三维培养汗腺腺上皮细胞形成汗腺样结构的初步研究

目的 探索体外构建人外泌汗腺样结构的方法 . 方法 取自愿捐献的正常腋部全层皮肤,分离培养汗腺腺上皮细胞,倒置相差显微镜下观察.将汗腺腺上皮细胞以2×105个/cm2密度接种至Matrigel凝胶下(A组)、凝胶上(B组)、凝胶中(C组),进行三维立体培养,激光扫描共聚焦显微镜、HE染色及免疫组织化学染色观察有无汗腺样结构形成. 结果 原代汗腺分泌部上皮细胞接种后24 h可见细胞贴壁,贴壁细胞呈梭形,2～3 d后细胞呈多克隆麦粒样生长,14 d后细胞融合呈铺路石样生长,融合后的汗腺腺上皮细胞呈扁平多角形,中间有较大圆形核;第1代细胞形态与原代极为相似;第2代细胞形态不规则,多数伸出长伪足;第3代细胞多呈星形状,细胞体积大,与邻近细胞相互融合.A组汗腺腺上皮细胞三维立体培养11 d形成管腔结构;B组汗腺腺上皮细胞立体培养8 h,细胞胞浆伸长呈丝状,与邻近细胞相连呈管腔或半管腔形,但细胞增殖不明显;C组汗腺腺上皮细胞三维立体培养2～3 d,细胞分裂增生,增生细胞彼此紧密排列成管腔结构,中间可见明显腔隙,随新生细胞增多,管腔结构逐渐演变为不规则球形结构.激光扫描共聚焦显微镜观察示C组形成球形结构,细胞团中央有管腔结构;球形结构HE染色示为管腔结构,免疫组织化学染色示角蛋白18、癌胚抗原表达阳性,与汗腺分泌部管状结构极为相似. 结论 汗腺腺上皮细胞在Matrigel凝胶中三维立体培养可形成汗腺样结构.     

上皮细胞条件培养液对BMSCs分化的影响

目的 探讨上皮细胞条件培养液(epithelial cell conditioned medium,ECCM)体外诱导犬BMSCs向上皮细胞分化的可行性.方法 成年健康雄性比格犬1只,体重10 kg.于犬髂后上棘采用骨髓穿刺法取骨髓5 mL,分离培养BMSCs.取犬口腔黏膜下组织,剪成约4 mm×4 mm大小,制备ECCM.取第2代BMSCs以2×104个/孔细胞密度接种,实验组于ECCM中培养,对照组于低糖DMEM完全培养基中培养.观察两组细胞形态特征,MTT法绘制生长曲线,诱导培养21 d免疫组织化学染色鉴定上皮细胞特异性标志物--细胞角蛋白19(cytokeratinl9,CK-19)和细胞角蛋白AE1/AE3,透射电镜观察细胞超微结构.结果 倒置相差显微镜下见两组细胞均呈长梭形,均匀分布,折光性较强,增殖迅速.两组细胞生长曲线均呈"S"形,实验组生长曲线较对照组右移,提示ECCM对细胞增殖有抑制作用.实验组CK-19和细胞角蛋白AE1/AE3免疫组织化学染色均呈阳性反应,对照组呈阴性.透射电镜下实验组细胞胞浆内可见紧密连接.结论 ECCM体外有诱导同种BMSCs向上皮细胞分化的作用.     

