DNA甲基转移酶1对胆管癌细胞中端粒酶的调控作用

目的 观察丙型肝炎病毒核心蛋白(HCVc)阳性肝内胆管癌细胞中人端粒酶逆转录酶(hTERT)的表达,并探讨DNA甲基转移酶1(DNMT1)对hTERT表达的影响.方法 将HCVc质粒瞬转入肝内胆管癌细胞株RBE,5-氮杂-2'-脱氧胞嘧啶核苷(AZA)处理转染后细胞;Western blot 法及逆转录-聚合酶链反应(RT-PCR)检测细胞中hTERT及DNMT1的mRNA及蛋白表达.结果 比较空白对照组,转染HCVc质粒后,RBE细胞株中hTERT及DNMT1的mRNA、蛋白水平分别上调3.457±0.081、1.684±0.020、1.826 ±0.060、2.513±0.119(P＜0.05);AZA处理转染后细胞可逆转hTERT的升高,mRNA和蛋白水平分别下调2.755±0.098、1.491±0.045(P ＜0.05).结论 DNMT1参与HCVc诱导的hTERT表达上调过程.     

组蛋白去乙酰化酶抑制剂对胆囊癌细胞系和肝外胆管癌细胞系HDAC1表达的影响

目的 观察组蛋白去乙酰化酶抑制剂-曲古抑菌素(TSA)在体外和体内对胆囊癌细胞和肝外胆管癌细胞HDAC1表达的影响.方法 用TSA作用于胆囊癌细胞系(Mz-ChA-1)和肝外胆管癌细胞系(QBC939、KMBC、OZ),然后用逆转录-聚合酶链反应(RT-PCR)检测HDAC1之mR-NA的表达变化,用Western blot检测其蛋白的表达变化.将这些细胞接种在裸鼠皮下建立胆囊癌和肝外胆管癌裸鼠种植瘤模型,用免疫组织化学方法 观察TSA在体内对裸鼠种植瘤组织中HDAC1蛋白表达的影响.结果 TSA可以减弱胆囊癌细胞系(Mz-ChA-1)和肝外胆管癌细胞系(QBC939、KMBC、OZ)HDAC1 mRNA和蛋白的表达;TSA作用前后的胆囊癌细胞系(Mz-ChA-1)和肝外胆管癌细胞系(KMBC)裸鼠成瘤组织中的各种蛋白的表达均无变化.结论 TSA在体外可以抑制胆囊癌和肝外胆管癌HDAC1的表达;TSA抑制HDAC1表达的作用可能受到体内环境的影响而消失.     

TSA对人肝癌细胞株E-cadherin启动子区甲基化及表达的影响

目的 探讨去乙酰化转移酶抑制剂TSA对人肝癌SMMC-7721细胞株E-cadherin基因(E-cad)启动子区甲基化及其表达的影响.方法 TSA(300 nm/L)处理人肝癌SMMC-7721细胞,MTT法、TUNEL染色法分别检测细胞生长抑制及凋亡情况,甲基化特异性的PCR(methylation-specificPCR,MSP)检测处理前后E-cad启动子区CpG岛甲基化状态;Western blot检测处理前后E-cad及DNMT3b表达水平的变化.结果 TSA能抑制人肝癌SMMC-7721细胞生长并诱导其发生凋亡,与对照组相比,实验组细胞生长抑制率为21.85%,对照组细胞凋亡率为(4.69±0.56)%,实验组凋亡率为(14.94±0.91)%,与对照组相比,凋亡细胞明显增多(P=0.000).用药前E-cad启动子区CpG岛为甲基化状态,E-cad蛋白表达阴性.TSA处理后E-cad启动子区CpG岛发牛脱甲基化,E-cad蛋白恢复表达.TSA亦导致DNMT3b的表达水平降低. 结论去乙酰化转移酶抑制剂TSA能抑制人肝癌SMMC-7721细胞生长,并可诱导其发生凋亡,逆转E-cad基因启动子区的甲基化状态,并恢复该基因表达.TSA有可能通过DNMT3b发挥脱甲基化作用.     

