Fas介导的病理性瘢痕成纤维细胞的凋亡及部分相关死亡信号递质的传递

目的研究和比较增生性瘢痕和瘢痕疙瘩成纤维细胞经FasMcab(Fas单抗)诱导产生凋亡的能力,同时探讨Ca2+、H+在其相应死亡信号通道中的作用.方法取手术切除的增生性瘢痕和瘢痕疙瘩组织各 6例,通过细胞培养6～8代后,以FasMcab为处理因素作用于增生性瘢痕及瘢痕疙瘩成纤维细胞24小时,比较两者凋亡率.同时,应用粘附式细胞仪检测FasMcab作用下胞内Ca2+ 、H+的变化.结果①增生性瘢痕成纤维细胞在工作浓度以上的FasMcab作用下,随着单抗浓度的增高,其凋亡率不断增高而瘢痕疙瘩成纤维细胞在各浓度梯度下,均未发现明显的凋亡,且各组间无显著差异;③在FasMcab作用下,增生性瘢痕成纤维细胞内Ca2+显著增高而瘢痕疙瘩成纤维细胞内Ca2+无变化;④在Fa sMcab作用下,增生性瘢痕、瘢痕疙瘩成纤维细胞内H+均下降,两组间无显著的差异.结论①瘢痕疙瘩成纤维细胞有别于增生性瘢痕成纤维细胞,FasMcab 不能诱导其产生正常的凋亡.鉴于Fas介导的凋亡被认为是介导死亡信号传递的最主要通道,Fas介导凋亡的异常可能是瘢痕疙瘩成纤维细胞增殖-凋亡调控异常的细胞生物学机制之一 ;②Ca2+作为Fas信号通道中一种重要的下游信号通道介质,在Fas介导的病理性瘢痕成纤维细胞凋亡中起着重要作用;③H+参与了成纤维细胞内Fas信号的传递;但H+ 作为重要的信号递质,它的变化并非Fas介导成纤维细胞凋亡所必需的.     

Fas介导下瘢痕成纤维细胞中死亡信号传导的研究

目的　研究和比较增生性瘢痕和瘢痕疙瘩成纤维细胞经Fas单抗 (FasMcab)诱导产生凋亡的能力 ,同时探讨Ca2 、氢过氧化物 (LPO)在其相应死亡信号通道中的作用。方法　取手术切除的增生性瘢痕和瘢痕疙瘩患者的瘢痕及瘢痕疙者组织各 6例 ,通过细胞培养 6～ 8代后 ,以FasMcab为处理因素作用于增生性瘢痕及瘢痕疙瘩成纤维细胞 2 4h ,应用透射电镜证实凋亡现象的发生 ;应用流式细胞仪检测及比较两者凋亡率。同时 ,应用粘附式细胞仪检测FasMcab作用下胞内Ca 2 、LPO的变化。结果　增生性瘢痕成纤维细胞在工作浓度以上的FasMcab作用下 ,发生明显的凋亡现象 ,其凋亡率随着单抗浓度的增高不断增高。瘢痕疙瘩成纤维细胞在各浓度梯度下 ,均未发现明显的凋亡 ,且各组间差异无显著意义。在FasM cab作用下 ,增生性瘢痕成纤维细胞内Ca2 、LPO显著增高 ,而瘢痕疙瘩成纤维细胞内Ca2 、LPO的变化差异无显著意义。结论　Fas介导凋亡的异常可能是瘢痕疙瘩成纤维细胞增殖～凋亡调控异常的细胞生物学机理之一。在FasMcab作用下 ,细胞内Ca2 、LPO产生的障碍可能直接导致瘢痕疙瘩的凋亡异常。     

