多发性硬化症与可溶性白细胞介素-2受体的关系

目的 探讨多发性硬化症(multiple sclerosis,MS)患者血清中可溶性白细胞介素2受体(sIL-2R)水平的变化及临床意义.方法 将21例 MS患者按病情分为2组,MS急性复发组(n=15例)和MS缓解组(6例).另选健康体检者(n=25)为对照组.采用双抗体夹心ELISA法检测3组血清sIL-2R水平的变化.结果 MS急性复发组和MS缓解组血清中sIL-2R水平均显著高于对照组(均P< 0.01);MS急性复发组sIL-2R 水平高于MS缓解组(P<0.05).重型MS急性复发者SIL-2R水平高于轻型MS急性复发者(P＜0.05).结论 检测sIL-2R 水平的变化可用于评估机体免疫状态和作为MS 患者病情严重程度的标志.     

sIL-2R在多发性骨髓瘤患者中的表达及其临床意义

目的:探讨可溶性白细胞介素-2受体(sIL-2R)在多发性骨髓瘤(MM)患者中的表达及其临床意义。方法:选取福建医科大学附属第二医院2020年2月-2021年12月初诊MM患者54例作为观察组,同期选取本院60例健康体检者作为对照组。采用酶联免疫吸附测定法(ELISA)检测两组受试者血清中sIL-2R表达水平,比较MM患者在性别、年龄、ISS分期、血红蛋白(Hb)、白蛋白(ALB)、血肌酐(Cr)、乳酸脱氢酶(LDH)、β₂-微球蛋白(β₂-MG)、血钙、骨髓浆细胞比例以及治疗反应等临床参数不同分组间sIL-2R表达水平的差异,分析sIL-2R表达水平与MM患者无进展生存期(PFS)和总生存期(OS)的关系。结果:MM患者血清sIL-2R表达水平明显高于健康对照组(P<0.05),治疗反应未达到完全缓解(CR)的MM患者血清sIL-2R表达水平明显高于治疗反应达到CR者(P=0.037),而性别、年龄、ISS分期、Hb浓度、ALB含量、Cr水平、LDH水平、β₂-MG含量、血钙浓度以及骨髓浆细胞比例等不同分组间血清...     

白细胞介素3受体α在急性白血病中的表达及临床意义的研究

目的研究白细胞介素3受体α mRNA(IL-3RαmRNA)在急性白血病(AL)中的表达及其在急性白血病中的临床意义。方法对80例急性白血病患者(包括56例初治急性白血病患者、9例复发患者和15例缓解患者),另外,15例健康人为正常对照组,KG-1α细胞株为阳性对照,应用半定量逆转录-聚合酶链反应检测各组IL-3RαmRNA水平。结果IL-3RαmRNA在初治AL患者中表达水平明显高与正常对照组(P<0.05);IL-3Rα mRNA在缓解组表达水平高于正常对照组,但差别无统计学意义(P>0.05),但缓解组表达水平低于初治AL组,且差别有统计学意义(P<0.05);复发组平均表达水平高于正常对照组(P<0.05);AL患者中42例可进行疗效评估,初治IL-3Rα mRNA阳性AL患者中分为高表达与低表达组,IL-3Rα低表达患者的缓解率明显高于高表达患者,两者比较差别有统计学意义(P<0.05);7例复发的AL患者,仅有1例用药后达到完全缓解(CR),其IL-3Rα mRNA表达均阳性;余6例均未达到CR。结论在急性白血病患者IL-3Rα mRNA有异常过度高表达;IL-3Rα mRNA高表达的患者缓解率低,表明与白血病的发病及疗效预后有关;可用来作为判断疗效预后的一新指标。     

慢性特发性血小板减少性紫癜患者血清转化生长因子β1测定的意义

目的 探讨血清转化生长因子β1(TGF-β1)在慢性特发性血小板减少性紫癜(CITP)中的临床意义.方法 采用ELISA法检测38例初治CITP患者治疗前后TGF-β1水平.结果 CITP患者治疗前TGF-β1水平[(132.57±5.17)μg/L]明显高于对照组[(76.81±4.42)μg/L],差异有统计学意义(P<0.01).经治疗缓解后血清TGF-β1水平[(81.26±3.78)μg/L]与治疗前相比明显下降(P<0.01).未缓解者TGF-β1水平[(123.49±4.31)μg/L]与初诊患者无明显差异(P>0.05).TGF-β1水平与血小板数呈负相关(r=-0.342,P<0.05),与巨核细胞数呈正相关(r=0.409,P<0.01).结论 TGF-β1参与了CITP的发病,检测TGF-β1水平变化有助于CITP病情判断,可作为疗效观察的辅助指标.     

