缬沙坦和螺内酯对高血压大鼠心肌c-Jun氨基末端激酶的影响

目的观察血管紧张素Ⅱ受体拮抗剂缬沙坦和盐皮质激素受体拮抗剂螺内酯对自发性高血压大鼠(SHR)心肌中活化的丝裂原活化蛋白激酶家族(MAPK)中的c-Jun氨基末端激酶(JNK)的影响。方法将18只雄性SHR随机分为三组,每组6只。其中两组分别用缬沙坦30 mg.kg-1.d-1、螺内酯20mg.kg-1.d-1溶于饮水,灌胃,连续治疗13周;对照组给正常饮水,并与Wistar-Kyoto大鼠(WKY)比较。用Western-blot方法检测大鼠心肌磷酸化JNK的表达。结果SHR对照组心肌磷酸化JNK/actin值高于其余三组(P<0.01),缬沙坦组高于螺内酯组和WKY组(P<0.01),螺内酯组与WKY水平接近。两治疗组的LVW/BW较SHR对照组明显减低(均P<0.01),但较WKY对照组有所升高(P<0.05,P<0.01)。两治疗组胶原容积分数(CVF)低于SHR对照组(均P<0.01),高于WKY组(均P<0.05)。结论缬沙坦和螺内酯均能通过抑制心肌中活化的JNK蛋白表达而抑制SHR的左室肥厚和心肌纤维化。     

氯沙坦对SHR心肌及心肌血管周围胶原影响的实验研究

【目的】探讨氯沙坦治疗对自发性高血压大鼠 (SHR)左心室心肌及心肌周围胶原纤维增殖的影响。【方法】以 4 2只 12周龄雄性SHR为对象 ,分为氯沙坦治疗组 (SHR L ,30mg·kg-1·d-1)及未服药组(SHR C) ,每组 2 1只 ;另以 2 1只WKY大鼠为正常对照组。治疗组降压治疗 12周。同步测量各组收缩压 ,测量左心室重量 ,计算心脏左室重量与体重比值 (LV/BW ) ,测量心肌间质胶原容积分数 (CVF)和心肌血管周围胶原面积 (PVCA)。【结果】①SHR L组LV/BW明显降低 (P <0 .0 1) ,随治疗时间的延长其降低程度越明显。②WKY组 12～ 2 4周龄CVF、PVCA明显增加 ,差异有显著性 (P <0 .0 5 )。SHR C组随周龄增加其CVF、PVCA值亦升高 (P <0 .0 5 ) ;与同周龄WKY比较 ,CVF及PVCA明显升高 (P <0 .0 5 )。SHR L组与SHR C组比较 ,CVF、PVCA明显下降 (P <0 .0 5 ) ,接近WKY组 (P >0 .0 5 )。【结论】氯沙坦使胶原异常增生明显得到抑制 ,并促进胶原蛋白降解 ,从而预防和阻止心肌纤维化 ,使SHR肥厚左室明显逆转 ,     

丹参对高血压大鼠心脏醛固酮及心肌蛋白激酶C表达的影响

目的：研究丹参对自发性高血压大鼠(SHR)心脏醛固酮及左室心肌蛋白激酶C表达的影响。方法：用WKY大鼠做阴性对照组，SHR大鼠分为对照组和治疗组。治疗组给予丹参注射波腹腔内注射12周，其余两组分别注射相当容积的蒸馏水。测量大鼠动脉收缩压(SBP)及左室重量指数(LVMI)，用放免法测量心脏局部醛固酮含量，应用免疫组织化学方法则量左心室蛋白激酶C(PKC)表达。结果：与WKY大鼠相比较，SHR有较高的血压、LVMI增加、心脏局部醛固酮升高、PKC表达上调(P＜0．01)，而丹参治疗组用丹参治疗后，SHR除收缩压外余指标均显著性下降(P＜0．05)。结论：丹参能降低自发性高血压左室肥厚大鼠心脏醛固酮含量并使左室心肌蛋白激酶C表达减少。     

胰激肽原酶对高血压大鼠心肌MMP-2表达及NO含量的影响

目的本研究通过观察胰激肽原酶对自发性高血压大鼠(SHR)血压及心肌基质金属蛋白酶-2(MMP-2)表达及NO含量的影响,探讨胰激肽原酶的降压及逆转心室重构的作用。方法雄性15周龄SHR 24只,随机分成SHR组、胰激肽原酶小剂量组(7.2 U.kg-1.d-1)、胰激肽原酶大剂量组(14.4 U.kg-1.d-1),每组8只。8只正常WKY大鼠作为阴性对照组。试验4周后结束,测量各组血收缩压(SBP)、左心室重量指数(LVMI)、心肌胶原体积比例(CVF)和心肌血管周围胶原与管腔面积的比例(PVCA)及血清NO含量。心肌组织经VG染色作形态学观察,用免疫组化SP法检测心肌组织切片内MMP-2的表达。结果SHR组SBP、LVMI、CVF、PVCA增高及MMP-2的表达增加,血清NO含量明显下降,较WKY组有显著差异(P<0.05)。应用胰激肽原酶后,给药组NO含量呈剂依赖性的明显升高,接近正常WKY组水平,其余各指标均较SHR组显著下降(P<0.05),但未达到正常WKY组水平。结论胰激肽原酶治疗具有降低SHR血压和逆转心室重构的作用,其机制可能与增加NO含量、抑制心肌MMP-2表达有关。     

