中期因子转录物及其蛋白在肝细胞癌中的定位与表达研究

目的了解中期因子 (Midkine,MK)转录物及其蛋白产物在肝细胞癌 (hepatocellularcarci noma ,HCC)中的定位情况与表达特点。方法应用原位杂交、免疫组织化学染色等方法对 33例人HCC组织、10例良性肝肿瘤组织及其配对瘤旁肝组织进行了MKmRNA及蛋白的定位与表达研究。结果免疫组织化学结果与原位杂交结果具有一致性 (χ2 =0 5 0 0 ,P >0 0 5 )。MK在HCC组织中呈高表达。MKmRNA及蛋白的阳性信号聚集于HCC细胞质。在HCC细胞外组织中亦有MK表达 ,尤以血管密集处明显。HCCMK表达率与肝癌组织学类型、分级等临床病理学特点无相关性。结论HCC在mRNA和蛋白水平上表达MK增加 ,并可能与促进HCC血管生成有关     

金属硫蛋白在肝细胞癌中表达的临床意义

目的 探讨金属硫蛋白（metallothionein,MT)在肝细胞癌（hepatocellular carcinoma,HCC)组织中、癌旁组织和正常肝组织中的表达及其临床意义。方法 对30例HCC病人的癌组织、10例癌旁组织和10例正常肝组织标本进行免疫组化染色，观察MT的表达状况，分析MT在HCC中的表达与癌旁组织、正常肝组织、细胞分化和预后等的关系。结果 正常肝组织有很强而稳定的MT染色；癌旁组织（包括肝硬化结节）有较高的MT着色；癌组织中MT染色很弱，甚至无MT染色。相互比较有显著性差异（P＜0．05）。MT在肝细胞癌组织中的表达与生存率之间存在着正相关关系（P＜0．05）。结论 MT在正常肝组织、癌旁组织和肝细胞癌组织中的表达呈递减趋势，肝细胞癌组织中MT表达与癌细胞分化无关，而与瘤体组织坏死及肝切除术后病人生存状况相关。     

肿瘤-睾丸抗原SSX1基因mRNA在肝细胞肝癌中的表达

目的：检测肿瘤－睾丸抗原SSX1基因mRNA在肝细胞肝癌（HCC）中的表达情况。方法：用逆转录－聚合酶链反应（RT－PCR）对47例HCC患者的癌组织和相应癌旁组织以及15例肝硬化和15例正常肝组织的SSX1基因mRNA表达情况进行检测，随机选择4例RT－PCR扩增产物的目的片段进行DNA序列测定。结果：47例HCC患者中，39例表达SSX1 mRNA，阳性率为83％，相应的癌旁组织中有3例为弱阳性，其中2例患者获得了离癌灶更远处的活检组织，对其进行RT－PCR检测，结果显示阴性；所测的15例肝化和15例正常肝组织均未检测到SSX1的表达。4例DNA测序结果表明RT－PCR产物确为SSX1 cDNA。SSX1的表达与年龄、性别、肿瘤大小、分化程度、血清甲胎蛋白（AFP）水平、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染无显著相关性（P＞0．05）。结论：SSX1在HCC中呈高比例、高特异表达，可望成为HCC免疫治疗的理想靶位。     

肝细胞癌中SFRP1和APC基因启动子甲基化与其mRNA的表达

目的探讨肝细胞癌（HCC）中SFRP1和APC基因启动子甲基化状态及其mRNA表达的关系。方法应用甲基化特异性聚合酶链反应（MSP）和逆转录-聚合酶链反应（RT—PCR）技术，检测30例肝细胞癌（HCC组）及相应的癌旁组织（癌旁组）和10例正常肝组织（正常对照组）中SFRP1及APC基因启动子甲基化状态和mRNA的表达水平，分析甲基化与某些临床参数与mRNA表达的关系。结果HCC组、癌旁组及正常对照组中的SFRP1和APC基因启动子甲基化率分别是11／30，4／30，0／10和14／30，5／30，0／10；HCC组明显高于其余两组（P〈0．05）。SFRP1基因启动子甲基化与临床资料无关（P〉0．05）；APC基因启动子甲基化与年龄（〈60）岁和癌肿无假包膜有关（P〈0．05）。HCC组SFRP1基因mRNA表达明显低于其余两组（P〈0．05），各组APC基因mRNA表达差异无显著性。两基因甲基化之间无相关性。结论SFRP1和APC基因启动子甲基化与HCC的形成和进展有关，但HCC组织中基因甲基化与mRNA表达的关系尚不明确。     