Fas Mcab对病理性瘢痕成纤维细胞生物学活力的影响

目的　探讨FasMcab对病理性瘢痕成纤维细胞生物学活力的影响。方法　以体外培养的病理瘢痕成纤维细胞为研究对象 ,应用MTT法 ,3H -TDR核苷掺入法 ,观察了FasMcab对增生性瘢痕成纤维细胞活力的影响 ;应用流式细胞仪检测FasMcab作用下 ,增生性瘢痕和瘢痕疙瘩两类成纤维细胞的凋亡率。结果　①低浓度FasMcab对增生性瘢痕成纤维细胞的活力具有促进作用 ;②FasMcab在 4 μg/ml的浓度下可迅速诱导增生性瘢痕成纤维细胞的凋亡 ,但在相同条件下对瘢痕疙瘩成纤维细胞不具有诱导凋亡的作用。结论　瘢痕疙瘩成纤维细胞对FasMcab诱导的凋亡存在抗性。深入研究抗性产生的原因将有助于揭示病理性瘢痕增生的形成机理。     

FasMcab对病理性瘢痕成纤维细胞生物学活力的影响

目的探讨FasMcab对病理性瘢痕成纤维细胞生物学活力的影响.方法以体外培养的病理瘢痕成纤维细胞为研究对象,应用MTT法,3H-TDR核苷掺入法,观察了FasMcab对增生性瘢痕成纤维细胞活力的影响;应用流式细胞仪检测FasMcab作用下,增生性瘢痕和瘢痕疙瘩两类成纤维细胞的凋亡率.结果①低浓度FasMcab对增生性瘢痕成纤维细胞的活力具有促进作用;②FasMcab在4μg/ml的浓度下可迅速诱导增生性瘢痕成纤维细胞的凋亡,但在相同条件下对瘢痕疙瘩成纤维细胞不具有诱导凋亡的作用.结论瘢痕疙瘩成纤维细胞对FasMcab诱导的凋亡存在抗性.深入研究抗性产生的原因将有助于揭示病理性瘢痕增生的形成机理.     

FasMcab对病理性瘢痕成纤维细胞生物学活力的影响

目的 探讨FasMcab对病理性瘢痕成纤维细胞生物学活力的影响。方法 以体外培养的病理瘢痕成纤维细胞为研究对象，应用MTT法，^3H－TDR核苷掺入法，观察了FasMcab对增生性瘢痕成纤维细胞活力的影响；应用流式细胞检测FasMcab作用下，增生性瘢痕和瘢痕疙塔两类成纤维细胞的凋亡率。结果 ①低浓度FasMacb对增生性瘢痕成纤维细胞的活力具有促进作用；②FasMcab在4μg/ml的浓度下可迅速诱导增生性瘢痕成纤维细胞的凋亡，但在相同条件下对瘢痕疙成纤维细胞不具有诱导凋亡的作用。结论 瘢痕疙瘩成纤维细胞对FasMcab诱导的凋亡存在抗性。深入研究性产生的原因将有助寺揭示病理性瘢痕增生的形成机理。     

蛋白糖基化抑制剂对病理性瘢痕成纤维细胞Fas蛋白的表达与功能的影响

目的 研究N-糖链合成抑制剂衣霉素对病理性瘢痕成纤维细胞Fas蛋白的表达与诱导凋亡功能的影响.方法 瘢痕疙瘩及增生性瘢痕各5例,以健康皮肤为对照,免疫组织化学法检测组织中成纤维细胞Fas蛋白表达;组织块贴壁法培养成纤维细胞;Western Blot法及流式细胞术检测衣霉素处理及未处理各组成纤维细胞Fas蛋白水平的表达及凋亡率的变化.结果 病理性瘢痕及健康皮肤成纤维细胞胞质及胞膜中均可见Fas蛋白表达;增生性瘢痕、瘢痕疙瘩及健康皮肤成纤维细胞Fas蛋白糖基化水平依次降低,3组成纤维细胞在Fas单克隆抗体(Fas monoelonal antibody,FasMcAb)作用后凋亡率与Fas蛋白糖基化成正相关,衣霉素可明显降低病理性瘢痕成纤维细胞Fas蛋白糖基化水平,但对健康皮肤成纤维细胞Fas蛋白糖基化水平抑制作用不明显.结论 FasMcAb诱导病理性瘢痕成纤维细胞凋亡与成纤维细胞Fas蛋白糖基化水平成正相关,而衣霉素可显著降低成纤维细胞Fas蛋白糖基化水平.     

