脑梗死患者血浆胆红素和氧化低密度脂蛋白水平变化及意义

目的　探讨脑梗死患者血浆胆红素浓度和氧化低密度脂蛋白 (ox-LDL)含量的变化以及它们在脑梗死中的作用。方法　用钒酸盐氧化法和酶联免疫吸附法 (ELISA)分别测定 75例急性期脑梗死患者血浆胆红素浓度和ox -LDL水平 ,并与 30例其他疾病对照组及 4 6例正常对照组进行比较。结果　 (1)脑梗死患者血浆胆红素浓度为 (11 8± 4 3) μmol L ,咀显低于其他疾病对照组 (14 9± 4 7) μmol L及正常对照组 (15 5± 5 5 ) μmol L ,差异有显著性 (P <0 0 1) ;脑梗死患者血浆ox -LDL水平为 (6 2 5 3± 2 5 7 2 )μg L ,明显高于其他疾病对照组 (4 71 9± 195 0 ) μg L及正常对照组 (4 32 7± 184 4 ) μg L ,差异有显著性(P <0 0 1)。 (2 )大梗死灶组血浆胆红素浓度 (9 5± 3 1)mol L明显低于中梗死灶组 (10 3± 4 4 ) μmol L和小梗死灶组 (12 7± 5 0 ) μmol/L ,P <0 0 1。而大梗死灶组血浆ox -LDL水平 (6 80 4± 2 4 7 1) μg L明显高于中梗死灶组 (5 81 5± 2 6 3 5 ) μg L和小梗死灶组 (5 0 4 2± 2 2 5 7) μg L ,P <0 0 1。 (3)胆红素降低程度和ox -LDL增高程度与神经功能缺损程度密切相关。 (4 )经相关分析 :脑梗死时总胆红素与血浆ox -LDL水平呈负相关 (r=- 0 5 93,P <0 0 1) ,总     

冠心病、Ⅱ型糖尿病及肾透析患者OX-LDL和AOC分析

目的 :通过对冠心病、Ⅱ型糖尿病及肾透析后患者血清甘油三酯、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、氧化型低密度脂蛋白胆固醇、载脂蛋白及血液抗氧化状态的分析 ,探讨它们在动脉粥样硬化发生过程中的作用 ,以及氧化型低密度脂蛋白与血液抗氧化状态的关系 ,寻找评价冠心病危险性有效的血液生化指标。方法 :收集经临床确诊的冠心病患者、Ⅱ型糖尿病及肾透析患者各 5 0例及 5 0例无心血管疾病、糖尿病及肾病人群的空腹血清。进行血脂及血液抗氧化状态分析。结果 :冠心病组TG (1 39± 0 34)mmol/L、Chol (4 5 8± 0 92 )mmol/L、HDL -C (1 2 6± 0 36 )mmol/L、LDL -C (2 6 4± 0 4 6 )mmol/L、ApoA1(1 5 9± 0 37)g/L、ApoB10 0 (0 87± 0 2 7)g/L、OX -LDL (0 133± 0 0 3)nmol/L、AOC (14 1± 1 32 )U/ml;Ⅱ型糖尿病组TG (1 4 8± 0 5 1)mmol/L、Chol (4 5 7± 1 10 )mmol/L、HDL -C (1 4 2± 0 4 4 )mmol/L、LDL -C (2 6 9± 0 83)mmol/L、ApoA1(1 6 5± 0 4 7)g/L、ApoB10 0 (0 84± 0 2 1)g/L、OX -LDL (0 12 9± 0 0 2 )nmol/L、AOC (12 8± 2 4 8)U/ml;肾透析后组TG (1 5 5± 0 5 8)mmol/L、Chol (4 6 2± 0 5 8)mmol/L、HDL -C (1 2 7± 0 5 0 )mmol/L     