Heparanase-1和Syndecan-1与肝细胞癌侵袭转移的关系

目的探讨heparanase-1（HPR-1）和syndecan-1在孤立性大肝癌、结节性肝癌和小肝癌中的表达及其临床意义。方法选用30例肝细胞癌（HCC）癌组织和癌旁组织标本，用逆转录聚合酶链反应（RT-PCR）检测标本中的HPR1和Syndecan-1的表达，并结合临床病理资料进行分析。结果HPR-1 mRNA在HCC中的表达较癌旁肝组织高，差异有显著性意义（P=0．037）；Syndecawl在HCC中的表达较癌旁组织低，差异有显著性意义（P=0．007）。本研究显示HPR-1的高表达和Syndecanl的低表达同有无包膜、静脉浸润密切相关，而同性别、细胞分化程度、肝硬化程度无关。将30例HCC分为孤立性大肝癌组，结节性肝癌组和小肝癌组分析发现：孤立性大肝癌组同结节性肝癌组HPR-1mRNA的表达有着显著性差异（P〈0．05）。结论HPR1基因和Syndecan-1基因与HCC的发生发展和侵袭转移密切相关；孤立性大肝癌较结节性肝癌具有较好的生物学行为。     

肝癌及癌旁组织中β-葡萄糖醛酸酶蛋白及mRNA的表达及意义

目的探讨肝细胞癌及癌旁组织中β-葡萄糖醛酸酶（β-G）蛋白及β-G mRNA的表达和临床意义。方法采用逆转录-聚合酶链反应（RT-PCR）方法和免疫组织化学方法，对25例原发性肝细胞癌及其癌旁组织和10例正常肝脏组织进行检测，并分析其与临床病理特点之间的关系。结果半定量分析显示β-G mRNA的表达在肝脏癌组织（3．71±0．32）与癌旁肝组织（1.83±0.22）以及正常肝脏组织（1．71±0．32）间差异比较，均有统计学意义（均为P〈0．01），而癌旁肝组织和正常肝组织间比较，差异无统计学意义（P〉0．05）；从正常肝组织、癌旁组织到肝癌组织β-G蛋白的阳性细胞表达率分别为（48．2％±5．5％）、（56．8％±6．2％）和（83．8％±9．1％），呈递增趋势（χ^2=42．33，P〈0．01）；β-G蛋白的表达与肝癌病人的门脉癌栓以及淋巴结转移等临床因素有关（P〈0．01），而与肿瘤大小、AFP水平无关。结论β-G与肝细胞的癌变过程密切相关，可能在肝癌的侵袭和转移过程中也起一定的作用。     

SOCS1与c-myc在人肝细胞癌组织中的表达及相互关系

目的：研究细胞因子信号转导抑制因子1（SOCS1）和原癌基因c-myc在肝细胞癌（HCC）组织中的表达及二者在HCC中的相互作用。方法：应用免疫组织化学技术检测SOCS1蛋白和c-myc蛋白在41例HCC癌组织、癌旁组织和11例正常肝组织中的表达;采用RT-PCR技术检测上述组织中SOCS1mRNA的表达水平;分析临床、病理资料。结果：HCC癌组织中SOCS1蛋白阳性率和SOCS1mRNA的表达水平明显低于癌旁组织和正常肝组织（P〈0.01）,SOCS1蛋白在低分化HCC癌组织中的阳性率较高分化HCC癌组织明显减低（P〈0.01）。HCC转移组SOCS1蛋白表达阳性率较未转移组低（P〈0.05）。HCC癌组织中c-myc蛋白明显高于癌旁组织和正常肝组织;在HCC癌组织中SOCS1蛋白表达强度与c-myc蛋白表达强度呈负相关（P〈0.01）。结论：SOCS1在HCC癌组织中表达下调,可能通过一系列途径造成c-myc的激活,从而造成肿瘤的发生。     

