唾液酸化路易斯-X抗原和CD44v6表达与胆管癌生物学行为的关系

目的　探讨唾液酸化路易斯 X(sialylLewis X ,SLeX)抗原和CD44v6表达与胆管癌生物学行为的关系。方法　用催化信号放大 (catalyzedsignalamplification ,CSA)免疫组化方法 ,检测 43例胆管癌组织及 10例慢性胆管炎组织中SLeX抗原和CD44v6蛋白的表达 ,分析SLeX和CD44v6蛋白的表达与胆管癌临床病理特征的关系。结果　在胆管癌组织中 ,SLeX和CD44v6表达阳性率分别为 67.4%和 62 .8% ,显著高于对照组的 2 0 .0 % (P<0 .0 5)。SLeX和CD44v6表达阳性率与胆管癌的TNM分期、分化程度、淋巴结和脏器转移密切相关 (P<0 .0 5)。SLeX表达与CD44v6表达呈正相关 (r =0 .49,P<0 .0 0 1)。结论　检测SLeX和CD44v6的基因表达可作为评估胆管癌生物学行为和预后的参考指标     

CD44v6在甲状腺癌组织中的表达及其意义

目的 探讨甲状腺癌组织中CD44v6抗原的表达及其临床意义。方法 应用微波－ISAB免疫组织学法，检测50例甲状腺癌、45例甲状腺瘤和20例癌旁状腺组织中CD44v6的表达。结果 甲状腺癌中CD44v6表达阳性率（64．0％）显著高于甲状腺腺瘤（37．0％）和癌旁甲状腺组织（25．．0％（均P＜0．05）。CD44v6表达与甲状腺癌组织类型无关；CD44v6表达阳性率在淋巴结转移者显著高于无淋巴结转移者（P＜0．05）；病理分期Ⅲ－Ⅳ期病例显著高于病理分期Ⅰ－Ⅱ期病例（P＜0．05）。CD44v6阳性的甲状腺癌复发及死亡率显著高于CD44v6阴性者（P＜0．05）。结论 CD44v66表达对甲状腺癌恶性程度判断、生物学行为预测和预后评估是一种有意义的客观指标。     

PCNA、CD44v6在原发性肝细胞癌的表达及临床意义

目的探讨PCNA、CD44v6在肝细胞癌(HCC)组织的表达及其临床病理意义.方法采用PCNA、CD44v6单克隆抗体,对83例HCC标本进行免疫组化染色.结果PCNA、CD44v6在HCC的阳性率分别为87.95%和53.01%.PCNA在EdmondsonⅠ、Ⅱ、Ⅲ、Ⅳ级的阳性率分别为01).CD44v6在转移组的高表达率为00%,有显著性差异(P＜0.42.86%、89.47%一92.86%、139.29%.明显高于无转移组(10.91%,P＜0.01).CD44v6在包膜完整组和不完整组的阳性率分别为35.42%和77.14%,有显著性差异(P＜0.01).CD44v6阳性病人的生存期明显短于CD44v6阴性病人(P＜0.05).PCNA和CD44v6在HCC的表达呈正相关.结论PCNA、CD44v6有望成为预测HCC发生、发展、转移、预后的生物学指标.     

Galectin-3和CD44v6的表达与前列腺癌转移及预后的关系

目的：探讨Galectin-3和CD44v6蛋白表达与前列腺癌（PCa）临床病理特征和预后的关系。方法：应用免疫组织化学技术检测45例PCa、25例PIN和20例BPH组织中Galectin-3和CD44v6蛋白表达,并结合肿瘤的病理学行为和临床随访资料进行分析。结果：在PCa组织中,Galectin-3和CD44v6阳性表达率分别为（82．2±59．5）％、（75．6±24．0）％,均显著高于PIN和BPH组织（P〈0．05）。Galeetin-3和CD44v6表达与肿瘤分化程度、周围淋巴结转移、远处转移、预后密切相关（P〈0．05）。Galectin-3和CD44v6蛋白表达呈显著正相关（r=0．412,P==0．005）。结论：Galectin-3和CD44v6蛋白表达与PCa发生、转移和患者生存期密切相关,联合检测可以对PCa的发生、发展、预后及药物治疗提供重要依据。     