心脏糜酶在自发性高血压大鼠心肌纤维化中的作用

目的观察心脏糜酶在自发性高血压大鼠(SHR)心肌组织胶原合成和心肌纤维化中的作用。方法应用病理检查、计算机分析结合逆转录-聚合酶链式反应等方法,检测SHR应用糜酶抑制剂(Chy-Ⅰ)组、SHR(SHR)组及对照组(WKY)组收缩压、心肌胶原容积分数(CVF)、心肌血管周围胶原面积比(PVCA)和心肌糜酶及Ⅰ、Ⅲ型胶原mRNA表达。结果Chy-Ⅰ组心脏CVF、PVCA分别为(26.8±8.7)%和0.4±0.1,SHR组分别为(46.4±7.8)%和1.9±0.9,WKY组为(24.4±10.7)%和0.4±0.1,Chy-Ⅰ组比SHR组明显下降(P<0.01),与WKY组无明显差别(P>0.05)。Chy-Ⅰ组心肌组织Ⅰ、Ⅲ型胶原和糜酶mRNA表达相对含量均明显低于SHR组(P<0.01),与WKY组无明显差别(P>0.05)。应用Chy-Ⅰ后大鼠血压无改变。结论心肌组织糜酶参与胶原的合成,参与细胞外基质的形成和降解,促进自发性高血压大鼠心肌纤维化。     

丹参对自发性高血压大鼠左室肥厚及心脏局部醛固酮的作用

目的　探究长期应用丹参对自发性高血压大鼠 (SHR)左室肥厚的预防作用及其可能机制———抑制心脏局部醛固酮的作用。方法　实验动物采用WKY大鼠及SHR ,部分SHR给予丹参注射液腹腔注射 12周。测量收缩压、左心室重量指数 ;左心室组织切片用HE染色和VanGieson染色 ,全自动图象分析系统进行分析。用放免法测定心脏局部醛固酮含量。各组指标进行显著性检验。结果　与WKY大鼠相比较 ,SHR有较高的血压 ,左室胶原含量及心脏局部醛固酮含量升高 (P <0 .0 5 )。而应用丹参后 ,除收缩压外各指标均有显著性下降 (P<0 .0 5 )。结论　丹参能预防自发性高血压大鼠左室肥厚 ,抑制左室胶原合成 ,其机制可能于抑制心脏局部醛固酮作用有关     

高血压大鼠RAS阻断后心肌中MMP-2的蛋白表达

目的探讨高血压大鼠左室心肌中基质金属蛋白酶-2(MMP-2)蛋白表达的变化以及血管紧张素转化酶抑制剂(ACEI)、血管紧张素Ⅱ1型受体拮抗剂(AT1-ant)单独与联合治疗对高血压大鼠心肌中MMP-2蛋白表达影响。方法40只雄性8周龄的易卒中自发性高血压大鼠(SHRSP)随机分成5组(n=8)：SHRSP对照组、安慰剂组、缬沙坦组、苯那普利组及缬沙坦、苯那普利联用组。另外，取8只雄性8周龄的京都Wistar大鼠(WKY)作为对照。利用免疫组织化学的方法检测WKY以及SHRSP左室心肌中MMP-2蛋白的表达。结果SHRSP的收缩压(SBP)、左室重量指数(LVMI)、胶原容积分数(CVF)、血管周围胶原面积(PVCA)、左室心肌MMP-2蛋白表达较同龄的WKY显著增高。给予苯那普利、缬沙坦单独或联合治疗后SFIRSP的LVMI、CVF、PVCA、左室心肌MMP-2蛋白表达都显著降低。苯那普利、缬沙坦单独应用时的效果没有差异。而联合应用的效果更显著。结论SHRSP左室心肌中MMP-2蛋白表达增高，肾素血管紧张素系统(RAS)阻断后MMP-2蛋白表达显著减少；苯那普利、缬沙坦逆转高血压心室重塑的作用可能部分通过下调MMP-2蛋白表达而实现；苯那普利和缬沙坦都能降低SHRSP的血压以及逆转其左室重塑，而联合用药的作用更显著。     

