应用AdEasy腺病毒载体系统构建血管内皮生长因子165重组腺病毒

目的利用AdEasy腺病毒载体系统构建血管内皮生长因子165（VEGF165）重组腺病毒，并在293T细胞中扩增。方法将PCR获取的VEGF165基因酶切并插入到pAdTrack-CMV中，构建成腺病毒穿梭质粒pAdTrack-VEGF165，经PmeI酶切线性化后，采用电穿孔转化到事先电转化腺病毒骨架质粒pAdEasy-1的BJ5183大肠杆菌感受态细胞中，挑选同源重组菌落。提取质粒并用Pac I酶切鉴定，线性化重组质粒pAdEasy-VEGF165转染293T细胞，包装成重组腺病毒颗粒，荧光显微镜下观察绿色荧光表达，并扩增收集重组腺病毒，测定病毒滴度。结果经限制性内切酶检测、基因测序及和绿色荧光观察证实成功构建了携带VEGF165基因的重组腺病毒，并扩增出10^9pfu／mL的高滴度重组腺病毒。结论成功构建了携带VEGF165基因的重组腺病毒载体，为研究骨组织工程血管化局部基因治疗奠定了基础。     

应用AdEasy腺病毒载体系统构建人骨形成蛋白2基因重组腺病毒

目的利用AdEasy腺病毒载体系统构建人骨形成蛋白2(BMP2)基因重组腺病毒并在293E细胞中扩增制备重组病毒。方法自人骨形成蛋白2真核表达载体pcDNA3-hBMP2中酶切出hBMP2基因，插入pAdtrackCMV中构建成腺病毒穿梭质粒pAdtrackCMV—hBMP2，经酶切线性化后，采用电穿孔转化到事先电转化腺病毒骨架质粒pAdEasy的BJ5183大肠杆菌电感受态细菌中，挑选同源重组质粒，酶切线性化重组质粒并转染293E细胞包装成重组病毒颗粒，荧光显微镜观察绿色荧光表达。重组病毒上清感染293细胞，荧光显微镜观察绿色荧光表达。结果经限制性内切酶检测和GFP表达证实成功地构建了携带hBMP2基因的重组腺病毒载体并制备出高滴度重组病毒。结论成功地构建了携带hBMP2基因的重组腺病毒载体，为进一步研究rBMP2基因治疗奠定了基础。     

人骨保护素基因重组腺病毒的构建及鉴定

目的构建人骨保护素(hOPG)基因的重组腺病毒载体并检测其转染能力。方法采用基因工程技术,将hOPG基因片段插入到腺病毒载体质粒pAdTrack-CMV上,利用PadEasy系统与骨架质粒在大肠杆菌BJ5183胞内进行同源重组,经293细胞包装、扩增,得到携带hOPG基因的重组腺病毒AdEasy-PAdtrack-CMV-hOPG,将重组腺病毒AdhOPG对大鼠骨髓基质细胞(rMSCs) 进行感染。采用PCR方法对重组腺病毒载体进行鉴定,利用绿色荧光报告基因转染结果,以荧光计数法检测重组腺病毒的滴度。结果酶切鉴定及PCR结果证明hOPG基因重组腺病毒载体成功, 病毒滴度可达2．5×108pfu／ml,具有很强感染能力,结论应用细菌内同源重组法,成功构建了含 hOPG重组腺病毒载体。     

抑瘤细胞运动和侵袭的鼠FRNK重组腺病毒的构建

目的应用AdEasy复制缺陷型腺病毒载体系统构建小鼠FRNK基因重组腺病毒，并在293HEK细胞中扩增制备重组病毒。方法把小鼠FRNK基因克隆入腺病毒穿梭载体pAdTrack—CMV中，构建腺病毒穿梭质粒pAdTrack—CMV-FRNK，经PmeⅠ内切酶酶切成线性化后，采用电穿孔转化将其转化到含有腺病毒骨架载体pAdEasy-1的感受态大肠杆菌BJ5183中，通过卡那霉素筛选获得阳性腺病毒重组质粒。再将获得的腺病毒重组质粒转染到293HEK细胞进行包装，获得FRNK重组腺病毒pAdFRNK。荧光显微镜下观察绿荧光的表达。结果经酶切和绿荧光表达证明了小鼠FRNK基因的重组腺病毒载体pAdFRNK构建成功，并制备出高滴度的重组病毒。结论成功构建携带小鼠FRNK基因的重组腺病毒pAdFRNK，为研究FRNK的基因治疗奠定了基础。     