胃癌PCNA和CD44V6表达的相互关系及其临床意义的研究

目的　研究增殖细胞核抗原 (PCNA)和CD44V6表达与胃癌侵袭转移及预后的关系 ,探讨胃癌组织PCNA和CD44V6表达的相互关系。方法　采用SP免疫组化染色方法 ,检测 90例胃癌组织PCNA和CD44V6的表达情况。结果　胃癌组织PCNA标记指数 (LI)为6 3 83 %± 17 16 % ,CD44V6阳性表达率为 74 4% (6 7 90 ) ;PCNALI和CD44V6表达强度与胃癌淋巴结转移、浸润深度及TNM分期均呈显著正相关 (P <0 .0 5 ) ;PCNALI≥ 5 0 %或CD44V6强阳性表达的胃癌患者术后 1,3 ,5年生存率均显著降低 (P <0 .0 5 ) ;CD44V6阳性表达胃癌组织的PCNALI显著高于CD44V6阴性表达者 (P <0 .0 5 )。结论　PCNA和CD44V6表达与胃癌侵袭转移及预后显著相关 ;CD44V6的表达可能有助于胃癌增殖活性的增加     

胃癌组织中CD44v6和CyclinD1蛋白的表达特点及意义

探讨胃癌组织中的白细胞分化抗原分化群44(CD44v6)、细胞周期蛋白D1(CyclinD1)的表达及其意义。选取河南省信阳市中心医院2016年1月—2018年3月获取的90例胃癌组织标本(胃癌组)、45例胃癌癌旁组织标本(癌旁组),采用免疫组织化学染色技术检测两组标本中的CD44v6蛋白、CyclinD1蛋白表达情况,并分析不同病灶直径、组织学分化程度、淋巴结转移情况、TNM分期胃癌组织中的CD44v6蛋白、CyclinD1蛋白阳性表达率差异。胃癌组的CD44v6蛋白、CyclinD1蛋白阳性表达率分别为67.78%、62.22%,均高于癌旁组的24.44%、17.78%,差异均有统计学意义(P0.05);在不同组织学分化程度、不同TNM分期、是否发生淋巴结转移的胃癌组织中的CD44v6蛋白阳性表达率差异均有统计学意义(P0.05);不同TNM分期、是否发生淋巴结转移的胃癌组织中的CyclinD1蛋白阳性表达率比较差异均有统计学意义(P0.05)。CD44v6、CyclinD1蛋白在胃癌组织中呈高表达,并且与胃癌的发生发展关系密切。     

胆囊癌中CD44v6和Ezrin的表达及临床意义

目的：检测胆囊癌和胆囊良性病变中Ezrin和CD44v6蛋白表达水平,探讨Ezrin和CD44v6蛋白表达与胆囊癌发生、发展的关系;并结合临床病理特点,研究Ezrin和CD44v6蛋白表达与胆囊癌侵袭转移等生物学行为的关系。方法：采用免疫组织化学法检测31例胆囊癌组织和10例慢性胆囊炎组织石蜡切片标本中Ezrin和CD44v6蛋白的表达水平,对Ezrin和CD44v6蛋白表达情况进行统计学分析,并对Ezrin和CD44v6蛋白的表达与胆管癌临床病理资料进行讨论。结果：1）CD44v6和Ezrin阳性表达率在胆囊癌组明显高于慢性胆囊炎组（P〈0.05）;2）CD44v6和Ezrin蛋白在胆囊癌中有淋巴结转移和无淋巴结转移2组间差异有统计学意义（P〈0.01）;3）在胆囊癌病理类型中Ezrin和CD44v6蛋白在高分化、中分化、低分化组中差异均无统计学意义（P〉0.05）;4）Ezrin和CD44v6蛋白在Nevin分期的Ⅰ＋Ⅱ、Ⅲ＋Ⅳ、Ⅴ组中的表达差异有统计学意义（P〈0.01）;5）Ezrin和CD44v6与肿瘤标志物CEA、CA199间有显著相关性（P〈0.01）;6）胆囊癌中Ezrin、CD44v6蛋白的表达与患者年龄、性别无关。7）CD44v6与Ezrin在胆囊癌中的表达无相关性（P〉0.05）。结论：1）胆囊癌组织中Ezrin与CD44v6蛋白表达水平显著高于慢性胆囊炎组织,说明二者与胆囊癌的发展有密切联系。2）Ezrin与CD44v6蛋白表达水平与胆囊癌的浸润转移有密切联系,可以作为反映胆囊癌浸润转移的生物学指标。3）Ezrin与CD44v6蛋白在胆囊癌中的表达无相关性。     

