miR-124-3p靶向Axin1 调控糖尿病骨质疏松成骨的研究

目的 研究miR-124-3p靶向Axin1 调控糖尿病骨质疏松症大鼠骨髓间充质干细胞（bone marrow mesenchymal stem cells ，BMSCs）成骨分化的作用。方法 20只糖尿病大鼠模型-SPF级SD雌性大鼠分为分组对照组10例、实验组10例，经过药物注射，测血生化指标，测骨密度。BMSCs培养，流式细胞学鉴定。检测对照组和实验组miR-124-3p mRNA的表达。过表达miR-124-3p（模拟物）7、14、21 d，检测ALP、茜素红染色成骨能力。第7天检测miR-124-3p mRNA表达水平。实验组细胞用miR-124-3p模拟物转染，分为高糖组和低糖组，检测中Axin1 mRNA水平。构建载体，与模拟物共转染，荧光素酶报告基因检测miR-124-3p和Axin1靶向结合。将实验组BMSCs分为高糖组和低糖组，检测实验组BMSCs高糖组及低糖组miR-124-3p、Runx2 mRNA的表达及茜素红染色和ALP染色结果。检测实验组模拟物在高糖组及低糖组miR-124-3p、Runx2 mRNA的表达及茜素红染色和ALP染色结果。结果 ELISA检测血生化指标，实验组TG、TC、FPG、HbA1C值上调，β-CTX和SOST上调，OC和骨密度下调。BMSCs培养，流式细胞学鉴定显示CD73和CD105的表达为阳性， CD34 和 CD45 的表达呈阴性。符合间充质干细胞的抗原特点，证实为BMSCs。实验组miR-124-3p表达明显低于对照组。过表达miR-124-3p（模拟物）7、14、21 d，ALP、茜素红染色随时间逐渐升高。第7天miR-124-3p表达水平显著升高。实验组细胞用miR-124-3p模拟物转染，结果高糖组Axin1 mRNA表达水平上调，但用miR-124-3p模拟物转染时水平下降。荧光素酶报告基因检测miR-124-3p和Axin1可以靶向结合。RT-qPCR检测实验组BMSCs高糖摄入显著降低了miR-124-3p、Runx2表达；高糖可抑制成骨分化，减少钙沉积，减少ALP表达。高血糖条件下miR-124-3p过表达（模拟物）中Runx2的表达显示，高糖+对照明显低于低糖+对照组；高糖+miR-124-3p模拟物明显高于高糖+对照组。茜素红染色和ALP染色显示，高糖+对照明显低于低糖+对照组；高糖+miR-124-3p模拟物明显高于高糖+对照组。结论 miR-124-3p能通过靶向抑制Axin1促进糖尿病骨质疏松症大鼠BMSC的成骨发生。     

微小RNA-23a-3p负调控Runx2基因抑制骨髓间充质干细胞成骨分化诱导绝经后骨质疏松的研究

目的:观察微小RNA(miR)-23a-3p通过调控Runx2基因对骨髓间充质干细胞(BMSCs)成骨分化的影响。方法:绝经后骨质疏松症(PMOP)患者及正常的女性志愿者各30例,检测两组血清中miR-23a-3p表达水平。建立雌性小鼠骨质疏松模型后提取BMSCs,将miR-23a-3p inhibitor和miR-阴...     

