刺五加皂甙对缺氧复氧性神经元损伤的保护作用

目的:从细胞分子水平研究刺五加皂甙(acanthopanaxsenticosussaponins,ASS)对培养神经元缺氧复氧损伤的保护作用及其机制。方法:取孕13～15dICR胎鼠大脑皮质神经元进行原代分离培养,建立缺氧复氧诱导的皮质神经元损伤模型。随机分成正常对照组、缺氧复氧组及ASS组;用MTT法测定神经元存活率,用硝酸还原酶法测定细胞培养上清液中一氧化氮合酶(NOS)的含量,用流式细胞仪检测神经元凋亡率。结果:神经元缺氧2,4,6,8h复氧24h后,存活率分别为(0.604±0.022)%,(0.592±0.017)%,(0.543±0.037)%,(0.534±0.021)%;缺氧8h复氧24h后,神经元凋亡率由(4.13±0.87)%增加至(31.34±0.85)%,NOS含量由(5.23±0.28)μmoL/L增加至(11.39±0.21)μmoL/L(P<0.01);ASS组神经元存活率、神经元凋亡率、NOS含量分别为(0.636±0.021),(16.37±0.66)%,(8.02±0.18)μmoL/L,与缺氧8h复氧24h比较差异有非常显著性意义(P<0.01)。结论:ASS对缺氧复氧引起的神经元损伤有保护作用;ASS可能是通过抑制一氧化氮的释放、抑制神经元凋亡来拮抗神经元损伤。     

刺五加皂甙对缺氧复氧性神经元损伤的保护作用

目的：从细胞分子水平研究刺五加皂甙(acanthopanax senticosus saponins，ASS)对培养神经元缺氧复氧损伤的保护作用及其机制。方法：取孕13～15d ICR胎鼠大脑皮质神经元进行原代分离培养，建立缺氧复氧诱导的皮质神经元损伤模型。随机分成正常对照组、缺氧复氧组及ASS组；用MTT法测定神经元存活率，用硝酸还原酶法测定细胞培养上清液中一氧化氮合酶(NOS)的含量，用流式细胞仪检测神经元凋亡率。结果：神经元缺氧2，4，6，8h复氧24h后，存活率分别为(0．604&;#177;0．022)％，(0．592&;#177;0．017)％，(0．543&;#177;0．037)％，(0．534&;#177;0．021)％；缺氧8h复氧24h后，神经元凋亡率由(4．13&;#177;0．87)％增加至(31．34&;#177;0．85)％，NOS含量由(5．23&;#177;0．28)μmoL／L增加至(11．39&;#177;0．21)μmoL／L(P&;lt;0．01)；ASS组神经元存活率、神经元凋亡率、NOS含量分别为(0．636&;#177;0．021)，(16．37&;#177;0．66)％，(8．02&;#177;0．18)μmoL／L，与缺氧8h复氧24h比较差异有非常显著性意义(P&;lt;0．01)。结论：ASS对缺氧复氧引起的神经元损伤有保护作用；ASS可能是通过抑制一氧化氮的释放、抑制神经元凋亡来拮抗神经元损伤。     

纳洛酮对缺氧大鼠皮层神经元细胞的保护作用

目的　观察缺氧对大鼠皮层神经元细胞的影响及纳洛酮的保护作用。方法　取体外培养 12d的Wistar大鼠皮层控经元细胞 ,随机分为正常对照组、缺氧组、纳洛酮组 (缺氧前 2 4h加纳洛酮预处理 ) ;缺氧 6h后在常氧下继续培养 2 4h。观察各种条件下神经元细胞的存活率和形态学的改变 ,测定培养液中乳酸脱氢酶 (LDH)含量。结果　缺氧后可见神经元胞体肿胀、细胞死亡 ,LDH渗出量增多 ,细胞存活率减少 (P <0 0 1)。经纳洛酮预处理的神经元 ,缺氧后神经元胞体肿胀、细胞死亡程度轻于缺氧组 ,LDH渗出显著低于缺氧组 (P <0 0 1) ,而存活率明显高于缺氧组 (P <0 0 1)。结论　缺氧能诱导皮层神经元损伤 ,而纳洛酮对神经元的缺氧损伤具有明显的保护作用     