转化生长因子-β1反义RNA腺病毒载体的构建

目的构建含转化生长因子β1(TGF-β1)反义RNA的重组腺病毒重组体。方法将TGF-β1的cDNA5＇端630bp片段反向插入穿梭载体pAdTraek-CMV,构建为TGF-β1反义RNA的重组体(pAdTrack-antiTGFβ1),将重组体pAdTrack-antiTGFβ1与包装质粒pAdEasy-1共转染BJ5183细菌。用选择培养基筛选同源重组的阳性克隆,同源重组的腺病毒载体转染293细胞,在荧光显微镜下观察细胞中的绿色荧光蛋白(GFP)及PCR扩增目的基因等方法鉴定重组的腺病毒。结果构建了含rGF-β1反义RNA的重组腺病毒,其滴度为2.4×10     

携带白蛋白启动子和IDO基因重组腺病毒的构建

目的 构建携带小鼠白蛋白启动子和IDO基因的重组腺病毒载体,研究肝脏Hepa l石细胞的IDO基因mRNA及蛋白表达情况.方法 酶切含有小鼠全长IDO cDNA的IDO质粒,亚克隆至穿梭载体pAdTrack.ALB上,在BJ5183细菌中和AdEasy-1进行同源重组,生成并筛选阳性克隆,测序、鉴定正确后,转染AD-293细胞进行包装、扩增,检测病毒滴度,RT-PCR和荧光显微镜鉴定重组腺病毒转染AD-293细胞后IDO的表达.重组腺病毒进一步感染Hepa 1-6细胞,RT-PCR和WesternBlot法分别检测IDO基因在细胞内表达情况.结果 经酶切及测序证实携带白蛋白启动子和IDO基因重组腺病毒载体构建成功,RT-PCR检测到转染后AD-293细胞内IDO的表达,病毒感染滴度为2.9×10~6pfu/ml.感染Hepa 1-6细胞后,RT-PCR和Western Blot可以检测到IDO mRNA水平和蛋白水平表达.结论 构建了携带白蛋白启动子和IDO基因的重组腺病毒载体.     

血管内皮生长因子165基因重组腺病毒载体的构建及转染内皮祖细胞的实验研究

目的：利用细菌内同源重组法构建含血管内皮生长因子（VEGF）165基因的重组腺病毒，并观察其在内皮祖细胞（EPCs）中的表达，为进一步研究其在慢性肾脏病中的作用奠定基础。方法：用限制性内切酶XbaⅠ＋HindⅢ从质粒载体中切出VEGFl65基因片段，与KpnⅠ＋HindⅢ双酶切的pAdTrack-CMV形成转移质粒pAdTrack-CMV-VEGFl65，PmeI酶切线性化后与腺病毒基因组质粒pAdEasy-1共转化大肠杆菌BJ5183，由人胚肾293细胞包装成Ad-VEGFl65，PCR和westem blot法鉴定其表达。贴壁法体外培养获得大鼠骨髓来源的EPCs，Ad-VEGFl65基因体外转染EPCs，检测转染后目的基因的表达情况。结果：利用CSCI，法由pAdTrack-VEGFl65和pAdEasy-1共转化BJ5183感受态茵，可获得阳性重组体细菌克隆。PCR检测表明重组腺病毒已含有目的基因，病毒滴度1．4×10^10pfu／ml。Ad-VEGFl65转染培养第6天的EPCs后24h开始，培养上清中VEGF蛋白表达较对照组和转染前增加。结论：成功制备的重组体腺病毒Ad-VEGFl65转染体外培养的EPCs后，在体外能有效高表达目的基因产物，为今后VEGF在肾脏病中的深入研究奠定了基础。     