丙二酰二醛修饰的低密度脂蛋白与冠心病的相关性研究

目的探讨丙二酰二醛修饰的低密度脂蛋白(MDALDL)与冠心病及其他血脂之间的关系。方法选择冠心病患者组68例,正常对照组74名。采用酶联免疫吸附分析(ELISA)的方法检测人血清中MDALDL,同时对受检者的血脂水平进行检测,结果进行统计学分析。结果冠心病患者血清氧化低密度脂蛋白(oxLDL)水平为(115.62±53.4)U/L,明显高于正常对照组(86.7±27.6)U/L(P<0.05);MDALDL与低密度脂蛋白胆固醇(LDLC)水平的比值在冠心病患者组为(43.25±2.64)mmol/U,明显高于正常对照组(33.74±1.58)mmol/U(P<0.01)。血清总胆固醇(TG)、LDLC与MDALDL水平呈显著正相关,相关系数r=0.486,而高密度脂蛋白胆固醇(HDLC)与MDALDL水平呈负相关,相关系数r=0.402。结论MDALDL与冠心病有着非常密切的关系,参与冠心病的发生发展过程。     

免疫分离法测定血浆脂蛋白残粒胆固醇的临床评价

目的　对免疫分离法测定血浆脂蛋白残粒胆固醇 (RLP C)进行方法学评价 ,并探讨其临床应用价值。方法　分析免疫分离法测定血浆RLP C的精密度、准确度、干扰因素 ,并将该法与超速离心法 (UC)进行比较 ,同时用该法测定 80例正常人、70例冠心病患者、72例 2型糖尿病患者和2 5例Ⅲ型高脂蛋白血症患者空腹血浆RLP C水平。结果　免疫分离法测定血浆RLP C的批内CV为 2 .78%～ 4 .98% ,批间CV为 3.99%～ 7.5 7% ,RLP C浓度 2 .4 4mmol/L以下时线性良好 ,r =0 .992。分析灵敏度为 0 .0 5mmol/L ,回收率为 92 .1%～ 98.3% ,免疫分离法 (X)与超速离心法 (Y)具有良好的相关性 ,Y =1.0 2 2X +0 .0 2 1,r =0 .989。甘油三酯 (TG) <15 .3mmol/L ,血红蛋白 (Hb) <5g/L ,低密度脂蛋白胆固醇 (LDL C) <7.0mmol/L ,高密度脂蛋白胆固醇 (HDL C) <3.0mmol/L ,胆红素 <342 μmol/L ,抗坏血酸 <15 0mmol/L时对方法无显著干扰。冠心病患者、2型糖尿病患者和Ⅲ型高脂蛋白血症组空腹血浆RLP C分别为 (0 .4 4 5± 0 .2 5 1)mmol/L、(0 .336± 0 .172 )mmol/L和(0 .878± 0 .6 72 )mmol/L ,均显著高于正常人 [(0 .190± 0 .0 70 )mmol/L],P <0 .0 0 1。结论　免疫分离法测定RLP C操作简单 ,结果准确可靠 ,精密度好 ,符合临床常规使用     

脂蛋白(a)与血脂指标对冠心病诊断价值的比较和评价

目的　评价脂蛋白 (a)及其联合其他血脂指标对冠心病的诊断价值。方法　分析 6 38例怀疑冠心病患者 (其中经冠状动脉造影确诊的冠心病 4 10例 ,非冠心病 2 2 8例 )的临床资料 ,用标准方法检测血脂水平 ,比较各个血脂指标的诊断价值。结果　冠心病患者的血清总胆固醇 [(5 .0± 1.2 )mmol/L]、低密度脂蛋白胆固醇 [(LDL C) (3.0± 1.0 ) ]mmol/L、脂蛋白 (a) [(2 6 0± 2 2 6 )mg/L]水平及总胆固醇与高密度脂蛋白胆固醇 (HDL C)的比值 (5 .2± 2 .0 )显著高于非冠心病患者 [(4 .6± 1.1)mmol/L ,(2 .6± 0 .9)mmol/L ,(192± 174 )mg/L ,4 .5± 1.5 ,P≤ 0 .0 0 1],HDL C水平 [(1.0± 0 .3)mmol/L]明显低于非冠心病患者 [(1.1± 0 .3)mmol/L ,P =0 .0 4 5 ],而两组间其他血脂水平差异无统计学意义。冠心病患者中 ,血清总胆固醇、LDL C、脂蛋白 (a)及总胆固醇与HDL C比值的异常率显著高于非冠心病患者 ,其他血脂指标的异常率在两组无明显差别。脂蛋白 (a)对冠心病的预测值及似然比并不优于其他血脂指标 ,联合LDL C可提高阳性预测值及似然比。在logstic多元回归中 ,冠心病的危险性与传统的危险因素均呈正相关 ,脂蛋白 (a)与冠心病的相关性不优于其他指标。结论　脂蛋白p(a)对冠心病的预测价值并不优于其他血     

