非手术脊柱减压系统治疗腰椎间盘突出症的疗效观察

目的：观察非手术脊柱减压系统对腰椎间盘突出症患者腰痛、腰椎活动功能和椎旁肌功能,以及腰椎间盘突出程度和椎间盘高度的疗效观察。方法：将40例腰椎间盘突出症（LDH）患者随机分为牵引组和非手术脊柱减压系统（SDS）组各20例。牵引组在常规康复治疗基础上予普通牵引治疗,SDS组在常规康复治疗基础上予SDS治疗。治疗前后,用视觉模拟（VAS）评分量表评估2组患者腰痛程度,日本骨科学会（JOA）下腰痛量表评估腰椎活动功能,表面肌电图评估椎旁肌功能,美国超导型核磁共振评估椎间盘突出指数（DHI）和椎间盘高度（DH）。结果：治疗6周后,2组患者VAS评分均明显低于治疗前（均P<0.05）,JOA评分均明显高于治疗前（均P<0.05）;SDS组VAS评分明显低于牵引组（P<0.05）,JOA评分明显高于牵引组（P<0.05）。2组患侧竖脊肌和多裂肌平均肌电值（AEMG）均明显高于治疗前（均P<0.05）;SDS组平均肌电值AEMG明显高于牵引组（P<0.05）。2组患者患侧竖脊肌和多裂肌平均功率频率斜率（MPFs）均明显高于治疗前（均P<0.05）,SDS组MPFs明显高于牵引组（P<0.05）。2组患者病变节段DHI均明显低于治疗前（均P<0.05）,DH明显高于治疗前（均P<0.05）;SDS组DHI明显低于牵引组（P<0.05）,但2组DH比较,差异无统计学意义。结论：SDS能明显减轻腰痛,改善LDH患者腰椎活动功能、椎旁肌功能和腰椎间盘突出程度,疗效优于普通牵引。     

悬吊训练治疗脑卒中患者平衡功能障碍的临床研究

目的: 观察悬吊训练（SET）对脑卒中患者平衡功能恢复的影响。方法: 脑卒中平衡功能障碍患者40例,随机分为对照组和观察组各20例,2组均接受常规康复训练,在此基础上,观察组加以悬吊训练。治疗前和治疗4周后采用Berg平衡量表（BBS）、Barthel指数（BI）以及采集竖脊肌表面肌电平均肌电值（AEMG）和中位频率值（MF）对2组患者进行评定。结果: 治疗4周后,2组BBS、BI评分均明显高于治疗前（均P<0.01）,且观察组以上评分均明显高于对照组（均P<0.05）。治疗前,2组患者AEMG、MF值组内比较健侧均明显高于患侧（均P<0.05）;治疗４周后,2组患者健患侧竖脊肌AEMG、MF值均较治疗前明显提高（均P<0.05）,观察组健患侧AEMG、MF值均较对照组明显提高（均P<0.05）,但观察组健患侧AEMG、MF值之间无统计学差异。结论: SET能够改善脑卒中患者的竖脊肌AEMG、MF值及BBS和BI评分,提高脑卒中患者躯干肌肉运动功能,从而提高平衡功能以及日常生活活动能力,值得在临床推广应用。     

青少年特发性脊柱侧弯症患者椎旁肌表面肌电信号时域指标变化规律

目的:采用表面肌电图（sEMG）检测技术对青少年特发性脊柱侧弯症(AIS)患者脊柱旁凸、凹侧椎旁肌肌电活动时域指标变化规律进行初步探讨。方法:AIS患者25例,男7例,女18例,年龄11—21岁;正常对照组少年14例,男4例,女10例,年龄12—19岁;两组受试者均执行BST实验、抬物实验,采用ME6000型表面肌电仪记录受试者双侧椎旁肌表面肌电信号时域指标平均肌电值（AEMG）、频谱面积（SPA）。结果: AIS患者脊柱旁顶椎区凸、凹侧椎旁肌AEMG(凸侧106.76±47.73μV/s, 凹侧67.93±26.11μV/s,P<0.01),SPA（凸侧11.01±8.81 m2,凹侧4.38±3.14m2,P<0.01）,差异具有显著性意义;正常对照组椎旁肌左、右侧表面肌电值差异无显著性意义。结论: AIS患者脊柱旁顶椎区凸、凹侧椎旁肌肌电活动不对称,表面肌电图可用作评定AIS脊柱旁凸、凹侧肌电活动差别的客观检查之一,具有较好的临床应用价值。     

