人巨细胞病毒感染对非特异性下腰痛患者内皮功能的影响

目的探讨内皮功能异常与人巨细胞病毒(HCMV)感染致非特异性下腰痛(NLBP)的关系,及其在NLBP发病中的作用。方法NLBP组50例,对照组36例,检测尿沉渣HCMV-DNA和包涵体,外周血HCMV-IgM、IgG和内皮素水平。结果NLBP组尿HCMV-DNA和包涵体,血HCMV-IgM、IgG阳性率高于正常对照组(P<0·05)。NLBP组内皮素水平增高(P<0·05)。结论NLBP常伴有HCMV感染及内皮功能异常。     

儿童特发性血小板减少性紫癜与人类巨细胞病毒感染

目的为探讨特发性血小板减少性紫癜（ITP）与人类巨细胞病毒（HCMV）感染之间的关系，采用非抗凝血清用ELISA方法检测CMV—IgM及清洁晨尿用聚合酶链反应（PCR）方法测定HCMV—DNA含量。结果显示36例ITP患者中，HCMV—DNA阳性者17例，阳性率47．2％，儿童保健门诊正常体检儿童对照组28例，HCMV—DNA阳性者4例，阳性率14．3％，P〈0．01，差异有显著性。ITP患者CMV—IgM阳性者8例，阳性率22．2％，儿童保健门诊正常体检儿童对照组中CMV—IgM阳性者0例。P（0．01，差异有显著性。结论HCMV感染与ITP密切相关。     

首发精神分裂症患者弓形虫感染情况及其对精神症状的影响

背景：弓形虫感染被认为至少与部分精神分裂症的发生有关，不少临床和实验性研究支持该假说。目的：调查首发精神分裂症患者及其母亲弓形虫抗体阳性率，比较弓形虫抗体阳性与阴性患者在临床表现上的区别。设计：采用成组病例对照观察。单位：武汉大学人民医院精神卫生中心。对象：选择2000-01／2004-12武汉大学人民医院精神科住院600例精神分裂症患者为精神分裂症组，患者家属同意参加此调查。选择同期本院参加健康体检的、无任何躯体疾病和精神障碍的正常人200人为正常对照组。选择本院内外科住院的、精神健康的躯体疾病患者200例为疾病对照组。收集252份精神分裂症患者母亲的血样本。方法：①采用酶联免疫法检测血清样本中弓形虫IgG，IgM抗体的水平。②在患者人院两三天后作30～40min的半结构式晤谈，结合患者家属和管床医师提供的有关资料，记录患者的精神障碍家族史、病程、受教育程度、发病年龄、母亲年龄、居住地区。③精神症状评定采用阳性与阴性症状量表，该量表包括阳性症状量表7项（分别为妄想、概念紊乱，幻觉行为、兴奋、夸大、多疑／被害、敌对性），阴性症状量表7项[分别为情感迟钝、情绪退缩、（情感）交流障碍、被动／淡漠社交退缩、抽象思维困难、交谈缺乏自发性和流畅性、刻板思维]和一般精神病理量表16项（分别为关注身体健康、焦虑、自罪感、紧张、装相和作态、抑郁、动作迟缓、不合作、不寻常思维内容、定向障碍、注意障碍、判断和自知力缺乏、意志障碍、冲动控制障碍、先占观念、主动回避社交），共30项，及3个补充项目（分别为愤怒、延迟满足困难、情感不稳）评定攻击危险性（7项评分：1为无．7为极重度）。④计量资料差异比较采用两样本独立t检验；计数资料差异比较采用X^2检验。主要观察指标：①正常对照组、疾病对照组、精神分裂症组及其母亲弓形虫抗体阳性率比较。②弓形虫抗体阳性组和阴性组患者年龄、教育程度、病程、发病年龄和母亲年龄比较。③弓形虫抗体阳性组患者和阴性组患者精神障碍家族史阳性率、居住地区比例．母亲弓形虫抗体阳性率比较。④弓形虫抗体阳性组和阴性组患者阳性与阴性症状量表评分结果。结果：精神分裂症组600例，正常对照组200人，疾病对照组200例，精神分裂症患者母亲252例，其中抗体阴性组患者母亲206例，阳性组患者母亲46例，均进入结果分析。①正常对照组、疾病对照组、精神分裂症组和精神分裂症患者母亲间IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率差异明显（P〈0．01）。②进一步X^2检验表明，正常对照组和疾病对照组IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率差异不明显。③精神分裂症患者母亲IgG抗体阳性率明显高于精神分裂症组和正常对照组＋疾病对照组（P〈0．05，0．01），精神分裂症组明显高于正常对照组＋疾病对照组（P〈0．01）。④精神分裂症患者母亲IgM抗体阳性率明显高于精神分裂症组和正常对照组＋疾病对照组（P〈0．05，0．01），精神分裂症组明显高于正常对照组＋疾病对照组（P〈0．05）。⑤分裂症患者母亲IgG抗体或IgM抗体阳性率明显高于精神分裂症组（P〈0．01）和正常对照组十疾病对照组（P〈0．01），精神分裂症组明显高于正常对照组＋疾病对照组（P〈0．01）。⑥根据患者弓形虫抗体是否阳性分组，IgG抗体或IgM抗体中任一个为阳性则为阳性组n=99），IgG和IgM抗体均为阴性则为阴性组（n=501）。弓形虫抗体阴性组和阳性组患者年龄、受教育情况、发病时间、病程、母亲年龄相近。⑦弓形虫抗体阴性组患者有精神障碍家族史的比例显著高于弓形虫抗体阳性组患者（P〈0．01）；弓形虫抗体阳性组患者的母亲IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率均高于阴性组患者（P〈0．05～0．01）；弓形虫抗体阳性组和阴性组患者阳性与阴性症状量表、阳性症状量表、阴性症状量表、一般精神病理量表总分差异不明显。⑧弓形虫抗体阳性组阳性与阴性症状量表分量表患者兴奋、敌对、装相和作态、意志障碍、冲动控制障碍、愤怒、延迟满足困难得分明显高于弓形虫抗体阴性组（P〈0．01）；而多疑得分低于弓形虫抗体阴性组（P〈0．01）。结论：①弓形虫感染是精神分裂症的重要候选病因。②弓形虫感染与精神分裂症患者年龄、受教育情况、发病时间、病程、母亲年龄关系不大。③未感染弓形虫的精神分裂症患者有精神障碍家族史的更多，感染弓形虫的精神分裂症患者母亲感染弓形虫情况更多见。④弓形虫感染阳性的精神分裂症患者临床表现倾向于兴奋、激越和行为紊乱，对于紊乱性兴奋的精神病患者应注意其是否存在弓形虫感染。     