LncRNA DANCR靶向调控对绝经后骨质疏松BMSCs成骨分化的作用

目的 研究长链非编码RNA（lncRNA）分化非蛋白编码 RNA（DANCR）靶向微小RNA（miR）-19a-3p对绝经后骨质疏松（PMOP）骨髓间充质干细胞（BMSCs）成骨分化的调控作用。方法 选择健康女性志愿者4例和PMOP患者4例，分离培养BMSCs；PMOP患者BMSCs进行分组，转染阴性对照（NC）siRNA、lncRNA DANCR siRNA、miR-NC抑制物、miR-19a-3p抑制物。检测lncRNA DANCR、miR-19a-3p、PTEN的表达水平，成骨诱导分化后检测茜素红染色的OD405水平、碱性磷酸酶（ALP）活力、骨钙素（OCN）及骨桥蛋白（OPN）的mRNA表达水平。结果 PMOP患者BMSCs中lncRNA DANCR、PTEN的表达水平高于健康女性，miR-19a-3p的表达水平及成骨诱导后的OD405水平、ALP活力、OCN及OPN的表达水平均低于健康女性。在PMOP患者BMSCs中，si-DANCR组的lncRNA DANCR、PTEN的表达水平低于si-NC组，成骨诱导后的OD405水平、ALP活力及miR-19a-3p、OCN、OPN的表达水平高于si-NC组；si-DANCR+miR-19a-3p抑制物组成骨诱导后的OD405水平、ALP活力及miR-19a-3p、OCN、OPN的表达水平低于si-DANCR+miR-NC抑制物组，PTEN的表达水平高于si-DANCR+miR-NC抑制物组。结论 LncRNA DANCR靶向miR-19a-3p调控PMOP患者BMSCs的成骨分化。     

miR-187-5p 对骨髓间充质干细胞成骨分化能力的调控作用

目的利用小鼠骨髓间充质干细胞(BMSCs)的成骨分化模型,探讨miR-187-5p在成骨分化中的表达趋势及调控作用。方法通过切除雌性小鼠双侧卵巢构建小鼠骨质疏松模型;应用qRT-PCR技术检测组织和细胞中miR-187-5p的表达;应用基因转染技术观察过表达或敲减miR-187-5p对BMSCs向成骨分化的影响;应用茜素红和碱性磷酸酶染色检测BMSCs中矿化结节的数量和矿化区域的染色面积。结果 qRT-PCR结果显示miR-187-5p在骨质疏松模型小鼠的骨组织及BMSCs中均表达下降。过表达miR-187-5p可提高ALP、Collagen-1、Runx2、BMP4、OCN和OPN等成骨分化相关基因mRNA的表达,促进BMSCs向成骨分化;而敲减miR-187-5p降低ALP等成骨分化相关基因mRNA的表达,抑制BMSCs向成骨分化。在体实验同样证实,过表达miR-187-5p可以显著促进骨质疏松小鼠BMSCs向成骨分化,改善小鼠的骨质疏松表型。结论过表达miR-187-5p促进BMSCs向成骨分化,敲减miR-187-5p抑制BMSCs向成骨分化。     

miR-21对骨质疏松小鼠骨髓基质细胞增殖的影响

目的探讨miR-21对骨质疏松小鼠骨髓基质细胞(BMSCs)增殖的影响。方法采用双侧卵巢切除法构建骨质疏松小鼠模型(VOX),分离、培养、纯化小鼠BMSCs并采用si PORT Neo FX转染pre-miR-21、pre-miR-negative control(pre-miR-NC)、antmiR-21、ant-miR-negative control(ant-miR-NC)并进行RT-PCR验证,MTT法检测小鼠BMSCs增殖情况、茜素红与碱性磷酸酶染色法检测小鼠BMSCs成骨能力、Western-blotting检测细胞增殖、成骨分化相关蛋白水平。结果骨质疏松症小鼠BMSCs中miR-21相对表达水平低于Ctrl组(P0.05),OVX-pre-miR-21组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均高于OVX-pre-miR-NC组(P0.05),OVX-premiR-NC组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于Ctrl-pre-miR-NC(P0.05); OVX-ant-miR-21组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于OVX-ant-miR-NC组(P0.05),OVX-ant-miR-NC组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于Ctrl-ant-miR-NC(P0.05)。结论提高miR-21表达水平可促进骨质疏松小鼠BMSCs增殖能力与成骨分化能力。     

右美托咪定通过miR-483-3p/CTNNB1轴调控绝经后骨质疏松血管生成

目的确定右美托咪啶(dexmedetomidine, Dex)在绝经后骨质疏松症(postmenopausal osteoporosis, PMOP)中的作用及其分子机制。方法选取2020年1月至2021年1月烟台山医院收治的27例PMOP患者作为PMOP组, 同时选取20例健康志愿者作为Normal组。筛选PMOP中差异表达的miRNAs, 在临床上通过qRT-PCR试验检测miR-483-3p、连环蛋白β1(catenin beta 1, CTNNB1)在PMOP患者血清样本中的表达。体外实验中, 诱导骨髓间充质干细胞(bone marrow mesenchymal stem cells, BMSCs)为成骨细胞, Dex处理BMSCs且干预BMSCs中miR-483-3p、CTNNB1的表达, 检测成骨相关指标(RUNX2、OCN、OPN)的表达水平。将人脐静脉内皮细胞(human umbilical vein endothelial cell, HUVECs)和BMSCs共培养后, 借助血管生成实验检测BMSCs的血管生成能力。结果相对于Normal组(1±0.46)(1.03...     

