表观扩散系数与乳腺浸润性导管癌预后因素的相关性分析

目的：通过ADC值的测量探讨DWI在乳腺浸润性导管癌预后评价中的临床应用价值。材料与方法分析47例病理证实为浸润性导管癌的患者病灶ADC值,并与预后因素进行对照分析。结果乳腺浸润性导管癌ADC平均值为(0.957±0.151)×10-3 mm2/s,组织学分级与ADC值间存在负相关关系(r=0.876, P=0.000);病灶>2 cm组平均ADC值低于≤2 cm组(t=2.600,P=0.013);淋巴结转移阳性组平均ADC值低于阴性组(t=4.123,P=0.000);ER及PR阳性组平均ADC值低于阴性组(t=3.557,P=0.003;t=3.599,P=0.002);HER-2阳性组平均ADC值低于阴性组,但差异无统计学意义(t=1.399,P=0.173)。结论ADC值与乳腺浸润性导管癌部分预后因素存在相关性,它可能是评价乳腺浸润性导管癌预后的潜在参数。     

不同乳腺非特殊型浸润性癌分子分型的MRI表观扩散系数特点研究

目的探讨乳腺非特殊型浸润性导管癌各分子亚型(Luminal A、Luminal B、HER-2过表达、基底细胞样型)及其生物学因子[雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、HER-2及Ki-67]的表观扩散系数(apparent diffusioncoefficient,ADC)是否具有一定的特征性,为鉴别不同分子亚型及评估乳腺癌预后提供理论依据。材料与方法回顾性分析术前行MRI检查的158例乳腺非特殊型浸润性癌患者的资料,术前获得扩散加权成像并测定平均ADC值,术后采用免疫组化检查获得ER、PR、HER-2及Ki-67等生物学因子和4种分子亚型。比较不同分子亚型间及乳腺癌生物学因子间的ADC值是否具有各自特征。结果 ER、PR、Ki-67阴性者的ADC值(1.013±0.099,1.002±0.094,1.003±0.087)高于阳性者(0.932±0.066,0.940±0.079,0.952±0.089),差异有统计学意义(P均<0.01);HER-2阳性者ADC值(1.004±0.088)显著高于阴性者(0.948±0.088),差异有统计学意义(P<0.05);HER-2过表达型的ADC值(1.048±0.073)较管腔B型及基底细胞样型(0.923±0.074,0.960±0.095)高,差异有统计学意义(P均<0.01)。结论乳腺非特殊型浸润性癌的各分子分型及生物学因子的ADC值具有一定的特征性。     

乳腺非特殊型浸润性癌和非典型导管增生组织中Caspase-3、P53及Ki-67表达变化

目的探讨乳腺非特殊型浸润性癌、非典型导管增生组织中Caspase-3、P53及Ki-67表达变化。方法回顾性收集200例乳腺手术切除标本,其中100例非特殊型浸润性癌、100例非典型导管增生症。观察乳腺非特殊型浸润性癌、非典型导管增生组织中Caspase-3、P53及Ki-67表达变化,分析Caspase-3、P53、Ki-67三者表达的相关性及其与乳腺非特殊型浸润性癌的临床病理特征的关系。结果乳腺非特殊型浸润性癌中Caspase-3显著低于非典型导管增生组织,P53、Ki-67阳性表达例数均显著高于非典型导管增生组织,差异有统计学意义(P0.05)。Caspase-3、P53及Ki-67表达与非特殊型浸润性癌的组织学分级、临床分期、淋巴结转移有关(P0.05);而与非特殊型浸润性癌的年龄、肿瘤直径无关(P0.05)。在乳腺非特殊型浸润性癌中,Caspase-3表达与P53、Ki-67呈负相关(r=0.445,P0.05;r=0.417,P0.05),P53与Ki-67呈显著性正相关(r=0.387,P0.05)。结论与非典型导管增生组织相比,Caspase-3在乳腺非特殊型浸润性癌中表达较低,P53及Ki-67在乳腺非特殊型浸润性癌中表达较高,而且上述三种蛋白表达情况与肿瘤临床病理特征有关,可为临床诊断、治疗提供一定依据。     

浸润性导管癌钼靶X线征象:高密度与等密度肿块比较

目的:比较乳腺浸润性导管癌钼靶X线中肿块高密度组与等密度组浸润性导管癌的钼靶X线征象异同.方法:回顾性分析49例浸润性导管癌的钼靶X线资料并采用t检验或两独立样本秩和检验对出现肿块征象的39例按密度分成高密度组及等密度组进行单因素分析:(1)计算Spearman相关系数,(2)比较两组包括年龄、腺体分型、侧别、象限、肿块形态、边缘、密度、肿块短径、肿块长径、钙化形态、分布、腋下淋巴结改变、乳头改变、皮肤改变、病理淋巴结转移、病理分级差异是否具有统计学意义.结果:(1)肿块密度与腺体组成成分呈中度正相关(r=0.332,P=0.039),肿块边缘呈中度负相关(r=-0.506,P=0.001),淋巴结转移呈中度负相关(r=-0.421,P=0.036).(2)肿块高密度组较肿块等密度组腺体更少(Z=-2.048,P=0.041),边缘更不规则(Z=-2.065,P=0.039),淋巴结转移更常见(Z=-2.235,P=0.025).结论:钼靶X线中浸润性导管癌病例出现肿块为高密度者乳腺腺体成分相对更少,肿块边缘更不规则,更多出现淋巴结病理转移,结合乳腺癌预后指数Cox预测模型,预后指数增高,患者预后差.     