调脂治疗对老年心绞痛冠脉血流储备的影响

目的 :研究普伐他汀治疗对临床有心绞痛症状而冠状动脉造影轻度狭窄伴高胆固醇血症老年患者冠脉血流储备 (CFR)的影响。方法 :用彩色多普勒超声仪检测 18例冠心病心绞痛冠状动脉造影轻度狭窄伴高胆固醇血症老年患者 ,采用普伐他汀调脂治疗 6个月后进行治疗前后CFR比较 ,并与 2 0例健康老年血浆胆固醇正常者 (对照组 )比较。结果 :18例患者经过 6个月治疗后 ,血浆总胆固醇 (TC)由 6 84± 0 85mmol/L降至 5 2 9± 0 82mmol/L(P <0 .0 0 1) ,低密度脂蛋白胆固醇 (LDL C)由 4 2 2± 0 73mmol/L降至 3 4 3± 0 82mmol/L(P <0 .0 0 1) ,CFR由治疗前 3 33± 0 71mmol/L升至 3 86± 0 83mmol/L(P <0 .0 1)。TC及LDL C与CFR呈负相关关系 (r =- 0 4 3及- 0 4 6 ,P <0 .0 5 )。结论 :普伐他汀调脂治疗可以改善心绞痛冠状动脉轻度狭窄患者的冠状动脉微循环 ,提高CFR。     

早产儿血清胆红素与脑干听觉诱发电位的关系及其影响因素分析

目的 :探讨早产儿高胆红素血症患儿血清胆红素水平对脑干听觉诱发电位的影响 ,以及探讨其影响因素。方法 :收集 2 0 0 0年 1月至 2 0 0 2年 12月在我院新生儿科住院的早产儿高胆红素血症患儿病例共 151例 ,以脑干听觉诱发电位出现异常作为神经损害标志。入院后即检测血清胆红素浓度及脑干听觉诱发电位 ,当出现皮肤黄染后每日检测血清胆红素浓度及脑干听觉诱发电位一次 ,直至脑干听觉诱发电位出现异常 ,并记录出现异常时对应的血清胆红素值。同时记录各患儿的胎龄、出生体重、血清白蛋白值和血pH值。结果 :151例早产儿 ,引起脑干听觉诱发电位异常时 ,其血清总胆红素临界值为 (189 3 6± 2 4 2 9) μmol/L ,血清间接胆红素临界值为 (177 41±2 7 2 3 ) μmol/L。对于出生胎龄 <3 2周、～ 3 4周、～ 3 7周的患儿 ,导致脑干听觉诱发电位异常时 ,其血清总胆红素临界值分别为 (160 3 6± 2 1 43 ) μmol/L、(170 67± 14 56) μmol/L和 (182 44± 15 3 7) μmol/L ;血清间接胆红素临界值分别为 (154 67± 2 8 92 ) μmol/L、(161 61± 16 0 6) μmol/L和 (173 76± 19 2 2 ) μmol/L。应用二元变量相关分析研究 ,提示出生胎龄、出生体重、血清白蛋白浓度及血pH值均与血清间接胆红素临界值有相关性 ,其相     