呼吸道合胞病毒感染大鼠肺干扰素调节因子1表达与Th1／Th2失衡的相关性研究

目的探讨呼吸道合胞病毒（RSV）感染时干扰素调节因子1（IRF-1）对辅助性T淋巴细胞（Th1／Th2）类细胞因子分泌的调控作用。方法随机将16只SD大鼠分为对照组、RSV感染组（RSV滴鼻法建立RSV感染模型）,每组8只。在第8周测定气道反应性;取肺组织苏木素伊红（HE）染色观察病理改变;通过免疫组织化学染色和蛋白质印迹（western—blot）法检测IRF-1在肺组织中的表达;酶联免疫吸附试验（ELISA）检测肺组织匀浆白细胞介素4（IL-4）和干扰素Ⅱ型（IFN-7）水平。结果RSV感染组大鼠肺部病理学切片呈现典型的过敏性炎症表现,而且RSV感染组气道阻力增高程度明显高于对照组大鼠。免疫组织化学染色RSV感染组灰度值较对照组灰度值20838±9931 vs 14514±6553,较对照组显著减低（P〈0．01）。蛋白质印迹法检测肺组织中IRF-1的表达RSV感染组积分光密度值也较对照组积分光密度值0．428±0．02 vs 0．756±0．04显著减低（P〈0．01）。RSV感染组IL-4蛋白水平较对照组明显增强（P〈0．01）,而IFN-γ蛋白水平明显减低（P〈0．01）。肺IBF-1水平与IFN-γ水平呈正相关（P〈0．01）,与IL-4水平呈负相关（P〈0．01）,与IFN-／IL-4比值呈正相关（P〈0．01）。结论RSV感染可以下调IRF-1在肺组织中表达,并可能与Th1／Th2的免疫失衡有关。     

病毒性肝炎患者血脂水平观察

目的：了解病毒性肝炎患者的血脂水平。方法：将90例患者分两组，38例血清抗-HCV抗体阳性患者为HCV感染组，52例血清HBsAg阳性携带者为HBV感染组。结果：（1）HBV感染组和HCV感染组的血清总胆固醇水平[分别为（3．91±3．75）mmol／L；（3．54±3．94）mmol／L]均比正常对照组低，存在显著差异（P〈O．05）；甘油三酯水平[分别为（1．25±0．35）mmol／L；（1．44±0．4）mmol／L]均比正常对照组高，且存在显著差异（P〈O．05）。（2）HCV感染组的总胆固醇比HBV感染组的低（P〈O．05），比甘油三脂的水平要高（P〈O．05）。（3）HDL-CH、LDL-CH浓度两组间无显著差异（P〉0．05），与正常对照组也无显著差异（P〉0．05）。结论：病毒性肝炎患者依其感染病毒的不同而血脂水平有差异。     