脑卒中后偏瘫上肢康复过程中表面肌电分析

目的 观察脑卒中偏瘫患者在康复进程中其偏瘫侧肱二头肌、拇短屈肌及第一骨间背侧肌做最大等长收缩时表面肌电信号（sEMG）变化及其与上肢运动功能恢复间的相关性，为临床制订个体化康复干预方案提供参考资料。 方法 选取20例脑卒中患者（将其纳入实验组）及10例年龄、性别与患者相匹配的健康志愿者（将其纳入正常对照组）。记录所有受试者双侧上肢分别做肘屈、拇屈、食指外展最大等长收缩时肱二头肌、拇短屈肌、第一骨间背侧肌sEMG信号，并跟踪记录患者偏瘫侧上述肌肉sEMG在康复进程中的变化；采用简式上肢Fugl-Meyer量表（FMA）和徒手肌力评定（MMT）评估患者上肢运动功能及肌力改善情况，计算sEMG信号的均方根值（RMS）、中值频率（MDF）及与上肢FMA、MMT评分的相关性。 结果 正常对照组所检肌群RMS及MDF值左、右侧间差异均无统计学意义（P>0.05）；实验组偏瘫侧所检肌肉RMS、MDF值均显著小于健侧及正常对照组水平（P<0.05），健侧RMS、MDF值均显著大于正常对照组水平（P<0.05）。实验组偏瘫侧所检肌肉RMS、MDF值随康复日程延长呈上升趋势，且末次检测值明显大于首次检测值（P<0.05）。实验组患者上肢FMA评分、MMT评分与上肢所检肌肉RMS值、MDF值均具有正相关性。 结论 脑卒中偏瘫侧上肢sEMG既可反映上肢康复进程，又能反映肌力及运动功能恢复情况，可作为一种定量康复评估指标，从而为制订个体化上肢功能康复训练方案提供参考资料。     

局部振动治疗对颈肩痛患者肌肉物理特性及表面肌电信号的影响

目的观察单次局部振动肌肉刺激治疗对颈肩痛患者肌肉物理特性及肌电信号的影响以及其发挥作用的有效时长。 方法筛选符合入选标准的颈肩疼痛患者34例，应用局部振动肌肉刺激仪对斜方肌和肩胛内侧缘进行治疗，每个部位治疗30s，重复3～5次。分别于治疗前、治疗后即刻、治疗后2h和治疗后6h，采用目测类比法（VAS）评分对患者的疼痛程度进行评估；采用MyotonPRO数字化肌肉功能评估系统评估患者双侧颈肩部上斜方肌的肌肉状态，包括F-振动频率、D-振幅的对数衰减值、S-动态硬度；采用Noraxon 16通道表面肌电仪记录患者双手上举时上斜方肌的sEMG信号，取时域指标积分肌电值（IEMG）、平均肌电值（AEMG）及频域指标中位频率（MF），并比较治疗前后和治疗后不同时间点的肌电信号的变化。 结果治疗后即刻患者的F、D、S值（12.55±2.13、0.94±0.16、200.70±55.38）及治疗后2h患者的F、D、S值（12.83±2.22、0.99±0.16、205.80±57.80）均较患者治疗前（15.24±3.22、1.14±0.20、265.50±78.57）明显降低（P<0.05），VAS评分亦显著下降（P<0.01），治疗后6h与治疗前比较，F、D、S、VAS评分差异均无统计学意义（P>0.05）。双上肢上举过程中，治疗后即刻疼痛侧上斜方肌的AEMG（88.50±19.09）较治疗前（48.24±13.41）显著升高（P<0.01），IEMG（404.40±190.04）和MF（0.15±0.15）仍明显高于治疗前（171.00±47.64、0.04±0.01），差异有统计学意义（P<0.05）。治疗后2h患者的AEMG（79.28±18.18）和IEMG（383.20±191.07）均较治疗前明显升高（P<0.05），而MF与治疗前比较差异无统计学意义（P>0.05）。治疗后6h，AEMG、IEMG和MF与治疗前比较，差异均无统计学意义（P>0.05）。 结论单次局部振动治疗可以降低颈肩痛患者颈肩部肌肉的硬度，缓解疼痛，激活肌肉收缩强度，治疗效果可以持续2h。     