急性肺损伤病人中性粒细胞凋亡变化的研究

目的　观察急性肺损伤 (ALI)病人中性粒细胞 (PMN)凋亡的发生以及与肺损伤的关系 ,并探讨其临床意义。方法　对 37例符合ALI诊断标准的病人 ,分离纯化肺灌洗液中的PMN ,应用流式细胞术测定PMN凋亡、坏死、存活细胞比例及呼吸瀑发功能的变化 ,设健康对照组 ,并观察与乳酸脱氢酶 (LDH)和胞浆游离Ca2 变化之间的关系。结果　ALI病人肺灌洗液中PMN凋亡比例显著降低 ,2 4h持续在低水平 (P <0 0 5 ,P <0 0 1) ;各检测点活细胞增多 (P <0 0 5 ,P <0 0 1) ;而灌洗液PMN的呼吸瀑发明显升高 ,8h达峰值 ,并持续升高 (P <0 0 1)。灌洗液中LDH水平 2～ 2 4h明显高于正常对照组 (P <0 0 5 ,P<0 0 1) ;PMN胞浆游离Ca2 各检测点显著增高 (P <0 0 5 ,P <0 0 1)。PMN凋亡与LDH水平呈显著相关性 (r =- 0 715 1,P <0 0 1) ;PMN凋亡与胞浆游离Ca2 的浓度有显著的相关性 ( r=- 0 6 0 39,P <0 0 1)。结论　ALI时PMN在肺组织中大量扣押 ,且正常的凋亡途径发生障碍 ,造成PMN持续处于激活状态及毒性内容物的持续释放 ,与肺组织的损伤有密切关系 ,并且PMN凋亡延迟可能与LDH、胞浆游离Ca2 的升高有关     

隐丹参酮与多奈哌齐合用对Aβ诱导大鼠皮层神经元损伤的保护作用

目的：观察隐丹参酮与多奈哌齐合用对Aβ42诱导大鼠皮层神经元凋亡的保护作用及其可能机制。方法通过Aβ42诱导体外培养的大鼠皮层神经元,建立阿尔茨海默病（Alzheimer＆#39;s disease,AD）细胞模型,MTT比色法检测细胞存活率,流式细胞仪检测细胞凋亡率,分光光度法测定SOD活性、MDA含量及LDH漏出量。结果成功建立大鼠皮层神经元AD细胞模型,经检测模型组MDA含量及LDH漏出量显著高于空白对照组且SOD活力明显低于空白对照组;隐丹参酮组、隐丹参酮加多奈哌齐组MDA含量及LDH漏出量均低于模型组,且SOD活力明显高于模型组,差异均有统计学意义（P〈0.05）;隐丹参酮与多奈哌齐合用在抑制神经元凋亡,降低MDA含量、LDH漏出量及提高SOD活性方面的效果显著强于隐丹参酮与多奈哌齐单用。结论隐丹参酮与多奈哌齐合用对Aβ损伤细胞有保护作用,其机制可能与协同抗氧化能力有关。     

鸦胆子油乳对膀胱癌细胞系BIU-87坏死与凋亡的影响

目的探讨鸦胆子油乳对膀胱癌BIU 87细胞坏死与凋亡的影响及其可能的作用机制。方法将不同浓度的鸦胆子油乳加入体外培养的BIU 87细胞 ,用流式细胞仪检测细胞凋亡与坏死比例、并检测线粒体膜电位 (MMP) ,用激光共聚焦显微镜观察细胞色素C分布。结果高浓度鸦胆子油乳作用 4h后 ,肿瘤细胞MMP明显降低 ,2 4h后多数细胞发生坏死 ,与对照组相比有非常显著性差异 (P <0 0 1) ;低浓度鸦胆子油乳作用 6h后 ,诱导细胞色素C释放 ,2 4h后可见典型的凋亡现象 ,与对照组相比有显著性差异 (P <0 0 5 )。结论鸦胆子油乳高浓度主要诱导肿瘤细胞坏死 ,低浓度诱导细胞凋亡。     