两种体外培养兔膀胱变移上皮细胞方法的比较

目的 比较组织贴块法和酶消化法体外培养兔膀胱变移上皮细胞的优缺点,探索简单、高效培养膀胱变移上皮细胞的方法,为膀胱组织工程种子细胞的培养提供实验基础。方法 采用组织贴块法和酶消化进行兔膀胱变移上皮细胞体外培养,相差显微镜下观察其生长特点,应用细胞免疫荧光染色对细胞进行鉴定,测定细胞生长曲线了解细胞生长的基本规律。结果 培养的细胞具有上皮细胞的典型形态,生长曲线呈“S”形,角蛋白（CKAE1/AE3）单克隆抗体免疫荧光染色阳性,波形蛋白染色阴性。结论 组织贴块法和酶消化法均能成功培养出兔膀胱变移上皮细胞。组织贴块法原代培养时间长,但是成功率高。酶消化法可以在较短时间内获取大量细胞,但是操作步骤多,细胞容易污染或损伤。     

兔半月板纤维软骨细胞的培养及生物学特性研究

目的 :通过半月板纤维软骨细胞的分离、培养、鉴定 ,观察其生长特点 ,研究半月板生物学特性及其损伤修复的细胞学基础。方法 :机械分离兔半月板软骨 ,胰蛋白酶、胶原酶联合消化 ,10 ?S的DMEM中原代和传代培养 ,倒置显微镜动态观察细胞形态及生长情况 ,GAG、Ⅱ型胶原免疫组化染色 ,电镜观察细胞超微结构。结果 :培养细胞呈多角形 ,有突起 ,富含分泌颗粒 ,GAG、Ⅱ型胶原染色阳性 ,细胞线粒体和内质网发达。结论 :培养的细胞保持了体内纤维软骨细胞的基本特性。     

成人表皮干细胞和汗腺细胞的体外分离和培养

背景：人表皮干细胞和汗腺细胞的分离培养及鉴定,为探讨人表皮干细胞再生汗腺的可行性打下基础。目的：探讨体外分离培养人表皮干细胞及汗腺细胞的有效方法。方法：采集不同年龄段的泌尿外科患者术后包皮组织,充分清洗消毒后去除皮下组织,将其修剪成0.5cm×0.5cm的皮片,用Ⅳ型胶原纯化、富集成人表皮干细胞,倒置相差显微镜观察细胞形态：使用免疫荧光染色对成人表皮干细胞表型进行分析;CCK-8检测细胞的增殖曲线;采用胶原酶消化法从人全层无损伤皮肤中分离提取汗腺细胞,并进行扩增和鉴定。结果：倒置相差显微镜下见分离培养的成人表皮干细胞呈卵圆形、细胞之间紧密相连,呈铺路石状,免疫荧光染色显示细胞表达CK19、β1整合素。倒置相差显微镜下见汗腺细胞呈扁平多角形,表达汗腺细胞标志细胞CK7、18、19及CEA。结论：本实验结果说明胶原酶消化法分离培养成人表皮干细胞及汗腺样细胞是可行的。     

显微剥离酶消化法体外培养人胚胎食管鳞状上皮细胞的方法研究

目的 探讨利用显微剥离酶消化法行人胚胎食管鳞状上皮细胞原代培养的可行性，并对所得细胞进行纯化及传代培养。方法选择意外流产20周龄胎儿食管标本，通过显微剥离法获得菲薄食管黏膜上皮，经短时酶消化分离所得细胞，在10％胎牛血清混合培养基中培养，通过倒置显微镜、透射电镜及免疫组织化学方法鉴定所得细胞，并测定其生长曲线。结果倒置显微镜下见细胞呈不规则圆形或多边形，透射电镜可见其具有鳞状上皮细胞特征性的张力微丝，细胞表面微突起，细胞角蛋白免疫组织化学染色胞浆呈棕黄色阳性表现，MTT法测定第2代细胞在传代培养3～4d达生长高峰。3、4d吸光度（A）值与1、2、5及6d比较，差异有统计学意义（P〈0．05）。结论通过显微剥离酶消化法可获得足量、较纯食管鳞状上皮细胞，混合培养基中细胞能快速传代、扩增，适宜作为种子细胞构建组织工程食管。     

