犬骨髓基质干细胞体外定向分化为软骨细胞

目的 体外诱导犬骨髓基质干细胞(BMSCs)定向分化为软骨细胞，探讨体外诱导成软骨的方法和条件。方法 自犬肋骨取骨髓2～3ml，体外行原代和传代培养扩增，顺序加入碱性成纤维细胞生长因子(bFGF)和转化生长因子β1(TGF-β1)，以培养瓶内较高细胞浓度培养，诱导BMSCs分化为软骨细胞。甲苯胺蓝、阿新蓝染色检测软骨基质的分泌，免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。结果 诱导的软骨样细胞甲苯氨蓝异染性、阿新蓝染色阳性；Ⅱ型胶原免疫组织化学检测阳性。结论 应用bFGF和TGF-β1体外可以诱导犬BMSCs分化为软骨细胞，诱导的软骨细胞可作为软骨组织工程较理想的种子细胞。     

转化生长因子β1缓释载体诱导骨髓基质干细胞成软骨分化

目的探讨转化生长因子β1（TGF—β1）缓释对骨髓基质干细胞诱导成软骨分化的影响。方法乳化交联法制备TGF—β1壳聚糖缓释微球并将其与壳聚糖支架复合，将骨髓基质干细胞置于复合载体中立体培养，通过HE染色、Ⅱ型胶原免疫组化染色、扫描电镜观察复合载体对细胞的增殖、分化及功能的影响。结果骨髓基质干细胞于复合载体中培养，细胞形态类似软骨细胞，并可见细胞增殖及细胞外基质分泌，Ⅱ型胶原免疫组织化学染色示基质中有Ⅱ型胶原表达，其细胞增殖率及Ⅱ型胶原分泌功能均较对照组明显增强。结论复合载体能够控制TGF-β1的释放并保持其活性，可促进骨髓基质干细胞的增殖并诱导其向软骨细胞分化。     

不同浓度转化生长因子-β1对人骨髓间充质干细胞/海藻酸钠复合物体外软骨形成能力的影响

目的探讨人骨髓间充质干细胞（MSCS）体外定向分化为软骨样组织的可行性以及不同浓度TGF-β1对人MSCs／海藻酸钠复合物体外软骨形成能力的影响。方法将体外培养扩增的人骨髓间充质干细胞与海藻酸钠结合，制成MSCs／海藻酸钠复合物，诱导培养液中添加不同浓度TGF-β1，在培养的不同时间进行Ⅱ型胶原的免疫组织化学，原位杂交，蛋白多糖的特殊染色，以及蛋白多糖的定量检测。结果细胞在海藻酸钠中生长良好，可见细胞分裂增殖，形成同源细胞团。10μg／L诱导组Ⅱ型胶原表达阳性，基质中有红染的黏多糖物质的堆积，蛋白多糖定量检测均高于其他实验组（P〈0.05）。结论TGF-β1浓度过低不能诱导软骨形成，而浓度过高则不利于软骨形成，10μg／L是体外诱导软骨形成的适宜浓度。海藻酸钠是运载MSCs的理想载体和支架。     

CDMP-1促进成人骨髓间充质干细胞成软骨分化的研究

目的 探讨软骨源性形态发生蛋白1(CDMP-1)诱导成人骨髓间充质干细胞(BMSCs)向软骨细胞分化的可行性及最佳诱导浓度.方法 分离培养BMSCs,免疫荧光法检测BMSCs表面CD34,CD45,CD105表达.采用含0、10、50、100ng/ml CDMP-1的软骨诱导液诱导培养BMSCs 21 d,倒置显微镜观察细胞形态变化;RT-PCR检测不同浓度CDMP-1组细胞Ⅱ型胶原和Aggrccan表达:免疫组化检测Ⅱ型胶原表达;番红O和阿利新蓝染色检测蛋白多糖表达.结果 成人BMSCs呈梭形漩涡状生长,CD44、CD105表达阳性,CD34呈阴性表达.CDMP-1诱导7 d后细胞形态逐渐由长梭形向多边形、多角形转化.不同浓度CDMP-1诱导21 d,Ⅱ型胶原表达量各组间差异均具有统计学意义(P<0.05);Aggrecan的表达CM组和10 ng组之间差异无统计学意义(P>0.05),其他各组间差异均具有统计学意义(P<0.05).免疫组化检测Ⅱ型胶原表达阳性,阿利新蓝和番红O染色均为阳性.结论 含100 ng/mJ CDMP-1软骨诱导液能有效促进成人BMSCs向软骨表型分化.     