原发性肝癌癌旁组织生长激素受体的基因研究

目的探讨原发性肝癌癌旁组织生长激素受体（GHR）的基因表达情况或变化。方法采用放射配体法、半定量的逆转录-多聚酶链式反应（RT—PCR）对45例原发性肝癌（HCC）的癌旁组织进行了生长激素受体（GHR）的检测,以8例正常肝组织作为对照,并随机选择12例RT—PCR阳性扩增产物直接进行DNA序列测定。结果在蛋白表达水平,应用放射性配体法于正常肝组织与45例HCC癌旁组织中检测到单一的GH特异性结合位点（即GHR）。对照组肝组织GHR的RT值为40．2932±3。5667．fmol／mg;protein,Kd为0．6167±0．1007nmol／L。HCC癌旁组织GHR的RT为33．6283±3．6218fmol／mg。protein,Kd值为0．6319±0．1978nmol／L,与正常肝组织相比,HCC癌旁GHR的RT降低（P〈0．05）．而Kd无显著性改变（P〉0．05）。半定量的RT—PCR法发现GHRmRNA在正常肝组织与HCC癌旁组织的表达率均为100％。GHRmRNA在正常肝组织与原发性肝癌癌旁组织的表达两者之间差异无显著性（P〉0．05）。结论全部肝癌癌旁组织在蛋白与mRNA水平均表达GHR,在其受体功能未明的情况下,目前rhGH在肝癌患者中的使用应慎重,以免造成肿瘤的增殖与复发。     

人肝细胞性肝癌性激素受体的表达

目的：研究人肝细胞性肝癌组织、癌旁组织和正常肝组织中雄激素受体（AR）和雌激素受体（ER）的表达水平及分布规律。方法：应用单克隆抗体免疫组化法检测50例肝细胞性肝癌标本的肿瘤组织、癌旁组织和10例肝内胆管结石的肝组织中AR和ER的表达情况。结果：在肝癌组织、癌旁组织和肝内胆管结石的肝组织中，AR的阳性表达率分别为30％、8％和0％，除癌组织显著高于癌旁组织外（P＜0．01），其它各组无显著性差异（P＞0．05）；ER的阳性表达率分别为12％、10％和20％，在三组中均无显著性差异（P＞0．05），在所有阳性片中，AR和ER的标记指数（LI）均＜25。结论：AR和ER在肝细胞性肝癌组织中的表达率很低。     

NF-кB与P-gp在肝细胞肝癌组织中的表达

目的探讨核转录因子（NF-κB）与P糖蛋白（P-gp）在肝细胞肝癌（HCC）及癌旁肝组织的表达及其相互关系。方法采用免疫组织化学S-P法检测30例HCC中NF-κB、P-gp的表达情况，以30例相应癌旁肝组织作为对照组，所得结果用统计学卡方检验及列联表等相关分析进行比较。结果NF-κB蛋白在HCC、癌旁肝组织中阳性表达率分别为63．3％（19／30）、16．7％（5／30），HCC与癌旁肝组织中NF-κB蛋白表达差异有显著性（P〈0.05）；P-gp蛋白在HCC、癌旁肝组织中阳性表达率分别为83．3oA（25／30）、30％（9／30），HCC与癌旁肝组织表达差异有显著性（P〈0.05）。NF-κB蛋白的表达与P-gp蛋白的表达呈正相关（r=0.89，P〈0.05）。结论NF-κB和P-gp在HCC中的表达提示其可能参加了HCC和多药耐药的发生。NF-κB与P-gp在HCC表达中呈正相关，提示NF-κB与P-gp可能介导的多药耐药，共同参与了HCC多药耐药机制。     

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.     

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.     

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.