癌症患者血中氧化应激标记物的实验室评价

目的评价癌症患者血中氧化应激标志物状况。方法测定111例癌症患者和36例健康对照血中丙二醛(MDA)和抗氧化标志物谷胱苷肽、谷胱苷肽过氧化物酶、黄嘌呤氧化酶、维生素E、维生素C及总抗氧化力浓度。结果癌症患者脂质过氧化产物MDA浓度明显高于健康对照(5.21±1.05nmol/L相对4.04±0.68nmol/L,P<0.001),而机体总抗氧化能力明显低于健康对照(4.39±0.98U/L相对5.78±0.93U/L,P<0.001),但内源性抗氧化标志物(谷胱苷肽、谷胱苷肽过氧化物酶、黄嘌呤氧化酶、维生素E和维生素C)无明显变化(P>0.05)。结论癌症患者体内脂质过氧化水平增高,总抗氧化能力下降。内源性抗氧化标志物谷胱苷肽、谷胱苷肽过氧化物酶、黄嘌呤氧化酶、维生素E和维生素C无明显变化。     

癌症患者血中氧化应激标记物的实验室评价

目的评价癌症患者血中氧化应激标志物状况.方法测定111例癌症患者和36例健康对照血中丙二醛(MDA)和抗氧化标志物谷胱苷肽、谷胱苷肽过氧化物酶、黄嘌呤氧化酶、维生素E、维生素C及总抗氧化力浓度.结果癌症患者脂质过氧化产物MDA浓度明显高于健康对照(5.21±1.04nmol/L相对4.04±0.68nmol/L, P＜0.001),而机体总抗氧化能力明显低于健康对照(4.39±-0.98U/L相对5.78±0.93U/L,P＜0.001),但内源性抗氧化标志物(谷胱苷肽、谷胱苷肽过氧化物酶、黄嘌呤氧化酶、维生素E和维生素C)无明显变化(P＞0.05).结论癌症患者体内脂质过氧化水平增高,总抗氧化能力下降.内源性抗氧化标志物谷胱苷肽、谷胱苷肽过氧化物酶、黄嘌呤氧化酶、维生素E和维生素C无明显变化.     

癌症患者血中微量元素与氧化应激的相关分析

背景:肿瘤的发生与发展是多因素作用的结果。肿瘤的早期诊断、疗效监测、预后评价至今较难。研究肿瘤发生与发展机制或肿瘤患者血液成分、组织分布的变化情况可为肿瘤患者的康复提供理论依据。目的:研究癌症患者血清中某些微量元素水平和过氧化-抗氧化系统的变化情况。设计:对照观察实验。单位:绵阳市中心医院检验科。对象:选择1999-09/2000-12四川自贡第三人民医院、四川宜宾第一人民医院和四川内江市隆昌县人民医院就诊的癌症患者111例,其中肝癌21例,胃癌16例,结肠直肠癌15例,乳腺癌11例,肺癌13例,食道癌13例,脑癌7例,其他癌种15例。同期健康体检者36例,为对照组。方法:受试者空腹,用VACUTEINER真空采血管(普通管,美国BD公司)抽取静脉血液样品至少5mL,2.0～3.0h以3000r/min离心15min分离血清2.0～3.0mL,测定前置冰箱冰冻保存。谷胱苷肽测定采用二硫代二硝基苯甲酸比色法。黄嘌呤氧化酶测定采用黄嘌呤-硝基四唑蓝比色法。谷胱苷肽过氧化物酶测定采用二硝基苯甲酸比色法。丙二醛测定采用硫代巴比妥酸比色法。抗坏血酸、维生素E和总抗氧化力测定采用菲罗啉比色法。白蛋白测定采用溴甲酚紫法。转铁蛋白、铜蓝蛋白测定采用散射比浊法。硒、铜、锌、铁测定采用原子吸收分光光度法。主要观察指标:丙二醛(作脂质过氧化指标);微量元素铜、锌、铁、硒及其转运蛋白(铜蓝蛋白、白蛋白和转铁蛋白);抗氧化态标志物:黄嘌呤氧化酶、谷胱苷肽、谷胱苷肽过氧化物酶、维生素E、维生素C浓度和总抗氧化力水平。结果:癌症患者脂质过氧化水平(以丙二醛计)明显高于对照[癌症组为(5.21±1.05)nmol/L,对照组为(4.04±0.68)nmol/L,P<0.001],总抗氧化力明显低于对照[癌症组为(4.34±0.98)U/L,对照组为(5.87±0.93)U/L,P<0.001]。抗氧化标志物黄嘌呤氧化酶、谷胱苷肽、谷胱苷肽过氧化物酶、维生素E和维生素C无明显变化。癌症患者血清白蛋白浓度明显低于对照[癌症组为(34.19±6.94)g/L,对照组为(42.34±4.89)g/L,P<0.001],血清铜蓝蛋白浓度明显高于对照组[癌症组为(0.371±0.031)g/L,对照组为(0.346±0.026)g/L,P<0.05],血清转铁蛋白浓度未发现有所改变(P>0.05)。血清铜水平明显高于对照[癌症组为(19.27±4.74)μmol/L,对照组为(14.92±2.71)μmol/L,P<0.001],血清硒水平明显低于对照组[癌症组为(1.175±0.333)μmol/L,对照组为(1.413±0.446)μmol/L,P<0.001],但锌和铁水平无显著变化。癌症患者血中铜和丙二醛之间呈明显相关性(r=0.281,P=0.003),但对照组铜与丙二醛未发现相关性存在。另外,肝癌患者血清铁和丙二醛存在相关关系(r=0.680,P=0.001)。结论:癌症患者氧化应激和某些微量元素呈相关变化,然而其变化情况可因癌种、癌症分期以及癌症患者个因素的不同而有所差异。     