组蛋白去乙酰化酶抑制剂蛋白去乙酰化酶抑制剂对原发性肝癌细胞增殖的影响

目的 观察组蛋白去乙酰化酶(HDAC)抑制剂蛋白去乙酰化酶抑制剂(TSA)对原发性肝癌细胞增殖的影响.方法 噻唑蓝(MTT)法检测不同浓度(30、150、1000μg/L)TSA对原发性肝癌细胞生长的影响.结果 TSA浓度为30μg/L时,实验组与对照组细胞的吸光度值差异无统计学意义(P>0.05),说明TSA(30μg/L)对细胞的增殖基本无影响;当TSA浓度达到1000μg/L时,实验组细胞大量崩解、坯死,对细胞产生了严重的毒性作用;当TSA浓度为150μg/L时,实验组细胞无崩解、坏死现象,其36h和48h细胞的吸光度值低于对照组,差异有统计学意义(P<0.05).结论 HDAC抑制剂TSA对体外培养的原发性肝癌细胞的增殖生长具有抑制作用,并且这种抑制作用呈现一定剂量依赖性和时间依赖性.     

曲古菌素A对肾癌细胞增殖及对去乙酰化酶1、金属蛋白酶9表达的影响

目的 观察曲古菌素A(TSA)对肾癌细胞7860增殖抑制作用及对组蛋白去乙酰化酶1(HDAC1)、基质金属蛋白酶9(MMP9)表达的影响.方法 噻唑蓝(MTT)比色法测定不同浓度(100、200、400、800nmol/L)、不同时间(12、24、36、48 h)TSA作用后7860细胞的抑制率.吖啶橙/溴乙锭(AO/EB)双重染色检测细胞凋亡.逆转录-聚合酶链反应(RT-PCR)及Western blot检测HDAC1、MMP9的表达.结果 不同浓度TSA作用24h后,细胞生长抑制率分别为32%、45%、58%、62%.TSA作用后部分细胞发生凋亡形态改变.HDAC1、MMP9基因在TSA作用后mRNA表达降低(P<0.01).与空白组、阴性组比较,HDAC1蛋白在TSA作用后表达分别下调18.6%～87.5%(P<0.01)、21.3%～91.4%(P<0.01),MMP9蛋白表达分别下调24.6%～95.7%(P<0.01)、20.8%～89.2%(P<0.01).结论 TSA可抑制肾癌细胞增殖,并可能通过下调HDAC1、MMP9的表达抑制细胞的增殖.     

曲古抑菌素A诱导膀胱癌细胞p27kip1、XIAP表达的实验研究

目的 观察组蛋白去乙酰化酶(HDAC)抑制剂曲古抑菌素A(TSA)对体外培养膀胱癌细胞生长情况及相关基因(p27kip1、XIAP)表达的影响,并探讨其可能的作用机制.方法 采用MTT法检测不同浓度TSA(100、200、400、800nmol/L)对人膀胱癌BIU-87细胞生长的影响;流式细胞术(FCM)检测TSA处理后膀胱癌细胞周期分布的变化及对膀胱癌细胞凋亡的影响;Western blot检测TSA作用BIU-87细胞后p27kip1、XIAP蛋白表达的变化.结果 TSA体外能明显抑制BIU-87细胞的生长,且抑制作用呈明显的剂量、时间依赖性.FCM检测示处理后膀胱癌细胞阻滞于G0-G1期,Western blot结果示TSA处理能显著诱导p27kip1蛋白的表达和显著抑制XIAP蛋白的表达.结论 TSA可通过诱导细胞凋亡,使细胞阻滞于G1期而发挥体外抗膀胱癌作用,其作用机制可能涉及相关基因(p27kip1、XIAP)表达的调控.     