骨形成蛋白7重组腺病毒的构建及转染骨髓间充质干细胞的研究

目的 构建骨形成蛋白(BMP)7重组腺病毒，使其转染骨髓间充质干细胞并在细胞内得到表达。方法 将BMP7基因克隆到转移载体pAdTrack—CMV中，在细菌BJ5183中与pAdEasy腺病毒基因组进行同源重组，得到BMP7重组腺病毒基因组，通过转染HEK293细胞包装出重组腺病毒。利用BMP7重组腺病毒转染分离纯化后的骨髓间充质干细胞，鉴定BMP7在细胞内的表达。结果 经过多聚酶链反应(PCR)及酶切鉴定证明获得了BMP7转移质粒padTrack—BMP7和BMP7重组腺病毒基因组，并包装出重组腺病毒。逆转录PCR和免疫组织化学证明BMP7在重组腺病毒转染后的骨髓间充质干细胞中得到了表达。结论 BMP7重组腺病毒的构建和在骨髓间充质干细胞中的表达，为BMP7基因治疗的研究奠定了基础。     

携带Notch-1受体胞内段基因重组腺病毒载体的构建及其在胰腺腺泡细胞中的表达

目的构建并鉴定携带Notch-1受体胞内段基因（NICD）的腺病毒表达载体，同时观察重组腺病毒在胰腺腺泡细胞中的表达。方法提取K562细胞总RNA，利用逆转录-聚合酶链反应（RT—PCR）扩增NICD并将其克隆到腺病毒穿梭质粒pAdTrack-CMV中，经PmeI酶切线性化质粒后与pAdeasy-1质粒在大肠杆菌BJ5183中同源重组。将鉴定正确的同源重组质粒线性化后转染293细胞进行包装、扩增得到重组腺病毒颗粒Ad—NICD。将该病毒感染胰腺腺泡细胞并通过实时定量PCR检测其表达。结果经PCR、基因测序和酶切鉴定证实重组质粒pAd—NICD构建成功，将重组质粒导入293细胞可以观察到绿色荧光蛋白（GFP）的表达，实时定量PCR证实病毒颗粒Ad—NICD感染腺泡细胞后可以有效地增加NICD表达。结论成功构建Ad—NICD并证实其在腺泡细胞中的表达，为进一步研究Notch信号传导途径及其与胰腺的疾病的关系奠定了基础。     

MDR1启动子调控CD∷尿嘧啶磷酸核糖转移酶重组腺病毒载体的构建及表达

目的构建由人MDR1启动子调控CD∷upp融合基因表达的重组腺病毒,为对耐药肿瘤体内外靶向基因治疗奠定基础。方法自行设计一对含XhoⅠ和HindⅢ酶切位点的MDR1引物,从外周血中提取人类基因组DNA,通过PCR扩增MDR1启动子并插入PGL3-enhancer载体上,获得PGL3-MDR1质粒。从PORF-CD∷upp质粒中切下CD∷upp基因,插入PGL3-MDR1中MDR1启动子下游,并从中切下目的基因MDR1-CD∷upp,克隆到腺病毒穿梭质粒中,将带目的基因的穿梭质粒pAdTrack-MDR1-CD∷upp。与含有pAdeasy-1的BJ5183菌电转化,筛选提取>30 kb的阳性克隆,经线性化后转染293细胞,通过观察绿色荧光蛋白(GFP)的表达及PCR扩增出重组腺病毒中的目的基因MDR1、CD∷upp等方法加以鉴定。结果成功构建了含MDR1-CD∷upp靶向自杀基因的重组腺病毒载体Ad-MDR1-CD∷upp,病毒滴度为3.0×1010pfu/ml。结论该重组腺病毒的构建为下一步研究其对MDR1耐药细胞系的特异性杀伤作用和对耐药肿瘤模型的靶向基因治疗提供基础。     

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.