癌症患者血中微量元素与氧化应激的相关分析

背景：肿瘤的发生与发展是多因素作用的结果。肿瘤的早期诊断、疗效监测、预后评价至今较难。研究肿瘤发生与发展机制或肿瘤患者血液成分、组织分布的变化情况可为肿瘤患者的康复提供理论依据。 目的：研究癌症患者血清中某些微量元素水平和过氧化-抗氧化系统的变化情况。 设计：对照观察实验。 单位：绵阳市中心医院检验科。对象：选择1999-09／2000-12四川自贡第三人民医院、四川宜宾第一人民医院和四川内江市隆昌县人民医院就诊的癌症患者111例，其中肝癌21例，胃癌16例，结肠直肠癌15例，乳腺癌11例，肺癌13例，食道癌13例，脑癌7例，其他癌种15例。同期健康体检者36例，为对照组。方法：受试者空腹，用VACUTEINER真空采血管（普通管，美国BD公司）抽取静脉血液样品至少5mL，2．0～3．0h以3000r/min离心15min分离血清2．0-3．0mL，测定前置冰箱冰冻保存。谷胱苷肽测定采用二硫代二硝基苯甲酸比色法。黄嘌呤氧化酶测定采用黄嘌呤-硝基四唑蓝比色法。谷胱苷肽过氧化物酶测定采用二硝基苯甲酸比色法。丙二醛测定采用硫代巴比妥酸比色法。抗坏血酸、维生素E和总抗氧化力测定采用菲罗啉比色法。白蛋白测定采用溴甲酚紫法。转铁蛋白、铜蓝蛋白测定采用散射比浊法。硒、铜、锌、铁测定采用原子吸收分光光度法。主要观察指标：丙二醛（作脂质过氧化指标）；微量元素铜、锌、铁、硒及其转运蛋白（铜蓝蛋白、白蛋白和转铁蛋白）；抗氧化态标志物：黄嘌呤氧化酶、谷胱苷肽、谷胱苷肽过氧化物酶、维生素E、维生素C浓度和总抗氧化力水平。 结果：癌症患者脂质过氧化水平（以丙二醛计）明显高于对照[癌症组为（5．21&;#177;1．05）nmol／L，对照组为（4．04&;#177;0．68）nmol／L，P〈0．001]，总抗氧化力明显低于对照[癌症组为（4．34&;#177;0．98）U／L，对照组为（5.87&;#177;0．93）U/L，P〈0．001]。抗氧化标志物黄嘌呤氧化酶、谷胱苷肽、谷胱苷肽过氧化物酶、维生素E和维生素C无明显变化。癌症患者血清白蛋白浓度明显低于对照[癌症组为（34．19&;#177;6．94）g／L，对照组为（42．34&;#177;4．89）g／L，P〈0．001]，血清铜蓝蛋白浓度明显高于对照组[癌症组为（0．371&;#177;0.031）g，对照组为（0．346&;#177;0．026）g／L，P〈0．05]，血清转铁蛋白浓度未发现有所改变（P〉0．05）。血清铜水平明显高于对照[癌症组为（19．27&;#177;4．74）μmol／L，对照组为（14．92&;#177;2．71）μmol／L，P〈0．001]，血清硒水平明显低于对照组[癌症组为（1．175&;#177;0．333）μmol／L，对照组为（1．413&;#177;0．446）μmol／L，P〈0．001]，但锌和铁水平无显著变化。癌症患者血中铜和丙二醛之间呈明显相关性（r=0．28l，P=0．003），但对照组铜与丙二醛未发现相关性存在。另外，肝癌患者血清铁和丙二醛存在相关关系（r=0．680，P=0．001）。 结论：癌症患者氧化应激和某些微量元素呈相关变化，然而其变化情况可因癌种、癌症分期以及癌症患者个因素的不同而有所差异。     