CD44v6与乳腺癌转移和预后的关系

目的　研究CD44v6表达与乳腺癌转移和预后的关系。　方法　用免疫组化方法对 78例乳腺癌石蜡标本及 37例乳腺癌新鲜标本的CD44v6蛋白的表达水平进行了检测 ;RT PCR方法对 37例乳腺癌新鲜标本的CD44v6mRNA表达水平进行了检测。并对患者CD44v6的表达水平、肿瘤大小、腋淋巴结转移状况、TNM分期、组织学分级与预后间的关系进行了分析 ,同时比较 2种方法的敏感性。　结果　乳腺癌患者的CD44v6表达水平与原发肿瘤大小、腋淋巴结转移状况、TNM分期明显相关 ,是影响患者术后 5年生存率的重要因素。乳腺癌新鲜标本中CD44v6mRNA和蛋白的阳性表达率分别是 70 3%和 5 9 5 % ,两者差异无显著性意义 (P >0 0 5 )。　结论　乳腺癌患者的CD44v6的表达水平与癌细胞的转移和患者的预后相关 ;免疫组化和RT -PCR 2种方法 ,在检测CD44v6的敏感性方面差异无显著性。     

CD44v6在食管癌中的表达及其临床意义

目的　为探讨食管癌手术标本中CD44v6的表达及其临床意义。方法　应用免疫组织化学strept avidin biotin complex法 ,检测食管癌手术标本中CD44v6的表达。 结果　CD44v6的表达的阳性率 :浸润于粘膜以及粘膜下层为 3 3 % ( 3 2 /4 7) ,浸润达肌层者为 2 5 % ( 6/2 4)。浸润达浆膜层者为 68% ( 3 2 /4 7) ;淋巴结转移阳性者阳性率为 72 % ( 3 4/4 7) ;临床病理分期第 1、2、3期阳性率分别为 2 2 % ( 2 /9) ,2 9% ( 7/2 4)和 68% ( 3 2 /4 7)。经统计学检验 ,差异有非常显著性 (P <0 .0 1) ,CD44v6在食管癌中的表达与癌组织的浸润深度、淋巴结转移程度及病理分期呈现明显负相关。结论　食管癌组织中 ,CD44v6的过度表达促进肿瘤的浸润和转移 ,检测癌组织中CD44v6的表达情况 ,有助于评估肿瘤的生物学行为 ,对患者的预后判断具有重要意义。     

结直肠癌组织中CD44v6和survivin的蛋白表达及意义

为探讨结直肠癌组织中CD44v6和survivin蛋白表达及其与临床病理参数的关系。笔者采用微波-LSAB免疫组化染色法检测60例结直肠癌组织中CD44v6和survivin的表达情况，并分析其与结直肠癌浸润转移的关系。结果示CD44v6阳性表达主要在细胞膜和细胞质，survivin主要在细胞质。60例结直肠癌CD44v6和survivin蛋白阳性表达率分别为71.7%和65.0%。它们与肿瘤临床Dukes分期、浸润程度、淋巴结转移及术后复发有关(P<0.05)。提示分别检测CD44v6和survivin蛋白表达，对了解结直肠癌的生物学行为和判断患者的预后有一定价值     

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.     

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.     

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.