脑梗死患者颈动脉斑块形成与血尿酸、性别、年龄、糖尿病史等相关因素的回归分析

目的：分析脑梗死患者高尿酸血症与颈动脉斑块之间的关系。方法：选择清华大学第一附属医院神经内科2003—08／2004—10的住院脑梗死患者126例，均经CT和（或）MRI证实。根据颈动脉彩色超声检查的结果，发现颈动脉斑块的患者归为斑块组（n=68），未发现斑块的患者归为对照组（n=58）。比较两组血尿酸水平，以及高尿酸血症的发生率（男〉420μmol／L,女〉340μmol／L），同时比较其他可能的危险因素包括性别、年龄、吸烟、酗酒、高血压、糖尿病、血脂、脑卒中家族史等。危险因素的选择、混杂因素的控制及交互作用的判断用Logistic回归模型分析计算比值比（0R）及其95％可信区间（CI），应用SPSS 10．0软件进行统计分析。结果：①斑块组患者的年龄以及高血压、糖尿病的发生率均显著高于无斑块的患者[（67.0&;#177;8．2），（59．1&;#177;10．9）岁，P=0．001；86．8％，72，4％，P=0．044；38．2，20．7％，P=0．033]。②两组血尿酸水平比较差异不显著f（330．97&;#177;109．73），（311．28&;#177;101．96）μmol／L，P=0．299]，斑块组高尿酸血症发生率高于对照组，但差异无统计学意义（27．94％，13．79％，P=-0．061）。⑧反向条件Logistic回归分析显示年龄、糖尿病、高尿酸血症以及酗酒进入回归方程，除酗酒外均有统计学意义，高尿酸血症、年龄、糖尿病对于颈动脉斑块的0R值分别为2．829，1．100和2．753，P值分别为0．001，0．049，0．033。结论：高尿酸血症、年龄和糖尿病可能为脑梗死患者颈动脉斑块形成的独寺毹险因素。     

脑梗死伴颈动脉斑块与高同型半胱氨酸血症的关系

目的研究血清同型半胱氨酸(Hcy)水平与脑梗死发生以及颈动脉斑块形成之间的关系。方法对70例脑梗死患者和30例健康对照者,采用荧光偏振法测定血Hcy,彩色多普勒检查颈动脉内膜及斑块,同时测定血VitB12、叶酸及血脂水平。结果脑梗死患者血清Hcy平均水平(21.06±10.79μmol/L)高于对照组(16.51±7.46μmol/L),叶酸水平低于后者,两组比较有统计学差异(P<0.05)。脑梗死组中伴颈动脉斑块的患者Hcy水平高于无颈动脉斑块者(P<0.05)。脑梗死患者Hcy水平与叶酸存在轻度负相关(r=-0.306)。结论高同型半胱氨酸血症与脑梗死、颈动脉斑块的发生有一定关系,叶酸缺乏可能是其增高的原因。     

外周血PLR、LDL、Hcy水平与老年高血压患者颈动脉斑块形成及稳定性的关系分析

目的 探究外周血血小板淋巴细胞比值(PLR)、低密度脂蛋白(LDL)、同型半胱氨酸(Hcy)水平与老年高血压患者颈动脉斑块形成及稳定性的关系。方法 选取2019年10月至2022年10月黄山市人民医院收治的80例老年高血压患者纳入本研究,分析患者的临床资料,根据患者颈动脉斑块的有无将患者分为斑块组(n=58)和无斑块组(n=22),检测患者外周血PLR、LDL、Hcy水平,探究其与患者颈动脉斑块形成的关系及对患者斑块形成的预测价值。对斑块组患者进行分析,根据患者斑块是否稳定将其分为斑块稳定组(n=21)和斑块不稳定组(n=37),比较两组间患者外周血PLR、LDL、Hcy水平,探究其与患者颈动脉斑块稳定性间的关系及预测价值。结果 斑块组患者年龄、体重指数、冠心病史患者比率、糖尿病史患者比率、病程、PLR、LDL及Hcy水平均高于无斑块组,差异均有统计学意义(P<0.05)。PLR、LDL、Hcy、体重指数、病程等因素均为高血压患者颈动脉斑块形成的影响因素(P<0.05)。作血清PLR、LDL、Hcy水平预测高血压患者颈动脉斑块形成的预测价值曲线,其曲线下面积(AUC)值分别...     