栝楼桂枝颗粒抗缺血性脑卒中大鼠神经元及原代海马神经元凋亡研究

目的:观察栝楼桂枝颗粒(GLGZG)抗缺血性脑卒中大鼠神经元及原代海马神经元凋亡的作用,探讨其作用机制,为其治疗脑卒中提供依据。方法:建立谷氨酸诱导原代海马神经元兴奋性毒性损伤模型、大鼠脑缺血再灌注损伤模型,采用MTT、LDH法测定GLGZG对原代海马神经元细胞活性和LDH活性的影响,采用Western Blot、Real-time PCR检测GLGZG对原代海马神经元及大鼠海马组织中Caspase-3、Bcl-2、Bax m RNA及蛋白表达水平的影响。结果:用不同浓度(100μg/m L、200μg/m L、300μg/m L)的GLGZG分别作用于原代海马神经元24 h,3个剂量组细胞存活率较谷氨酸组细胞存活率升高,其中GLGZG 200μg/m L、300μg/m L 2组细胞活力显著升高(P0.05,P0.01);3个剂量组LDH活力较谷氨酸组显著降低,其中GLGZG 200μg/m L、300μg/m L 2组可显著抑制谷氨酸损伤神经元LDH的释放(P0.05,P0.01)。GLGZG 200μg/m L、300μg/m L 2组干预后,与谷氨酸组比较可显著降低原代海马神经元Caspase-3 m RNA、Bax m RNA的表达(P0.05,P0.01),升高Bcl-2 m RNA的表达(P0.05),蛋白表达的趋势与m RNA相似;GLGZG组与模型组比较,可降低大鼠海马组织Caspase-3、Bax蛋白的表达(P0.05或P0.01),升高Bcl-2蛋白的表达(P0.01)。结论:GLGZG对缺血性脑卒中大鼠及原代海马神经元有一定的保护作用,其保护作用与其抗细胞凋亡作用有关。     

低频经颅磁刺激对缺血缺氧脑损伤大鼠学习记忆及体外培养缺血缺氧神经元谷氨酸释放的影响

摘要 目的：观察低频经颅磁刺激（TMS）对缺血缺氧脑损伤（HIBI）大鼠学习记忆能力的影响,同时探讨低频TMS对体外培养的缺血缺氧（HI）大鼠神经元谷氨酸释放的影响。 方法：选用成年SD大鼠,制作缺血缺氧模型,将模型大鼠分为如下三组：HIBI组,TMS+HIBI组以及正常对照组。采用水迷宫来评估大鼠的学习记忆能力。与此同时,我们还体外培养大鼠海马区神经元,同样将其分为HI组、TMS+HI组以及正常对照组。采用氧气葡萄糖剥夺法制作细胞缺血缺氧模型,测定细胞外液谷氨酸及乳酸脱氢酶（LDH）浓度（与神经元损伤呈正相关）,同时观察细胞存活率。 结果：①HIBI后,WM结果显示大鼠的学习记忆能力受损,与正常对照组相比较,有显著差异（P＜0.05）。②经过TMS刺激14d后,TMS+HIBI组大鼠的学习记忆能力高于HIBI组（P＜0.05）。③HI刺激后,体外培养的神经元细胞外液谷氨酸及LDH浓度升高,显著高于正常对照组（P＜0.05）,而神经元存活率则显著下降,低于正常对照组（P＜0.05）。④TMS+HI组神经元细胞外液谷氨酸和LDH浓度低于HI组（P＜0.05）,神经元存活率也显著上升,高于HI组（P＜0.05）。 结论：①HIBI后,大鼠学习记忆能力显著下降,而低频TMS 可以显著改善HIBI大鼠的认知功能;②HI诱导体外培养的神经元损伤,谷氨酸释放增加,细胞存活率降低,而低频TMS可以抑制HI诱导的神经元损伤以及谷氨酸释放,减轻谷氨酸毒性作用,同时增加神经元存活率。这可能与低频TMS改善学习记忆能力有关,这为缺血缺氧脑损伤的治疗提供了新的思路。     