非霍奇金淋巴瘤患者血清可溶性白细胞介素-2受体检测及意义

目的探讨非霍奇金淋巴瘤(NHL)患者化疗前后血清可溶性白细胞介素-2受体(sIL-2R)水平的变化及临床意义。方法采用双抗体夹心酶联免疫吸附测定,动态监测40例NHL及10例淋巴瘤相关性噬血细胞综合征(LAHS)患者初治、化疗后血清sIL-2R的水平。根据患者治疗的效果分为完全缓解、缓解后复发以及未缓解组并进行比较。结果 NHL患者初治组、缓解后复发组、化疗后未缓解组以及LAHS组sIL-2R表达水平显著高于对照组和化疗后缓解组(P0.05),而NHL化疗后完全缓解组与对照组比较,差异无统计学意义(P0.05)。动态监测治疗前后sIL-2R表达水平变化与国际预后指数(IPI)、铁蛋白等均呈正相关关系(P0.05)。结论 NHL患者细胞免疫功能低下,并且与疾病的恶性程度有关,化疗有效的患者细胞免疫功能得到明显改善。通过对NHL患者血清sIL-2R表达水平监测有利于NHL复发早期诊断,并可判断其化疗疗效及预后。     

肝细胞生长因子和血管内皮生长因子在急性髓系白血病中的表达以及与血管新生的关系

目的 探讨肝细胞生长因子(HGF)和血管内皮生长因子(VEGF)在急性髓系白血病(AML)中的表达及与AML血管新生的关系.方法 应用酶联免疫吸附试验(ELISA)测定AML 25例初发未治、17例完全缓解、16例未缓解、12例复发患者血清中HGF和VEGF的浓度,并与正常对照组比较.结果 血清HGF的浓度:AML初发未治组[(1357.29±358.64) ng/L]、未缓解组[(1175.93±306.71)ng/L]、复发组[(1261.21±340.83) ng/L]患者均明显高于正常对照组[(232.62±99.13) ng/L]和缓解组[ (256.65 ±94.32) ng/L](F=78.35,P＜0.01);血清VEGF的浓度:AML初发未治组[(253.84±49.14) ng/L]、未缓解组[(245.87±54.68) ng/L]、复发组[(264.75 ±62.52) ng/L]患者均明显高于正常对照组[ (97.61±16.19) ng/L]和缓解组[(99.76±15.93) ng/L](F=68.65,P＜0.01);缓解组患者血清HGF和VEGF的浓度与正常对照组比较,差异均无统计学意义(P均＞0.05).HGF和VEGF在AML中呈正相关(r=0.49,P＜0.05).结论 HGF和VEGF与AML的发生、发展密切相关,通过阻抗HGF治疗白血病有望成为新的治疗方法.     

高血压患者胰岛素抵抗与内皮细胞功能障碍的关系

目的研究高血压患者胰岛素抵抗(IR)与内皮细胞功能的关系。方法72例原发性高血压(EH)患者分为胰岛素抵抗组(EH-IR)37例和非胰岛素抵抗组(EH非IR)35例,健康对照组25例。用化学法测定各组外周血的一氧化氮(NO)、一氧化氮合酶(NOS)、诱导型一氧化氮合酶(iNOS)和结构型一氧化氮合酶(cNOS)水平。结果EH非IR组和EH-IR组NO水平分别为(64.79±41.96)μmol/L和(74.69±45.66)μmol/L,较健康对照组(110.21±55.79)μmol/L)降低,差异有统计学意义(均P<0.05);EH非IR组和EH-IR组NOS水平分别为(34.74±4.12)kU/L和(33.44±5.09)kU/L,较健康对照组(42.54±4.04)kU/L降低,差异有统计学意义(均P<0.01);iNOS水平分别为(13.86±3.60)kU/L和(13.67±3.95)kU/L,较健康对照组(17.02±2.78)kU/L降低,差异有统计学意义(均P<0.01)。cNOS水平分别为(20.88±3.29)kU/L和(19.77±4.11)kU/L,较健康对照组(25.51±3.51)kU/L降低,差异有统计学意义(均P<0.01)。EH非IR组和EH-IR组NO、NOS、cNOS和iNOS含量的差异无统计学意义(P>0.05)。EH非IR组和EH-IR组的NO,NOS及其亚型水平与IR的相关性均无统计学意义(P>0.05)。结论高血压时内皮细胞释放NO能力的减弱与cNOS表达减弱和iNOS的表达缺陷均有关;高血压患者的IR与内皮系统损伤无明显关联。     