乳腺浸润性导管癌的3.0TMRI诊断

目的探讨乳腺浸润性导管癌的3.0T MR影像学特点,提高对浸润性导管癌术前诊断的准确性。材料与方法回顾性分析65例（69病灶）经手术或穿刺病理证实的浸润性导管癌患者的MRI资料,均采用3.0T MRI行平扫、动态增强及DWI序列扫描,分析病灶的MRI影像学特征,包括形态学表现、血流动力学特征、时间-信号曲线（TIC）及ADC值。采用配对设计t检验比较浸润性导管癌病灶和正常乳腺组织ADC值的差异,同时采用成组设计方差分析比较3型曲线间ADC值有无差异。结果 65例（69例病灶）浸润性导管癌表现为肿块型[58.0%（40/69）]或非肿块型[42.0%（29/69）],边缘不规则,T1WI呈等[36.2%（25/69）]或低信号[63.8%（44/69）],T2WI呈稍高[27.5%（19/69）]或高信号[72.5%（50/69）],DWI呈稍高[49.3%（34/69）]或高信号[50.7%（35/69）],增强扫描肿块型呈早期不均匀强化,内部间隔强化,非肿块型以导管样及簇集状强化为主,TIC以Ⅱ型[56.5%（39/69）]、Ⅲ型[37.7%（26/69）]曲线为主,ADC平均值（0.93±0.21）×10^-3mm^2/s,尚不能认为3型曲线间ADC值差异有统计学意义（F=0.182,P=0.834〉0.05）。结论应用3.0T MRI动态增强扫描及DWI序列,能较好的显示病变形态及强化方式,结合形态学表现、血流动力学及功能学特征,有助于对浸润性导管癌的术前诊断。     

乳腺浸润性导管癌3.0TMRI表现与预后因子相关性研究

目的：探讨乳腺浸润性导管癌磁共振表现与生物学预后因子间的相关性。材料与方法对128例原发性乳腺浸润性导管癌患者术前行MR扫描,根据MRI乳腺影像报告和数据系统描述乳腺癌的MR表现。术后标本行免疫组化染色测定ER、PR、Her-2、Ki67的表达情况,采用Spearman等级相关和二元Logistic回归统计学方法分析其与MRI表现参数的相关性。结果肿瘤分叶征和Ki67表达呈负相关（P=0.014）;环形强化和ER、PR表达呈明显负相关（P=0.002,P=0.016）;Ⅲ型时间信号强度曲线和Ki67表达显著正相关（P=0.012）。结论乳腺浸润性导管癌MR表现参数与生物学预后因子之间存在一定相关性,可根据MR表现对病灶的生物学行为和患者预后进行评估。肿瘤环形强化和Ⅲ型曲线常提示患者预后不良。     