癌症患者血中氧化应激的研究

目的：探讨癌症患者及各癌种之间氧化应激的改变情况和差异，抗氧化物在癌症形成中的作用。方法：测定110例癌症病人和76例健康对照者血中MAD浓度（以此作为脂质过氧化指标），抗氧化标志物GSH、XOD、GSHPx、VitE和总抗氧化力水平。结果：癌症患者MDA浓度明显高于对照组，总抗氧化力水平癌症组明显低于对照组；抗氧化标志物XOD、GSH、GSHPx、VitE无明显变化。结论：癌症患者脂质过氧化增高而抗氧化能力下降，然而，其变化情况可因癌肿、癌症分期及癌症患者个体因素的不同而有差异。     

慢性磷中毒患者脂质过氧化和抗氧化能力的调查分析

目的 探讨慢性磷中毒患者脂质过氧化和抗氧化能力的变化,为防治慢性磷中毒患者的职业病危害及进行健康监护提供手段和依据.方法 慢性磷中毒患者83例为研究对象,同时选择30例健康人作为正常对照组.以8-羟基脱氧鸟苷(8-OHdG)作为DNA损伤的标记物,以巴比妥酸盐反应物质(TBARS)作为脂质过氧化的标记物,应用相应的测定试剂盒分别对慢性磷中毒患者血清中8-OHdG及丙二醛(MDA)、总抗氧化能力(TAC)、超氧化物歧化酶(SOD)活力、谷胱甘肽过氧化物酶(GSH-Px)活力及维生素E含量进行测定并分析.结果 慢性磷中毒患者各组与对照组相比,血清中8-OhdG及MDA含量水平显著增高(P<0.01).而总抗氧化能力(TAC)、超氧化物歧化酶(SOD)活力、谷胱甘肽过氧化物酶(GSH-Px)活力及维生素E含量均较正常对照组降低(P<0.01).分层分析,中度组和重度组与对照组相比较.差异有统计学意义(P<0.01).结论氧化应激与慢性磷中毒发病具有一定的相关性,推测补充维生素C、E等抗氧化物质可能对慢性磷中毒的治疗和预防有重要作用.     

悄毒症及肾病综合征患者的脂质过氧化反应的观察

随着对氧自由基研究的不断深入,许多研究发现肾脏疾病与氧自由基及其所引发的脂质过氧化反应有关。我们测定了尿毒症和肾病综合征患者血浆丙二醛(MDA)、超氧化物歧化酶(SOD)和谷胱苷肽过氧化物酶(GSM-PX)的含量,以了解尿毒症和肾病综合征时机体的脂质过氧化反应及抗氧化系统的改变。     

尿毒症及肾病综合征患者的脂质过氧化反应的观察

随着对氧自由基研究的不断深入,许多研究发现肾脏疾病与氧自由基及其所引发的脂质过氧化反应有关.我们测定了尿毒症和肾病综合征患者血浆丙二醛(MDA)、超氧化物歧化酶(SOD)和谷胱苷肽过氧化物酶(GSM-PX)的含量,以了解尿毒症和肾病综合征时机体的脂质过氧化反应及抗氧化系统的改变.     

银可络在治疗高血压病患者过程中的抗氧自由基作用

目的:探讨银可络对高血压病的抗氧自由基作用。方法:采用黄嘌呤氧化酶法和硫代巴比妥酸比色法检测28例高血压病Ⅱ期患者在服用银可络加尼莫地平(银可络组)前后血清总超氧化物歧化酶(T-SOD)活性及丙二醛(MDA)含量,并与30例高血压病Ⅱ期患者单用尼莫地平(对照组)前后的T-SOD活性和MDA含量相比较。结果:两组治疗1月后,血压均降至正常,但银可络组T-SOD活性[(101.06±6.56)nU·ml~(-1)]较对照组[(74.93±10.87)nU·ml~(-1))明显升高(P<0.001),MDA含量[(3.47±0.89)μmol·L~(-1)]较对照组[(4.50±0.81)μmol·L~(-1)]显著降低(P<0.001)。结论:银可络在治疗高血压病过程中具有较强抗氧自由基损伤和抗脂质过氧化损伤作用。     

蛛网膜下腔出血与脑脊液血浆过氧化脂质及红细胞超氧化物歧化酶关系的探讨

对51例蛛网膜下腔出血急性期患者及脑脊液过氧化脂质(CSF—LPO)、血浆过氧化脂质(P—LPO)和红细胞超氧化物歧化酶活性(Ery-SODA)检测结果表明,CSF-LPO 和 P-LPO 显著高于对照组(P<0.001～0.01),Ery-SODA 显著低于对照组(P<0.01);CSF-LPO、P-LPO 值与颅内压以及出血量皆呈显著相关(r=0.6712、0.6536、0.4846、0.4923,P<0.001);恢复期 CSF-LPO 和 P-LPO 显著低于急性期(P<0.05),Ery—SODA 显著高于急性期(P<0.05),并分别接近于对照组(P>0.05)。提示蛛网膜下腔出血后患者体内氧自由基和脂质过氧化反应剧增,但在病情稳定后有所缓解。     

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.     

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.     

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.     

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.