人骨髓间充质干细胞向软骨细胞定向分化的研究

目的探讨体外单层培养中诱导人骨髓间充质干细胞(Human Bone Marrow-derived Mesenchymal Stem Cells,hBMSCs)向软骨细胞定向分化的条件.方法采集志愿者骨髓3例,分离培养BMSCs,流式细胞仪分析表面标志.用含TGF-β1的无血清诱导培养基培养7d后,分别行Ⅱ型胶原免疫组化、原位杂交检测,碱性磷酸酶染色,3H标记的胸腺嘧啶脱氧核苷(3H-TdR)掺入实验检测细胞的增殖情况.结果培养的BMSCs表达CD9,而CD34、CD38、CD45、CD61呈阴性.细胞经诱导培养7d后免疫组化、原位杂交可检测到Ⅱ型胶原的表达,碱性磷酸酶染色呈弱阳性,但细胞3H-TdR掺入量低于对照组(P<0.05).结论BMSCs在特定的诱导下能向软骨细胞方向分化,但在无血清培养基中无法有效的增殖.     

软骨细胞与骨髓基质细胞共培养裸鼠体内构建软骨组织的实验研究

目的：探讨软骨细胞在裸鼠体内促进骨髓基质细胞（BMSCs）向软骨分化并形成软骨组织的可行性。方法：从SD大鼠中分别分离出BMSC和软骨细胞进行体外培养。收集软骨细胞培养上清液,作为BMSCs诱导液从第2代开始进行诱导分化,7天后取出标本,免疫组织化学检测软骨特异性Ⅱ型胶原表达,RT-PCR检测Ⅱ型胶原和aggrecan的mRNA表达。SD大鼠BMSCs与软骨细胞按一定比例（7：3）混匀,取5.0×107个混合细胞/ml的各组细胞悬液接种至壳聚糖生物材料,体外培养一周后植入裸鼠皮下,相同数量的单纯软骨细胞或BMSCs同样方法植入,分别作为阳性对照及阴性对照,1.5×107个软骨细胞同样植入作为低浓度软骨细胞对照。各组均8周后取材检测。结果：经诱导后的大鼠BMSCs的Ⅱ型胶原免疫组化检测阳性,RT-PCR检测Ⅱ型胶原和aggrecanmRNA呈阳性表达;混合细胞组及阳性对照组均形成了成熟的软骨,组织学可见成熟软骨陷窝、异染基质及Ⅱ型胶原表达;BMSCs组仅形成了纤维性组织;低浓度软骨细胞组在局部形成了少量软骨。结论：软骨细胞能在一定程度上提供软骨形成的微环境,诱导BMSCs在裸鼠体内向软骨组织分化并形成软骨组织。 还原     

几丁质支架对体外间质干细胞成软骨分化的影响

目的鉴定间充质干细胞诱导分化为软骨细胞后,其在单层培养和几丁质支架上培养的差别。方法密度梯度离心兔股骨骨髓,分离BMSCs,用TGF-β1诱导第3代的BMSCs向软骨方向分化,2周后检测Ⅱ型胶原表达情况。将分化后的软骨样细胞传代,用无TGF-β1的培养基分别进行单层培养和接种在几丁质支架上培养2周,再用免疫组化检测Ⅱ型胶原表达情况。结果BMSCs经TGF-β1诱导后向软骨细胞方向分化,诱导后的细胞在无TGF-β1的培养中,采用单层培养方式的软骨细胞很快出现去分化表型,而接种在几丁质支架上的细胞仍能较好表达Ⅱ型胶原。结论几丁质支架在延缓软骨细胞去分化和老化方面有积极作用。     