乙型肝炎合并丙肝患者血清sIL-2R水平的检测与分析

【目的】了解乙型肝炎合并丙型肝炎患者血清可溶性白细胞介素2受体(sIL-2R)水平,探讨sIL-2R在病毒性肝炎发病中的作用。【方法】应用ELISA方法对23例乙型肝炎合并丙型肝炎患者,19例丙型肝炎患者,20例乙型肝炎患者、20例非活动期HBV携带者,20例正常对照组血清sIL-2R进行检测。【结果】乙肝合并丙肝患者sIL-2R含量(307.0±43.2)U/ml,单纯丙肝患者sIL-2R含量(264.1±35.1)U/ml,单纯乙肝患者sIL-2R含量(278.1±38.3)U/ml,三组均明显高于HBV携带组(221.3±25.1,P<0.05)及正常对照组(214.9±23.0,P<0.01),而三组之间相比并差异无显著性(P>0.05),HBV携带组与正常对照组相比无明显差异(P>0.05)。【结论】HCV合并HBV感染及单纯HCV、HBV感染时机体细胞免疫功能处于紊乱状态,sIL-2R可能在病毒性肝炎的发病过程中发挥重要作用,sIL-2R的测定可以作为判定肝组织损伤的指标之一。     

胃癌患者血清转化生长因子β1、癌胚抗原和糖链抗原19-9检测的临床价值

目的检测胃癌患者血清转化生长因子β1(transforming growth factor-beta,TGF-β1)、癌胚抗原(carcinoembryonic antigen,CEA)、糖链抗原(carbohydrate antigen,CA19-9)水平变化及临床意义。方法采用酶联免疫吸附法和全自动化学发光免疫法测定56例胃癌、10例重度胃黏膜不典型增生患者及33例正常人的血清转化生长因子β1、CEA、CA19-9水平。结果Ⅰ、Ⅱ、Ⅲ、Ⅳ期各期胃癌血清转化生长因子β1(426.3±54.6)pg/L、(529.5±68.2)pg/L、(638.6±53.4)pg/L、(742.6±78.9)pg/L,CEA(9.6±3.1)μg/L、(16.9±9.8)μg/L、(29.3±14.7)μg/L、(96.6±41.5)μg/L,CA19-9(52.1±22.8)kU/L、(64.2±42.1)kU/L、(82.1±52.8)kU/L、(89.5±56.2)kU/L水平均明显高于正常对照组(60.3±8.4)pg/L、(1.9±0.3)μg/L、(10.9±6.2)kU/L(P<0.001);Ⅲ、Ⅳ期胃癌组TGF-β1、CEA、CA19-9又显著高于Ⅰ、Ⅱ期(P<0.05);TGF-β1Ⅱ期明显高于Ⅰ期(P<0.05)。重度胃黏膜不典型增生组的CEA(3.8±3.3)μg/L、CA19-9(16.8±12.8)kU/L与正常对照组(1.9±0.3)μg/L、(10.9±6.2)kU/L差异无统计学意义(P>0.05),但TGF-β1(404.5±48.6)pg/L水平明显高于对照组(P<0.01),几乎接近胃癌水平。结论TGF-β1和CEA、CA19-9是用于胃癌血清学诊断较好的肿瘤标志物,其血清水平与肿瘤的浸润及转移密切相关,可作为判断肿瘤临床病理分期的辅助指标,其中TGF-β1水平有望作为胃癌癌前病变的一项有意义的指标。     

Ang-1在多发性骨髓瘤患者中的表达及临床意义

目的 研究血管生成素-1(angiopoietin-1,Ang-1)及其受体Tie-2在多发性骨髓瘤(MM)患者和骨髓瘤细胞株RPMI8226的表达情况,探讨其意义.方法 采用RT-PCR和Western blot方法检测112例MM患者、24例非肿瘤患者(对照组)以及RPMI8226细胞株中Ang-1及其受体Tie-2的表达水平,分析阳性率及表达水平在MM患者与对照组、MM不同分期间的差异,探讨Ang-1表达与MM患者骨髓微血管密度、临床分期及预后的关系.结果 MM组Ang-1表达阳性率、表达水平均显著高于对照组(P＜0.05);Ang-1表达阳性率在初治组和复发/难治MM组的差异无统计学意义(P＞0.05),但复发/难治MM组的Ang-1表达水平高于初治组(P＜0.05);Tie-2 mRNA仅在12例MM患者中检出,对照组未检出.MM患者骨髓微血管密度(25.21±0.80)明显高于对照组(5.23±0.20)(P＜0.01);Ang-1阳性患者的骨髓微血管密度(32.98±1.70)高于Ang-1阴性患者(16.55±1.30)(P＜0.05);Ang-1表达阳性率在Ⅱ期和Ⅲ期MM患者中差异无统计学意义(52.1%对60.9%,P＞0.05),但Ⅲ期MM患者Ang-1蛋白的表达水平(0.40±0.07)明显高于Ⅱ期患者(0.22±0.04)(P＜0.05);初治患者中,治疗无效组Ang-1表达阳性率(70.0%)明显高于有效组(19.1%)(P＜0.01).结论 Ang-1在MM患者中高表达;Ang-1表达与MM临床分期、预后判断及靶向治疗有关.     

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.