肺癌与幽门螺杆菌感染相关性研究

目的探讨肺癌与幽门螺杆菌（Hp）感染的关系。方法用酶联免疫吸附试验（ELISA）检测方法，对50例肺癌患者和50例非肿瘤患者进行血清幽门螺杆菌血清学抗体（Hp-IgG）和幽门螺杆菌细胞毒素相关蛋白抗体（Hp-CagA-IgG）检测。结果①肺癌组Hp-IgG阳性率92．0％，平均抗体水平250．714U／ml。显著高于对照组的阳性率44．0％（P〈0．01）和平均抗体水平77．674U／ml（P〈0．01）。②肺癌组Hp-CagA-IgG阳性率88．0％，显著高于对照组的阳性率20．0％（P〈0．01）。③鳞癌Hp-IgG平均水平（322．10U／ml），明显高于腺癌和小细胞癌（163．92U／ml、196．66U／ml）（P〈0．05）。结论肺癌与Hp感染密切相关，鳞癌平均Hp-IgG水平明显高于腺癌和小细胞癌。     

可溶性CD14和HCMV感染与冠心病病情变化关系

目的探讨可溶性CD14（sCD14）和人巨细胞病毒（HCMV）感染与冠心病（CHD）病情变化的关系。方法应用ELISA法测定120例CHD病人血清sCD14和HCMV—IgG的浓度,其中急性心肌梗死（AMI）、不稳定型心绞痛（UAP）和稳定型心绞痛（SAP）病人各40例,并与40例健康体检者（对照组）进行比较。结果AMI、UAP与SAP组SCD14和HCMV—IgG的浓度均显著高于对照组,差异有显著意义（F=132．94、49．07,q=9．70～27．58,P〈0．01）。AMI、UAP与SAP病人sCD14和HCMV-IgG比较,差异有显著性,且以AMI病人增高最明显（q=2．92～17．88,P〈0．05、0．01）。结论血清sCD14浓度升高和HCMV感染程度可能与冠状动脉病变程度有关,对冠状动脉病变程度有预测价值。     

肥大细胞及其脱颗粒在幽门螺杆菌相关性胃炎中的作用

目的：探讨肥大细胞（MC）在幽门螺杆菌（Hp）相关性胃炎中的作用。方法：选择200例慢性胃炎患者，取胃窦黏膜进行HE染色及Hp检查，计算黏膜及黏膜下的完整和脱颗粒MC数。结果：Hp阳性组黏膜内MC脱颗粒者多于Hp阴性组（P〈0．01）；MC计数在活动性炎症组高于非活动性炎症组（P〈0．01）。结论：MC可能在Hp相关性胃炎的发生中起着重要作用。     

老年脑梗死患者肺炎衣原体感染与血脂关系的研究

目的探讨老年脑梗死患者肺炎衣原体（Cpn）感染与血脂的关系。方法采用微量免疫荧光法检测老年脑梗死组88例及对照组80例外周血CpnIgG抗体，同时测定血脂。结果脑梗死组及对照组血清CpnIgG抗体阳性率分别为79．5％及47．8％，差异有统计学意义（P〈0．01），脑梗死组血脂总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、载脂蛋白A（apoA）显著高于对照组（P〈0．01），而高密度脂蛋白胆固醇（HDL—C）脑梗死组显著低于对照组（P〈0．01）；Cpn感染者特异性抗体IgG滴度与血中TG、LDL—C及apoA有明显相关性（r分别为0．47、0．65和0．43），而与HDL—C成负相关（r=-0．81）（P〈0．01）。结论Cpn感染可能是老年患者脑梗死的一个重要发病机制之一，Cpn可能通过影响脂质代谢在脑梗死的发生、发展中起作用。     

疼痛教育项目提高癌症患者疼痛治疗效果的有效性评价

目的：确定疼痛教育项目对减轻患者对疼痛治疗的顾虑、提高遵医行为，从而提高疼痛缓解程度及对疼痛治疗的满意程度的有效性。方法：对112例癌症疼痛患者开展疼痛教育，对比干预前后患者对疼痛治疗的顾虑和遵医行为的变化，对比干预前后患者的疼痛缓解程度及对疼痛治疗的满意度的变化。结果：与疼痛教育前比较，教育后患者对疼痛治疗的总体顾虑水平明显减低（P〈0．01）；能够完全遵医嘱用止痛药的患者比例明显增加（P〈0．01）；疼痛中度及明显缓解的患者比例增加（P〈0．01）；患者对疼痛治疗的满意度明显提高（P〈0．01）。结论：在规范化治疗的前提下，开展疼痛教育项目，可明显减轻患者对疼痛治疗的顾虑，提高其治疗依从性，从而保证疼痛治疗的顺利进行，对临床癌症疼痛控制起积极的促进作用。     

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.