重组腺病毒介导Fas基因转染瘢痕疙瘩细胞并诱导其凋亡的实验研究

目的　制备含人Fas基因的重组腺病毒 ,感染瘢痕疙瘩成纤维细胞后 ,使其稳定高效地表达以替换原有无功能的Fas蛋白 ,并恢复正常的重建后Fas信号传导通道。方法　Fas基因自PcDNA3 1 Fas质粒中切取 ,应用PDC315载体系统构建携带Fas基因的重组腺病毒 ,感染瘢痕疙瘩成纤维细胞 ,检测Fas蛋白的表达及功能。结果　成功地构建了携带Fas基因的重组腺病毒 ,感染后瘢痕疙瘩成纤维细胞能稳定表达的有功能的Fas蛋白。结论　利用重组腺病毒转染可以重建被阻断的瘢痕疙瘩成纤维细胞Fas死亡信号传导通道 ,并再次估证了Fas基因突变与瘢痕疙瘩之间的联系 ,为瘢痕疙瘩基因治疗展示了一条新途径     

病理性瘢痕和正常皮肤成纤维细胞缝隙连接介导的细胞间通讯

目的 研究和比较不同来源的成纤维细胞缝隙连接介导的细胞间通讯的差异。方法 取手术切除的正常皮肤、增生性瘢痕、瘢痕疙瘩组织各6例,通过细胞培养6-8代后,应用粘附式细胞仪检测及比较各种来源的细胞缝隙连接介导的细胞间通讯。结果 正常皮肤成纤维细胞的细胞间通讯正常,增生性瘢痕成纤维细胞的细胞间通讯受到抑制,瘢痕疙瘩成纤维细胞的细胞间通讯被阻断。结论 细胞间通讯被证明与细胞生长的接触抑制及细胞的浸润性生长密切相关。细胞间通讯被阻断是瘢痕疙瘩呈“蟹足样”浸润性生长的细胞生物学机理之一。     

圆盘状受体在病理性瘢痕成纤维细胞中表达

目的探讨圆盘状受体(discoidin domain receptors,DDRs)在病理性瘢痕形成中的作用。方法取13例瘢痕疙瘩,10例增生性瘢痕,10例正常皮肤,体外培养成纤维细胞,经荧光定量PCR,定量检测成纤维细胞中DDR1、DDR2水平。结果瘢痕疙瘩、增生性瘢痕成纤维细胞中DDR1水平明显高于正常皮肤成纤维细胞(20.98对4.2,P<0.01;7.9对4.23,P<0.05),瘢痕疙瘩与增生性瘢痕成纤维细胞中DDR1相比,有统计学意义(20.98对7.9,P<0.01),DDR2在瘢痕疙瘩、增生性瘢痕成纤维细胞和正常皮肤成纤维细胞中差异无统计学意义(358,332对278,P>0.05)。结论荧光定量PCR可准确测定组织中DDR含量,病理性瘢痕成纤维细胞的细胞学行为与DDR有关。     

Fas介导的病理性瘢痕成纤维细胞的凋亡及部分相关死？…

目的 研究和比较增生性瘢痕和瘢痕疙瘩成纤维细胞经ＦａｓＭｃａｂ（Ｆａｓ单抗）诱导产生凋亡的能力,同时探讨Ｃａ＾２＋、Ｈ＾＋在其相应死亡信号通道中的作用。方法 取手术切除的增生性瘢痕和瘢痕疙瘩组织各６例,通过细胞培养６￣８代后,以ＦａｓＭｃａｂ为处理因素作用于增生性瘢痕及瘢痕疙瘩成纤维细胞２４小时,比较两者调亡率。同时,应用粘附式细胞仪检测ＦａｓＭｃａｂ作用下胞内Ｃａ＾２＋、Ｈ＾＋的变化。结果 ①增     

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.     

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.     

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.