乳腺浸润性癌中P-ERK与CXCL14的表达及临床意义

目的分析人乳腺组织中P-ERK和CXCL14表达的变化,探讨P-ERK和CXCL14在乳腺癌中预后、鉴别诊断的作用。方法应用免疫组织化学S-P法检测P-ERK和CXCL14,在乳腺正常上皮(15例)、导管原位癌(20例)、乳腺非特殊类型浸润性癌(浸润性导管癌)(60例)中阳性表达情况;应用免疫组化方法检测P-ERK和CXCLl4在乳腺非特殊类型浸润性癌(浸润性导管癌)与乳腺浸润性小叶癌中表达,检测乳腺非特殊类型浸润性癌(浸润性导管癌)中CXCLl4的表达与乳腺非特殊类型浸润性癌(浸润性导管癌)分子分型的关系;乳腺非特殊类型浸润性癌(浸润性导管癌)及正常乳腺组织中应用Western blot方法 ,检测P-ERK、CXCL14蛋白表达情况。结果①乳腺正常组织、导管原位癌、乳腺非特殊类型浸润性癌(浸润性导管癌)中P-ERK阳性率分别为20.0%、50.0%、53.3%,CXCL14阳性率分别为73.3%、30%、26.7%。②CXCLl4在乳腺非特殊类型浸润性癌(浸润性导管癌)与乳腺浸润性小叶癌中,阳性表达率无统计学意义。③CXCL14阳性率与乳腺非特殊类型浸润性癌(浸润性导管癌)组织学分级、淋巴结癌组织转移(P0.05)相关,ER和PgR阳性表达不相关(P0.05);P-ERK的阳性率与乳腺癌的组织学分级相关(P0.05)。④乳腺非特殊类型浸润性癌(浸润性导管癌)中CXCLl4阳性率与分子分型不相关。⑤60例乳腺非特殊类型浸润性癌(浸润性导管癌)P-ERK和CXCL14阳性表达呈负相关性(rs=-0.418,P0.01)。⑥Western blot结果表明乳腺非特殊类型浸润性癌(浸润性导管癌)组织中CXCL14蛋白表达量(CXCL14:0.086±0.010)低于癌旁正常乳腺组织中CXCL14蛋白表达量(CXCL14∶1.35±0.028)(P0.05)。结论乳腺非特殊类型浸润性癌(浸润性导管癌)中CXCL14低表达,P-ERK高表达,P-ERK和CXCL14具有负相关性。乳腺非特殊类型浸润性癌(浸润性导管癌)中调控P-ERK表达可以负性调控CXCL14的表达,同时检测P-ERK和CXCL14对于乳腺良性病变、恶性病变的鉴别以及对乳腺非特殊类型浸润性癌(浸润性导管癌)诊断的治疗、预后评估有重要参考价值。     

扩散加权成像与乳腺浸润性导管癌分子生物标记的相关性研究

目的:研究表观扩散系数(apparent diffusion coefficient,ADC)与乳腺浸润性导管癌分子生物学标记之间的关系,以指导临床判断预后及选择治疗方案。方法:对67例乳腺浸润性导管癌患者进行磁共振扩散加权成像(diffusion weighted imaging,DWI)检查,并测量病灶ADC值。术后免疫组化分析人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、Ki-67,统计学分析ADC值与ER、PR、HER-2、Ki-67的相关性,并研究不同分子分型病灶之间ADC值的差别。结果:Spearman相关性分析表明,ADC值与Ki-67之间无相关性(P0.05);ER、PR、HER-2阴性表达者ADC值高于阳性者(P0.05);三阴性病灶ADC值明显高于Luminal A型、Luminal B型、HER-2过表达型(P0.05);HER-2过表达型病灶ADC值高于Luminal B型。结论:ADC值与乳腺浸润性导管癌分子生物标记及分子分型具有相关性,可辅助指导临床选择治疗方案及判断预后。     

肿块型乳腺导管癌淋巴结转移的影响因素

目的 探讨肿块型乳腺导管癌发生淋巴结转移的影响因素,为临床制定合理个体化治疗方案提供依据.材料与方法 回顾性分析本院经病理证实的女性乳腺导管癌患者177例.评价指标包括临床(年龄、肿瘤T分期、WHO分级)、病理分子分型、MRI特点(大小、位置、ADC值、动态增强曲线)等参数,并根据病理结果 将其分为淋巴结转移阳性组(A组),阴性组(B组).应用SPSS 20.0统计学软件进行分析,采用独立样本t检验,Fisher确切概率法、Pearson-卡方检验进行比较,检验水准:P<0.05.结果 与阴性组比较,阳性组T分期更高(χ2=45.14,P=0.000)、病理学分级高(χ2=138.67,P=0.000)、位置以外上象限为主,差异均存在统计学意义(P<0.05);而肿块大小、ADC值、年龄、动态增强曲线、病理分子分型等方面,两组差异没有统计学意义(P>0.05).结论 肿块型乳腺导管癌的淋巴结转移与肿瘤T分期、病理学分级、肿块在乳腺的位置有关(χ2=17.66,P=0.004),且肿瘤T分期≥2、WHO分级≥Ⅱb级、肿块位于中央区及全乳癌者是乳癌淋巴结转移的高危因素.     

DWI评价乳腺浸润性导管癌生物学特征

目的 探讨DWI评估乳腺浸润性导管癌（IDC）生物学特征的价值。方法 回顾性分析经手术病理证实的87个乳腺浸润性导管癌的DWI数据,测量ADC值,评价并比较ADC值在不同腋窝淋巴结状态、组织学级别及分子学分型间的差异,并分析ADC值与腋窝淋巴结状态、组织学级别及分子学分型的相关性。结果 淋巴结阳性病灶ADC值低于淋巴结阴性病灶（P=0.035）,高级别乳腺癌ADC值低于中级别、低级别乳腺癌（P=0.021、0.002）,ADC值在不同分子分型间差异无统计学意义。ADC值与组织学分级呈低度负相关（r_s=-0.357,P=0.001）,与腋窝淋巴结转移及分子分型呈弱的负相关（r_s=-0.227,P=0.034;r_s=-0.093,P<0.001）。结论 DWI能够反映乳腺浸润性导管癌的生物学特征。     

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.