悬吊运动疗法对颈椎病患者颈部肌肉功能的影响

目的 观察悬吊运动疗法（SET）对颈椎病治疗前、后的表面肌电活动的影响,并与常规推拿治疗效果相比较,探讨SET治疗颈椎病的疗效。 方法 将颈椎病患者40例按随机数字表法将40例患者分成SET组和对照组,每组20例。对照组采用常规的推拿治疗训练,SET组根据表面肌电图的结果实施特异性的SET治疗。2组患者均连续治疗6周。2组患者分别于治疗前和治疗6周后（治疗后）进行颈伸肌的sEMG测试［包括平均肌电值（AEMG）和中位频率斜率值（MF slope）］和视觉模拟评分（VAS）。 结果 治疗后,SET组颈部竖脊肌和斜方肌的AEMG较组内治疗前均显著改善,差异均有统计学意义（P<0.05）。治疗后,2组患者颈部竖脊肌和斜方肌的MF slope较组内治疗前均显著降低,差异均有统计学意义（P<0.05）,且SET组治疗后颈部竖脊肌和斜方肌的MF slope与对照组治疗后比较,差异均有统计学意义（P<0.05）。治疗后,SET组和对照组的VAS评分分别为（2.1±1.3）分和（3.0±1.1）分,均较组内治疗前显著改善（P<0.05）,且SET组治疗后的VAS评分与对照组治疗后比较,差异亦有统计学意义（P<0.05）。对2组患者治疗前、后颈部竖脊肌和斜方肌MF slope降低值与VAS的变化值进行Pearson相关分析,SET组分别为（r=0.463,P<0.05;r=0.678,P<0.05）,对照组为（r=0.550,P<0.05;r=0.486,P<0.05）,即颈部竖脊肌和斜方肌的MF slope的下降率与VAS变化值呈显著正相关。 结论 SET可显著改善颈椎病患者的颈部肌肉功能,且疗效优于推拿治疗。     

关于下背痛患者腰部多裂肌表面肌电信号与肌肉横断面积的研究分析

目的 比较下背痛患者双侧多裂肌表面肌电信号平均肌电振幅值（AEMG）与肌肉横断面积（CSA）变化差异，分析两者之间变化相关性。 方法 选取30例健康成年志愿者（对照组）和30例下背痛患者（病例组），利用表面肌电图检测仪和超声诊断仪分别对2组受试者L5～S1部位双侧多裂肌的AEMG值及CSA值进行比较分析。 结果 对照组多裂肌AEMG和CSA值的左右侧之间比较,均差异均无统计学意义（P>0.05）；病例组疼痛侧AEMG和CSA值均小于非疼痛侧，且两侧间差异均有统计学意义(P<0.01)。病例组疼痛侧的多裂肌AEMG值与CSA值呈显著相关（P=0.000，r=0.766)，病例组非疼痛侧多裂肌AEMG值与CSA值亦呈显著相关（P=0.000，r=0.763)；对照组左侧多裂肌AEMG值与CSA值呈显著相关（P=0.000，r=0.807)，对照组右侧多裂肌AEMG值与CSA值亦呈显著相关（P=0.000，r=0.800）。 结论 下背痛患者疼痛侧多裂肌AEMG和CSA值与健侧相比偏小，且双侧多裂肌AEMG值与CSA值变化均显著相关。     

悬吊运动疗法对产后下背痛的疗效和表面肌电信号观察

目的：观察常规康复基础上辅以悬吊运动疗法对产后下背痛患者的疼痛、日常生活活动能力以及竖脊肌表面肌电信号的影响。方法：32例产后下背痛患者按分娩方式分为观察组和对照组各16例。对照组采用常规康复治疗,观察组在此基础上增加悬吊运动疗法。2组治疗时间均为3d/周,共计4周。于治疗前、后评定患者疼痛相关的视觉模拟量表法（VAS）、简体中文版Oswestry失能问卷(SCODI),于治疗后使用时域指标平均肌电值（AEMG）、平均功率频率（MPF）和中位频率（MF）评价患者竖脊肌的痛侧和对侧表面肌电信号（sEMG）活动,比较2组疗效差异。结果：治疗后,2组患者VAS和SCODI评分均较治疗前明显降低(均P<0.05),且观察组患者VAS和SCODI评分更低于对照组(均P<0.05)。治疗后,观察组痛侧的竖脊肌的MF、MPF均较对照组痛侧下降、AEMG较对照组痛侧升高（均P＜0.05）。结论：常规康复基础上辅以悬吊运动疗法能够明显改善产后下背痛患者的疼痛和日常生活活动能力,同时sEMG变化亦提示悬吊运动疗法对患者竖脊肌功能水平和疲劳程度明显改善。     