自体骨髓单个核细胞移植治疗扩张型心肌病的临床观察

目的:观察自体骨髓单个核细胞冠脉内移植治疗扩张型心肌病的临床疗效。方法:扩张型心肌病16例(男性5例, 女性11例),平均年龄(45．3±10．8)岁,心功能Ⅳ级,左室射血分数(LVEF)<30％。抽取骨髓,用Ficoll密度梯度离心法分离骨髓单个核细胞,经外周动脉穿刺插管,将骨髓单个核细胞分别直接注入左、右冠脉。比较移植前后心功能的变化。结果:移植3个月后,心功能(NYHA分级)得到改善,总有效率87．5％,超声心动图检查均示左室舒张末径(mm)(72．94± 4．01 vs 63．63±2．58．P<0．001)、左室收缩末径(mm)(52．00±2．80 vs 44．38±1．78．P<0．001)减小,左室射血分数(％) (22．88±5．29vs33．81±3．33,P<0．001)、短轴缩短率(％)(12．00±2．39 vs 20．94±3．70,P<0．001)明显增加;心脏ECT 检查与术前相比,术后患者缺血及坏死心肌节段减少,(3．4±0．3vs2．1±0．4,P<0．05)(2．5±0．5 vs 1．6±0.3,P< 0．01)个。结论:自体骨髓单个核细胞移植有可能通过缺血心肌血运改善,坏死心肌区有心肌细胞再生而改善扩张型心肌病的心功能。     

颈动脉粥样硬化超声表现与血浆同型半胱氨酸浓度增高的关系研究

目的:探讨颈动脉内膜-中层增厚及动脉粥样硬化(AS)斑块形成与血浆同型半胱氨酸(Hcy)浓度增高的关系。方法:选取87例首发急性脑血栓形成住院病人作为病例组,平均(66.13±12.54)岁;选取80例同期眼科和耳鼻喉科住院病人作为对照组,平均(64.94±11.26)岁。应用Sequia 512彩超仪对病例组55例、对照组66例双侧颈总、颈内、颈外动脉进行扫查,测量颈动脉前后壁内膜-中层厚度(IMT),观察有无AS斑块形成及其位置,计算颈动脉狭窄程度。应用高效液相色谱-荧光法(HPLC-FD)测定两组所有病例的血浆Hcy浓度。并同时进行空腹血糖(FBS)、糖化血红蛋白(HbA1C)、肝肾生化、血脂、血压及体重指数(BMI)的测定。比较两组AS危险因素。结果:病例组和对照组平均空腹血浆Hcy浓度分别为(15.28±4.33)μmol/L和(11.32±3.86)μmol/L。病例组血浆Hcy浓度较对照组高且差异具统计学意义(P<0.001),病例组和对照组血浆Hcy升高者分别占31%和6.3%,差异具统计学意义(P<0.001)。病例组与对照组左、右颈动脉IMT及AS斑块发生率差异均有统计学意义(P<0.05)。比较两组AS危险因素,经Logistic回归分析,发现血浆Hcy浓度、收缩压、BMI是脑血栓形成的危险因素,在校正了高血压和肥胖后,血浆Hcy浓度升高是脑血栓形成的独立危险因素。结论:血浆Hcy浓度升高可导致AS,与颈动脉粥样硬化有关。     

高龄老年人原发性高血压与动脉粥样硬化的关系

目的探讨高龄老年人血压与动脉粥样硬化程度的关系。方法住院高龄老年人136例,年龄80～95岁。其中原发性高血压组92例,血压正常组44例,行颈动脉超声检测,比较两组动脉粥样硬化程度。结果高血压组与血压正常组在内膜中层厚度方面比较差异有统计学意义[(1.10±0.35)mm vs(0.96±0.29)mm,P<0.05],两组斑块数比较差异有统计学意义。结论高血压可使颈动脉内中膜增厚及斑块数增多,加重动脉粥样硬化。     

颈动脉粥样硬化斑块与相关因素的探讨

目的探讨颈动脉硬化斑块与其相关因素与脑梗塞发生的相关影响。方法对177例患者行颈动脉超声检查,根据颈动脉硬化斑是否存在,分为斑块组和无斑块对照组。同期CT观察颈内动脉供血区是否发生脑梗塞。生化检查血糖、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白。并将高血压患者分为I级、Ⅱ级、Ⅲ级。结果颈动脉斑块分布：两侧同时存在比例最高,达50％;仅单侧分布：左侧高于右侧,分别为33％、17％。颈动脉斑块组脑梗塞的发生率为79．54％;非动脉斑块组脑梗塞发生率为29．2％,低于斑块组（P〈0．05）。双侧颈动脉斑块中,发生双侧脑梗塞比例最高,左侧次之,右侧最低;左侧颈动脉斑块中,发生左侧脑梗塞比例最高,双侧次之,右侧最低;右侧颈动脉斑块中,发生右侧脑梗塞比例最高,双侧次之,左侧最低。颈动脉硬化斑块组的年龄、血糖均较无斑块组高;发生高血压比例高,且随着高血压分级的增加,斑块发生率也逐步提高,Ⅲ级高血压及脑梗塞的发生率高于无斑块对照组（P〈0．01）。而颈动脉斑块与血脂则相关性不大。结论颈动脉硬化斑块与年龄、血糖、高血压密切相关,发生脑梗塞的几率明显增加。与血脂相比,血糖增高和高血压对动脉硬化斑块的形成起到更重要的作用。     