大鼠小肠上皮类器官单位的分离培养鉴定

目的 采用机械分离和酶消化相结合的方法分离小肠上皮类器官单位(IOUs),并进行形态及功能鉴定,建立稳定的分离培养技术.方法 采用机械法剪碎小肠组织,中性蛋白酶和胶原酶联合消化分离组织碎片,差速沉淀法获得IOUs,通过相差显微镜观察IOUs形态,组织学、免疫组化证实其增殖特性及上皮刷状缘完整性,原代二维培养观察IOUs体外增殖及细胞群体组成.结果 分离的IOUs大部分形态完整,PAS染色显示连续的刷状缘,并可见杯状细胞,PCNA染色阳性并呈梯度改变,IOUs体外培养可见构成小肠的各胚层细胞.结论 采用机械分离和酶消化相结合的方法可以得到形态完整、增殖活跃的IOUs,有望为组织工程小肠构建提供种子细胞.     

人肛瘘管壁上皮细胞的体外分离培养和鉴定

目的:寻找建立人肛瘘管壁上皮细胞体外分离、培养及鉴定细胞起源的技术方法.方法:通过组织块法分离并原代培养人肛瘘管壁组织上皮细胞,观察上皮细胞形态并对培养细胞进行细胞化学鉴定.结果:分离后的上皮细胞在24～36 h贴壁,在7～9 d进入对数期生长期.细胞鉴定角蛋白免疫细胞化学染色为阳性,波形蛋白免疫细胞化学染色为阴性.结论:该方法获得的肛瘘管壁上皮细胞能够在体外稳定培养,可以为细胞分子水平上研究肛瘘瘘管愈合机制提供可靠的细胞模型.     

大鼠椎体生长板软骨细胞的改良培养及传代特征

[目的]建立体外培养及鉴定大鼠椎体生长板软骨细胞的方法,观察软骨细胞的传代特征.[方法]采用改良胰酶和Ⅱ型胶原酶序贯消化法对4只1周龄SD大鼠椎体生长板软骨细胞进行体外分离、培养.原代细胞传代后采用细胞HE染色和甲苯胺蓝染色对软骨细胞进行鉴定,采用MTT比色法绘制细胞生长曲线.将细胞传代至第6代,采用倒置相差显微镜观察各代软骨细胞的形态,采用免疫细胞化学染色鉴定各代软骨细胞Ⅱ型胶原的表达.[结果]MTT比色法显示,传3代以前的软骨细胞的生长曲线近似"S"形,从第4 d开始细胞呈对数生长,第9 d达平台期,至第11 d开始出现生长抑制.体外培养的软骨细胞随着传代次数的增加,细胞形态由原代的多角形逐渐变为长梭形.传3代以前的软骨细胞Ⅱ型胶原免疫细胞化学呈强阳性.[结论]本研究所采用的软骨细胞分离和培养方法,能在短时间内获得高纯度的软骨细胞,传3代及以前的细胞具有软骨细胞的特征性表型,增殖较快,这一方法为更深入地从细胞水平研究椎体的纵向生长奠定了基础.     

大鼠胰腺星状细胞分离培养与鉴定

目的：分离培养大鼠胰腺星状细胞,为体外研究胰腺纤维化提供细胞模型。方法：采用酶消化结合Nycodenz密度梯度离心法分离胰腺星状细胞,通过倒置显微镜观察细胞形态,油红O染色和免疫细胞化学染色desmin,α-SMA进行细胞鉴定,并绘制传代后细胞生长曲线。结果：原代培养的大鼠胰腺星状细胞呈星形或梭形生长;原代胰腺星状细胞油红O染色胞浆均可见红色密集脂滴,直至传代后消失;原代胰腺星状细胞培养48 h后,desmin表达开始减弱,α-SMA表达开始增强;传代后desmin基本不表达,α-SMA阳性表达100%;传代后第3 d-5 d的胰腺星状细胞处于快速增殖阶段。结论：酶消化结合Nycodenz密度梯度离心法分离培养大鼠胰腺星状细胞纯度高,重复性好,可以满足体外研究的需要。     

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.