多点多轴悬吊训练治疗非特异性腰痛的表面肌电研究北大核心CSCD

目的通过表面肌电图探讨多点多轴悬吊训练对非特异性腰痛(NLBP)的治疗效果。方法 2016年10月至2017年11月,24例单侧NLBP患者(NLBP组)随机分为动态组(n=12)和静态组(n=12);另选健康志愿者12例为对照组。NLBP组均采用多点多轴悬吊训练系统训练,动态组选择仰卧位骨盆上移训练,静态组选择仰卧位腰椎中立保持训练,共训练10 d。治疗前后测量痛侧多裂肌平均肌电值(AEMG)和疼痛视觉模拟评分(VAS);对照组测单侧多裂肌AEMG。结果治疗前,静息位及骨盆上移时NLBP组AEMG明显高于对照组(t>3.209, P<0.01),中立保持位NLBP组AEMG低于对照组(t=-2.364, P<0.05)。治疗后NLBP组各体位AEMG均改善(t>2.982, P<0.01),静息位和中立保持位AEMG与对照组无显著性差异(F<2.921, P>0.05),骨盆上移AEMG动态组显著高于对照组和静态组(P<0.001)。治疗后,静态组和动态组VAS均显著降低(t>10.416, P<0.001),静态组显著低于动态组(t=-4.389, P<0.001)。结论 NLBP患者疼痛肌肉出现特异性表面肌电改变;多点多轴悬吊训练通过改善腰部核心肌群产生治疗作用,且静态保持训练比动态上抬训练效果更佳。     

普拉提联合盆底康复训练对青年宫颈癌根治术后尿失禁患者盆底肌张力及性功能的影响

目的：探究普拉提联合盆底康复训练对青年宫颈癌根治术后尿失禁患者盆底肌张力及性功能的影响。方法：选前瞻性收集我院2022年1月~2023年1月宫颈癌术后尿失禁患者132例,按照随机数字表法将患者分为观察组和对照组各66例,对照组给予常规盆底康复训练,观察组实施普拉提联合盆底康复训练。对比2组患者术前、术后1周、术后13周膀胱功能（储尿时和排尿时的膀胱压、尿道分布压,采用牛津评分法（MOS）评估盆底肌张力;评估女性性功能指数量表（FSFI）评分;采用Kolcaba舒适度量表对舒适度进行评估比较,并观察术后并发症情况。结果：2组术前、术后1周时,储尿时及排尿时的膀胱压、尿道分布压组内及组间比较均无统计学差异,2组术后13周时储尿时的膀胱压、尿道分布压以及排尿时的膀胱压高于术前、术后1周时,排尿时尿道分布压低于术前及术后1周时（均P<0.05);观察组患者术后13周时膀胱功能储尿时的膀胱压、尿道分布压以及排尿时的膀胱压均高于对照组,排尿时尿道分布压低于对照组（均P<0.05);2组患者术前及术后1周时Ⅰ、Ⅱ类肌纤维肌张力比较无统计学差异,术后13周时Ⅰ、Ⅱ类肌纤维肌张力较术前、术后1周时均有所升高（P<0.05),且观察组明显高于对照组（P<0.05);随着治疗时间的延长2组性交痛评分逐渐降低,观察组明显低于对照组,其余各纬度及总分评分随着治疗时间的延长逐渐升高,观察组明显高于对照组,差异均具有统计学意义（均P<0.05）;术后13周,观察组患者的舒适度65/66（98.48%）显著高于对照组42/66（63.64%）（P<0.05）。观察组术后并发症发生率（9.09%）显著低于对照组（P<0.05）。结论：普拉提联合盆底康复训练对青年宫颈癌根治术后尿失禁患者提高盆底肌张力和性功能,降低了术后并发症的发生率。     

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.