血清胆红素、同型半胱氨酸水平与老年冠心病患者颈动脉粥样硬化斑块的相关性分析

目的探讨血清胆红素、同型半胱氨酸（Hcy）水平与老年冠心病患者颈动脉粥样硬化斑块之间的关系。方法选取我院210例老年冠心病患者,应用颈动脉超声技术检查颈动脉内中膜厚度（IMT）,根据IMT值分为斑块组82例和非斑块组128例,记录患者的年龄、性别、高血压史、糖尿病史、吸烟史等一般情况,检测血清总胆红素、直接胆红素、间接胆红素、Hcy、血脂等实验室指标。结果斑块组总胆红素、间接胆红素水平低于非斑块组,血Hcy水平高于非斑块组,差异有统计学意义（P<0.05）,总胆红素、间接胆红素水平与颈动脉斑块呈负相关（r=-0.447、-0.482,P<0.05）,Hcy水平与颈动脉斑块呈正相关（r=0.376,P<0.05）,Logistic逐步回归分析显示,总胆红素、间接胆红素水平降低和Hcy水平升高是颈动脉斑块形成的危险因素。结论干预颈动脉粥样硬化的冠心病患者血清胆红素及Hcy的生成,可以早期预防冠心病患者急性心脑血管事件的发生。     

颈动脉斑块形成的相关危险因素分析

[目的] 分析颈动脉粥样斑块形成的常见临床危险因素,为临床防治提供科学依据.[方法] 选择2015年9月至2016年4月本院神经内科收治的脑梗死患者200例,行颈动脉血管彩超检查筛选出其中有颈动脉粥样斑块的患者157例(斑块组),同期选取200例于本院神经内科住院无颈动脉斑块者(对照组).比较两组患者之间的性别、年龄、高血压发病率、有无吸烟史、有无饮酒史、空腹血糖(GLU)、三酰甘油(TG)、胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(HCY)等相关指标,分析其与颈动脉斑块形成的相关性.[结果] 两组患者年龄、高血压发病率、吸烟史差异有统计学意义(P<0.05) .两组的生化指标检测中的GLU、HCY、TG、LDL-C差异有统计学意义(P<0.05).多因素 logistic 回归分析法表明,年龄、吸烟、HCY、LDL-C是颈动脉粥样斑块形成的独立危险因素,对颈动脉粥样斑块形成的预测均有一定价值,其中HCY效能最高.[结论] 年龄、吸烟、HCY、LDL-C是颈动脉粥样斑块形成的独立危险因素,对颈动脉粥样斑块形成的预测有重要临床意义.     

8648例健康体检人员颈动脉彩色多普勒超声结果分析

目的 对健康体检人员各年龄段的颈动脉彩色多普勒超声结果进行分析,探讨颈动脉硬化的相关因素.方法 采用彩色多普勒超声对8 648例健康体检人员行双侧颈动脉检查,观察斑块的性质、血管狭窄及闭塞程度,分析颈动脉硬化与年龄、性别、血压、血糖、血脂及吸烟的关系.结果 8648例健康体检人员中,颈动脉内中膜( IMT)增厚、颈动脉斑块、颈动脉狭窄的检出率随年龄增长呈增加趋势,＞30～40岁,＞40～50岁,＞50～60岁,＞60～70岁,＞70～80岁,＞80岁组颈动脉(IMT)增厚分别为6.6％、29.0％、56.7％、80.4％、95.3％和98.9％;颈动脉斑块分别为5.3％、25.7％、49.9％、70.3％、87.5％和94.8％颈动脉狭窄分别为0、0.3％、0.8％、2.1％、5.8％和10.8％(均P＜0.05);在＞30～70岁各年龄组男性检出率明显高于女性(P＜0.05或＜0.01);单纯高血压、单纯高血糖、单纯高血脂及吸烟者颈动脉硬化的检出率与正常组比较差异均有统计学意义(P＜0.01);多因素logistic回归分析显示:年龄、高血糖、高血压、高血脂及吸烟是颈动脉硬化的独立危险因素(P＜0.05).结论 健康体检人员颈动脉硬化有较高的检出率;其检出率与性别、年龄、血压、血糖、血脂及吸烟有关.     

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.