脂质体介导下pcDNA3.1/BDNF基因转染对缺糖缺氧-再给氧损伤神经细胞保护作用的实验研究

目的 研究脂质体介导下pcDNA3.1/BDNF基因转染对缺糖、缺氧-再给氧损伤神经细胞的保护作用.方法 建立缺糖、缺氧-再给氧损伤SH-SY5Y神经细胞模型,应用显微镜观察细胞形态、MTT比色法测定细胞存活率、苔盼蓝染色排斥试验检测细胞活力、测定SH-SY5Y细胞 LDH 释放率、Annexin V-FITC和Propidium Iodide双染色法荧光显微镜下观察细胞凋亡以及流式细胞仪检测细胞死亡和凋亡等方法,观察应用基因转染方法导入表达BDNF的基因片段(pcDNA3.1/BDNF)对缺糖、缺氧-再给氧损伤神经细胞的保护作用.结果 显微镜下观察到,在转染了表达BDNF基因的SH-SY5Y细胞中,经ATRA诱导后,即使实施了缺糖、缺氧-再给氧处理,其死亡、凋亡的细胞数和对照组相比明显减少,且细胞的形态改善显著;在细胞存活率、死亡率、LDH 释放率的测定结果中,基因转染组和对照组相比,显著提高了细胞的存活率,降低细胞死亡率和LDH 释放率(P＜0.05);在Annexin V-FITC和Propidium Iodide双染色法荧光显微镜观察及流式细胞仪的检测中,转染了表达BDNF基因的SH-SY5Y细胞,经ATRA诱导后,其保护作用最好,和正常对照组比较,死亡、凋亡的细胞数显著减少.结论 应用基因转染方法导入表达BDNF的基因片段对缺糖、缺氧-再给氧损伤神经细胞具有保护作用.     

纳洛酮对缺氧大鼠皮质神经元的保护作用

背景纳洛酮对脑缺血再灌注损伤细胞的保护作用机制尚不明确.选择体外培养皮质神经元研究纳洛酮疗效可排除多重因素干扰.目的观察缺氧对体外培养大鼠皮质神经元的影响及纳洛酮的保护机制.设计重复测量设计.地点和对象实验地点军事医学科学院神经生物学研究室.研究对象体外培养12 d的Wistar大鼠皮质神经元.干预取体外培养12 d的Wistar大鼠皮质神经元,随机分为正常对照组、缺氧组、纳洛酮组(缺氧前24 h加纳洛酮预处理);缺氧6 h后在常氧下继续培养24 h.主要观察指标观察各种条件下神经元的存活率和形态学的改变,测定培养液中乳酸脱氢酶(LDH)含量.结果缺氧后可见神经元胞体肿胀、细胞死亡,LDH渗出量增多[6 h正常对照组为(78.68±7.34)%,缺氧组为(194.38 ±22.32)%;12 h正常对照组为(77.98±8.85)%,缺氧组为(331.66±36.12)%],细胞存活率减少[6 h正常对照组为(91.82±2.89)%,缺氧组为(66.96±4.98)%;12 h正常对照组为(90.84±2.61)%,缺氧组为(32.02±6.34)%],差异有显著性意义(P＜0.01).经纳洛酮预处理的神经元,缺氧后神经元胞体肿胀、细胞死亡程度轻于缺氧组,LDH渗出[6 h(159.86±34.03)%;12 h(256.28±28.29)%]显著低于缺氧组(P＜0.01),而存活率[6 h(78.08±4.15)%;12 h(53.68±4.32)%]明显高于缺氧组,差异有显著性意义(P＜0.01).结论对缺氧诱导的皮质神经元的损伤,纳洛酮具有明显的保护作用.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.