黄精多糖对TNF-α作用的大鼠成骨细胞增殖、凋亡影响及其机制研究

目的探讨黄精多糖(polygonatum sibiricum polysaccharide,PSP)对肿瘤坏死因子-α(TNF-α)作用的大鼠成骨细胞增殖、凋亡影响及其可能作用的机制。方法采用MTT法检测不同浓度的PSP对TNF-α诱导的成骨细胞增殖能力的影响,筛选出PSP的适宜浓度;通过流式细胞术检测PSP对TNF-α诱导的成骨细胞凋亡能力的影响。采用实时荧光定量PCR(qRT-PCR)检测PSP对TNF-α作用的成骨细胞中miR-212表达的影响;运用蛋白印迹法(Western blot)检测成骨细胞中Cyclin D1、Bc L-2、Bax、P21的蛋白表达水平。结果 TNF-α可抑制成骨细胞增殖,促进P21蛋白表达,而抑制Cyclin D1蛋白表达。PSP不同剂量组可明显促进成骨细胞增殖,令Cyclin D1蛋白表达上调,而P21蛋白表达下调; TNF-α可促进成骨细胞凋亡,上调Bax表达,而降低Bc L-2、miR-212表达,PSP可提高miR-212的表达水平,上调miR-212表达可显著逆转TNF-α对成骨细胞的作用;抑制miR-212表达可明显逆转PSP对TNF-α诱导的成骨细胞增殖及凋亡的作用。结论黄精多糖可通过上调miR-212表达,进而促进成骨细胞增殖及抑制细胞凋亡。     

5-氮杂脱氧胞苷与曲古抑菌素A对膀胱癌细胞株ALDH1a2基因表达及凋亡的影响

目的 探讨5-氮杂脱氧胞苷(5-Aza-dC)与曲古抑菌素A(TSA)对膀胱癌细胞中抑癌基因ALDH1a2启动子甲基化状态和基因表达及细胞凋亡的影响.方法 使用5-Aza-dC、TSA处理RT-4、253J、5637、BIU-87和T24后,应用甲基化特异性PCR(MSP)法、逆转录PCR(RT-PCR)法、Western blot法分别检测这5株膀胱癌细胞经药物干预前后ALDH1a2甲基化状态及基因表达情况,应用流式细胞学检测干预前后5株膀胱癌细胞株的凋亡情况.结果 在5株膀胱癌细胞中,ALDH1a2基因表现为高甲基化表达受到抑制,TSA不影响甲基化状态,5-Aza-dC可逆转高甲基化状态并恢复基因表达,联合给予5-Aza-dC和TSA的作用和单独给予5-Aza-dC相似;TSA和5-Aza-dC均可诱导膀胱癌细胞株凋亡,早期凋亡是膀胱癌细胞株死亡的主要方式,5-Aza-dC和TSA有协同作用,3个实验组与对照组比较,差异均有统计学意义(P<0.05).结论 在5株膀胱癌细胞株中,ALDH1a2基因启动子甲基化可能是导致其基因失活的主要原因;5-Aza-dC单独作用和5-Aza-dC及TSA联合应用效果相似,均能恢复基因重新表达进而诱导膀胱癌细胞株的早期凋亡.     

组蛋白去乙酰化酶抑制剂对人骨肉瘤细胞抑制增殖和诱导分化的研究

[目的]观察组蛋白去乙酰化酶抑制剂曲古抑菌素A(TSA)对人骨肉瘤MG-63细胞增殖和分化的影响.[方法]不同浓度的TSA作用MG-63细胞,采用噻唑蓝(MTT)法、倒置相差显微镜观察药物对细胞生长的影响并绘制细胞生长曲线;软琼脂集落形成实验观察细胞生长和侵袭能力的变化;流式细胞仪测定细胞周期变化.[结果]TSA可明显抑制MG-63细胞增殖,并呈现剂量和时间的依赖性;细胞形态呈明显的良性分化;瘤细胞的软琼脂集落形成率明显降低;TSA能够延缓细胞周期G1-S进程,阻滞细胞于G1期,停留在G2/M期.[结论]TSA对MG-63细胞有明显的抑制增殖和诱导分化作用.     

格尔德霉素对肿瘤坏死因子诱导的PC-3M细胞中c-FLIP表达上调的影响

目的:探讨热休克蛋白90抑制剂格尔德霉素(Geldanamycin,GA)对TNF-α诱导的前列腺肿瘤细胞PC-3M中白介素-1β转换酶抑制蛋白(c-FLIP)上调的影响及意义。方法:分别用TNF-α和GA TNF-α处理PC-3M细胞,用免疫细胞化学法测c-FLIP蛋白水平表达差异,采用RT-PCR测c-FLIP mRNA水平的表达差异。结果:使用TNF-α处理6小时后PC-3M细胞c-FLIP在蛋白及mRNA表达水平明显上调,而使用热休克蛋白90抑制剂GA预处理18小时后,能明显抑制TNF-α诱导的c-FLIP表达上调。结论:热休克蛋白90抑制剂能有效抑制TNF诱导的c-FLIP表达上调。     

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.