CDMP-1诱导骨髓间充质干细胞分化成髓核细胞的实验研究

目的探讨软骨衍生形态发生蛋白-1(CDMP-1)能否诱导骨髓间充质干细胞(BMSCs)向髓核细胞分化,并检测其诱导的细胞是否具有髓核细胞分泌细胞外基质的功能。方法 BMSCs采用0 ng/ml(对照组)以及10 ng/ml(观察组)的CDMP-1处理,将正常椎间盘髓核细胞作为阳性对照组。BMSCs诱导后采用PCR检测Ⅰ型、Ⅱ型胶原基因水平表达,用Western Blot法检测Ⅱ型胶原蛋白水平的表达。采用阿尔辛蓝染色及定量比较蛋白多糖含量的变化。结果 PCR检测结果发现,观察组和对照组中Ⅰ型胶原和Ⅱ型胶原均有增加,而阳性对照组中Ⅱ型胶原明显比观察组更少。基因水平检测结果发现,CDMP-1诱导BMSCs分化后Ⅱ型胶原基因表达比正常髓核细胞还高。观察组中Ⅱ型胶原的蛋白水平表达明显比阳性对照组和对照组细胞更高,对照组中Ⅱ型胶原蛋白水平表达几乎很少。阿尔辛蓝染色结果发现,观察组蛋白多糖含量稍高于阳性对照组,但差异无统计学意义(P0.05);阳性对照组与观察组蛋白多糖含量均高于对照组,差异有统计学意义(P 0.05)。结论 CDMP-1能够诱导BMSCs向髓核细胞分化,具有髓核细胞分泌细胞外基质的功能。     

生长分化因子-5诱导小鼠骨髓基质干细胞向软骨分化过程中对缝隙连接蛋白43表达的影响

目的探讨生长分化因子-5(GDF-5)在小鼠骨髓基质干细胞(BMSCs)向软骨分化过程中对缝隙连接蛋白43(Cx43)表达的影响。方法体外培养小鼠BMSCs,贴壁细胞传代,取第3代细胞,加入地塞米松、VitC、胰岛素和GDF-5诱导培养,72 h后免疫细胞化学和阿尔辛蓝染色分别检测软骨细胞特异性Ⅱ型胶原和蛋白多糖的表达；在诱导24、48和72 h后进行如下检测：MTT法测定GDF-5对小鼠BMSCs增殖的影响；RT-PCR、Western blotting和免疫细胞化学法检测GDF-5对Cx43蛋白表达的影响。结果MTT结果显示不同时间GDF-5对小鼠BMSCs的增殖无影响；RT-PCR、Western blotting和免疫细胞化学结果表明诱导后不同时间均有Cx43 mRNA和蛋白的表达；诱导72 h免疫细胞化学显示有Ⅱ型胶原蛋白的表达,阿尔辛蓝染色阳性,有蛋白多糖基质的分泌。结论GDF-5可以通过上调缝隙连接蛋白Cx43的表达来促进小鼠BM- SCs向软骨方向的分化。     

重组PGL3-转化生长因子β1基因转染兔骨髓基质干细胞体外诱导向软骨细胞分化的实验研究

目的探讨将编码细胞转化生长因子β1(transforming growth factor β1,TGF-β1)的重组PGL3-TGF-β1质粒转染兔骨髓基质干细胞(marrow stromal stem cells,MSCs),体外通过自分泌、诱导作用向软骨细胞方向分化的可行性,为基因加强组织工程学修复软骨损伤提供体外实验依据.方法兔MSCs体外密度梯度离心及贴壁筛选法分离培养,脂质体法转染重组PGL3-TGF-β1,转染后绘制不同时期细胞生长曲线,MTT法分析转染后细胞(实验组)生长活性,以未转染空载体细胞为实验对照组,未转染细胞为空白对照组;转染后第2、7天,分别进行抗TGF-β1和抗Ⅱ型胶原蛋白的免疫组织化学染色(SABC法),以未转染细胞为实验对照组,PBS作为一抗为空白对照组,进行图像定量分析.结果 MSCs体外分离培养,脂质体法转染后,生长曲线显示转染后细胞生长活性较对照组降低,MTT法显示实验组及实验对照组吸光度(A)值较空白对照组低,差异有统计学意义(P＜0.01);实验组转染细胞第2天,抗TGF-β1免疫组织化学染色可见细胞内阳性颗粒,实验对照组及空白对照组均为阴性;转染细胞第7天,抗Ⅱ型胶原免疫组织化学染色实验组可见细胞内阳性颗粒,实验对照组及空白对照组均为阴性.图像分析示,实验组抗TGF β1及抗Ⅱ型胶原免疫组织化学染色阳性值与实验对照组及空白对照组相比,差异均有统计学意义(P＜0.01).结论脂质体法重组PGI3-TGF-β1基因可成功转染兔MSCs,但对细胞生长有一定影响,转染细胞表达TGF β1,通过其自分泌、诱导作用,细胞分泌Ⅱ型胶原蛋白,表现出软骨细胞样生理特征,并向软骨细胞方向分化.     

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.