活性和生长变化。结果　注射转染pBBS hTR组和空载体组瘤体积抑制率分别为 48.7%和 2 .8% (P <0 .0 5 )。转染pBBS hTR组端粒酶活性降低 ,细胞生长受抑制。电镜观察见典型凋亡特征。 结论　端粒酶反义RNA基因瘤体内注射转染有效地抑制裸鼠人膀胱癌细胞生长 ,具有潜在临床应用价值。     

脂质体介导的端粒酶反义寡核苷酸体外转染率及对人膀胱癌EJ细胞的影响

目的通过以脂质体为载体介导端粒酶反义寡核苷酸(antisense oligodeoxynucleotide,asODN)转染人膀胱癌EJ细胞,促进反义寡核苷酸对膀胱癌EJ细胞的生长抑制。方法利用脂质体为载体将针对端粒酶RNA模板区的asODN转染膀胱癌EJ细胞;荧光显微镜观察细胞转染率;PCR-ELISA法测定端粒酶活性;MTT法检测反义寡核苷酸对膀胱癌细胞的抑制。结果脂质体介导的asODN在膀胱癌EJ细胞中的转染率1/2h、4h、8h分别为15%、56%、80%,并且细胞的端粒酶活性和细胞生长明显被抑制,与对照组比较,具有显著性差异(p(0.05)。结论脂质体介导的端粒酶asODN能够有效抑制膀胱癌EJ细胞端粒酶活性和生长,可应用于实验性肿瘤基因治疗研究和端粒酶与膀胱癌关系的进一步研究。     

冬凌草甲素对膀胱癌EJ细胞的生长抑制作用及机制

目的研究冬凌草甲素（ORI）对膀胱癌EJ细胞株的抑制作用及机制。方法 MTT法检测ORI对EJ细胞的生长抑制作用;电子显微镜和Hoechst 33258染色法观察细胞的形态学变化;Western blot检测Bcl-2和Bax表达的变化。TRAP-PCR-银染法检测端粒酶活性的变化。结果 ORI对EJ细胞有明显的生长抑制作用,呈明显的时间-效应关系和浓度-效应关系。随着ORI作用时间延长,Bcl-2的表达逐渐减弱,Bax的表达逐渐增强。EJ细胞的端粒酶活性随着ORI作用时间的延长而逐渐降低。结论 ORI对膀胱癌EJ细胞有明显的生长抑制作用;机制可能是通过下调Bcl-2/Bax和通过抑制端粒酶活性诱发EJ细胞凋亡的。     

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.     

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.