骨松安激活Runx 2/Osterix途径促进骨质疏松性骨折愈合的机制研究

目的初步探索骨松安促进骨质疏松性骨折愈合的机制。方法建立骨质疏松性骨折大鼠模型,采用骨松安进行治疗,分别于7、14、21 d取出骨折端骨痂,通过HE染色观察骨痂生长情况,采用免疫组化、RT-qPCR检测Runx 2、Osterix的表达。结果 HE染色结果显示,骨松安治疗可在早期促进骨质疏松性骨折大鼠骨折端软骨细胞增生、成骨细胞成熟分化及编织骨形成。免疫组化、RT-qPCR结果显示,骨质疏松性骨折组大鼠Runx 2与Osterix的表达一直处于较低水平,在骨松安持续治疗下,Runx 2与Osterix的表达得到明显改善。结论骨松安可激活Runx 2/Osterix途径,加速前成骨细胞向成骨细胞分化,促进骨质疏松性骨折大鼠的骨折愈合。     

水蛭素通过上调VEGF/Notch1信号通路促进人骨髓间充质干细胞成骨分化

摘要：目的 观察水蛭素对人骨髓间充质干细胞（bone marrow mesenchymal stem cell,BMSC）成骨分化的影响。方法 BMSCs细胞分为正常培养的对照组、成骨诱导的诱导组以及加入不同浓度（1、10、20 ATU/mL）处理的水蛭素组。MTT检测细胞增值并筛选水蛭素最适作用浓度。流式细胞仪检测细胞凋亡。RT-PCR和Western blot分别检测成骨基因Runx2、Osterix、COL1A1的mRNA和蛋白表达。BCIP/NBT染色法检测细胞中的碱性磷酸酶水平。茜素红染色检测矿化结节。检测VEGF、Notch1、Jagged1和CBF1的mRNA和蛋白表达。结果 骨髓间充质干细胞经成骨诱导细胞增殖显著增加,中高浓度的水蛭素可以不同程度促进成骨诱导的BMSCs细胞增殖（P＜0.05）,并筛选出20 ATU/mL作为水蛭素的使用浓度。水蛭素抑制成骨诱导的BMSCs细胞凋亡,上调Runx2、Osterix、COL1A1的mRNA和蛋白表达,增加碱性磷酸酶水平,促进细胞中矿化结节的生成,并提升BMSCs细胞中VEGF、Notch1、Jagged1和CBF1的表达（P＜0.05）。结论 水蛭素可能通过上调VEGF/Notch1信号通路促进人骨髓间充质干细胞成骨分化。     

miR-122-3p通过wnt/β catenin信号通道调控小鼠脂肪间充质干细胞成骨分化

[目的]探究miR-122-3p在小鼠脂肪间充质干细胞成骨分化中的调控机制。[方法]从6只雄性C57BL/6小鼠获取m ADSCs,成骨诱导培养基中培养,观察成骨情况。miR-122-3p、miR-NC、antimiR-122-3p和anti-NC基因慢病毒转染m ADSCs,q RT-PCR检测miR-122-3p表达以及成骨特异性基因Ocn及Alp的m RNA表达。Western blotting检测β-catenin的蛋白表达量。[结果]成骨诱导培养后,m ADSCs开始成骨分化,ALP染色和茜素红染色阳性。经转染后,过表达miR-122-3p会抑制m ADSCs成骨分化。反之,敲减miR-122-3p会促进m ADSCs成骨分化。Western Blotting检测表明,过表达miR-122-3p会激活Wnt/β-catenin信号通路。反之,敲减miR-122-3p会抑制Wnt/β-catenin信号通路。[结论] miR-122-3p通过调控Wnt/β-catenin信号通路,影响小鼠m ADSCs成骨分化。     

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.