全自动酶法测定血清总和游离卡尼汀浓度及临床应用

目的　建立自动化测定血清总和游离L 卡尼汀浓度的酶分光光度法 (CAT BTND)。方法　对卡尼汀酯水解条件及 pH和L 卡尼汀乙酰基转移酶浓度等反应条件作最佳化研究 ,同时对该法进行方法学评估 ,并用该法测定了 119名正常人的血清样本。结果　该法最低检出限为 4 81μmol/L ,线性范围可达 150 μmol/L(r =0 999)。批内和批间的平均CV分别为游离卡尼汀 5 52 %和5 90 % ,辛酯卡尼汀为 5 78%和 6 14 %。平均回收率为 98 5%和 98 4%。在胆红素≤ 12 0 μmol/L ,血红蛋白≤ 7g/L和抗坏血酸≤ 50 0 μmol/L的情况下 ,对测定结果无显著性影响。正常参考范围 :成人 :男 (3 2名 )总卡尼汀 (48 5± 17 7) μmol/L ,游离卡尼汀 (3 9 2± 14 2 ) μmol/L ,卡尼汀酯 (9 3±5 3 ) μmol/L ;女 (3 1名 )总卡尼汀 (42 7± 17 3 ) μmol/L ,游离卡尼汀 (3 2 4± 18 0 ) μmol/L ,卡尼汀酯(10 5± 5 5) μmol/L。儿童 (年龄 9～ 12岁 ) :男 (3 1名 )总卡尼汀 (57 3± 19 3 ) μmol/L ,游离卡尼汀(45 1± 14 4) μmol/L ,卡尼汀酯 (12 3± 10 4) μmol/L ;女 (2 5名 )总卡尼汀 (59 4± 15 7) μmol/L ,游离卡尼汀 (46 6± 12 6) μmol/L ,卡尼汀酯 (12 8± 7 8) μmol/L。 结论　该法正确快速 ,可作为L 卡尼汀缺乏症     

氧化低密度脂蛋白自身抗体与冠心病相关性研究

目的 :研究氧化低密度脂蛋白自身抗体在冠心病发病中的作用。方法 :检测 82例不同的冠心病人、2 5例正常人血清中常规血脂指标 (CHO ,TG ,LDL)及氧化低密度脂蛋白自身抗体 (OX -LDLAb)。结果 :①OX -LDLAb冠心病人显著高于正常人 (P<0 0 5 ) ,各冠心病组间无明显差异 ;②OX -LDLAbOD值与LDL水平相关 (γ =0 3 3 3 8,P <0 0 5 ) ;③各冠心病血脂指标正常 ,其OX -LDLAb显著高于正常人。结论 :OX -LDLAb与冠心病密切相关 ,OX -LDLAb与LDL浓度有关。OX -LDLAb与冠心病的相关性高于CHO、TG、LDL。     

KHC3法检测血清胆红素

目的采用KHC_3测定血清中总胆红素和直接胆红素,并进行了方法学和临床应用的评价。方法按照NCCLS评价方案对线性、精密度、方法比较和干扰试验作评价。结果精密度:总胆红素(TB)批内n=20,(?)_低=(34．1±1．42)μmol/L,CV%=2．94%;(?)_高=(360．0±2．04)μmol/L,CV%= 1．47%。直接胆红素(DB)批内n=20,(?)_低=(10．0±0．84)μmol/L,CV%=3．02%,(?)_高=(170．0±2．54)μmol/L,CV%=2．13%。TB批间n=20,(?)_低=(34．1±1．99)μmol/L,CV%=3．52%;(?)_高=(360．0±5．72)μmol/L,CV%=3．99%。DB批间n=20,(?)_低=(10．0±1．09)μmol/L,CV%=4．05%;(?)_高=(170．0±6．03)μmol/L,CV%=4．92%。线性范围:TB在0～480μmol/L、DB在0～170μmol/L范围内测定线性良好。回收试验:TB平均回收率为100．5%,DB平均回收率为99．8%。比对实验:与改良J-G法比较, Y_(TB)=1．005X_(TB)+0．789,r=0．991,Y_(DB)=0．953X_(DB)+1．975,r=0．978。参考范围:TB为1．55～22．7μmol/L,DB为0．25～5．01μmol/L。干扰试验:血红蛋白=10．0 g/L,葡萄糖=5%,枸橼酸钠=0．38%,肝素=1250μ/L,甘油三脂＜3．2 mmol/L,维生素C＜0．5g/L,EDTA-K_2＜7．5 g/L时,对TB测定结果无显著影响;血红蛋白=2．0 g/L,葡萄糖=5%,枸橼酸钠=0．38%,肝素＜625μ/L,甘油三脂＜3．2 mmol/L,维生素C＜0．5 g/L,EDTA-K_2＜4．5 g/L时,对DB测定结果无显著影响。结论KHC_3法测定胆红素准确度高,线性范围宽,精密度好,抗干扰能力强,溶血、脂血无明显干扰,液体单试剂,室温保存,试剂稳定,无需配制直接上机使用,是一种崭新、实用的胆红素测定方法。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.