复方鳖甲软肝方对自发性高血压大鼠心肌纤维化的抑制作用

目的:评价复方鳖甲软肝方对自发性高血压大鼠(SHR)心肌纤维化、左室重构及血浆中血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)、醛固酮的效应。方法:实验选用12周龄SHR50只,随机将其分为5组,即空白对照组、依那普利组、小、中、小剂量复方鳖甲组(小、中、大剂量药物组),每组各10只。另取正常SD大鼠10只作为正常对照组。测定治疗10周后各组大鼠收缩压、心脏质量指数(heartweightindex,HWI)、左室质量指数(leftventricularmassindex,LVMI)、胶原蛋白含量,血浆中血管紧张素Ⅱ、醛固酮含量,心肌胶原容积分数(collagenvolumefraction,CVF)和血管周围胶原面积(perivascularcircuferentialarea,PVCA)。结果:治疗10周后,空白对照组大鼠收缩压,HWI,LVMI,胶原蛋白含量犤(195±9)mmHg,(5.38±0.25),(3.81±0.09),(6.13±0.93)mg/g,1mmHg=0.133kPa犦均明显高于正常对照组犤(127±10)mmHg,(3.88±0.28),(2.57±0.17),(4.19±0.72)mg/g犦(P<0.01)。依那普利组大鼠收缩压明显低于与空白对照组(P<0.01),而复方鳖甲软肝方各组收缩压比较,差异无显著性意义(P>0.05);依那普利组大鼠HWI,LVMI明显低于空白对照组(P<0.01),而复方鳖甲软肝方各组差异无显著性意义(P>0.05);依那普利组,复方鳖甲软肝方中、大剂量组大鼠心肌组织胶原蛋白含量     

缬沙坦对自发高血压大鼠左室肥厚心肌Kv4．2表达的影响

目的：探讨缬沙坦对自发高血压大鼠（SHR）左室肥厚心肌Kv4．2表达的影响。方法：将16只10周龄雄性SHR随机分成缬沙坦组和非缬沙坦组各8只;8只10周龄Wistar—Kyoto大鼠为对照组。喂药8周后分别测定各组大鼠动脉收缩压、左室质量指数（LVMI）、左室心肌Kv4．2的表达。结果：非缬沙坦组和缬沙坦组LVMI明显大于对照组（3．7±0．02mg／gand3．2±0．03mg／gVS2．5±0．03mg／g,P〈0．001）,非缬沙坦组LVMI明显大于缬沙坦组（3．7±0．02mg／gVS3．2±0．03mg／g,P〈0．001）：非缬沙坦组和缬沙坦组左心室心肌Kv4．2表达明显低于对照组（P〈0．01）,缬沙坦组左心室心肌Kv4．2的表达明显高于非缬沙坦组（P〈0．01）。结论：缬沙坦通过逆转SHR左室心肌肥厚提高左室心肌Kv4．2的表达。     

复方鳖甲软肝方对自发性高血压大鼠心肌纤维化的抑制作用

目的：评价复方鳖甲软肝方对自发性高血压大鼠(SHR)心肌纤维化、左室重构及血浆中血管紧张素Ⅱ(angiotensin Ⅱ，AngⅡ)、醛同酮的效应。方法：实验选用12周龄SHR50只，随机将其分为5组，即空白对照组、依那普利组、小、中、小剂量复方鳖甲组(小、中、大剂量药物组)，每组各10只。另取正常SD大鼠10只作为正常对照组。测定治疗10周后各组大鼠收缩压、心脏质量指数(heart weight index，HWI)、左室质量指数(left ventricular mass index，LVMI)、胶原蛋白含量，血浆中血管紧张素Ⅱ、醛固酮含量，心肌胶原容积分数(collagen volume fraction，CVF)和血管周围胶原面积(perivascular circuferential area，PVCA)。结果:治疗10周后，空白对照组大鼠收缩压，HWI，LVMI，胶原蛋白含量【(195&;#177;9)mmHg，(5．38&;#177;0．25)，(3．81&;#177;0．09)，(6．13&;#177;0．93)mg／g，1mmHg=0．133kPa】均明显高于正常对照组【(127&;#177;10)mmHg．(3．88&;#177;0．28)，(2．57&;#177;0．17)，(4．19&;#177;0．72)mg／g】(P&;lt;0．01)。依那普利组大鼠收缩压明显低于与空白对照组(P&;lt;0．01)，而复方鳖甲软肝方各组收缩压比较，差异无显著性意义(P&;gt;0．05)；依那普利组大鼠HWI，LVMI明显低于空白对照组(P&;lt;0．01)，而复方鳖甲软肝方各组差异无显著性意义(P&;gt;0．05)；依那普利组，复方鳖甲软肝方中、大剂量组大鼠心肌组织胶原蛋白含量明显低于空白对照组(P&;lt;0．05-0.01)。空白对照组AngⅡ，醛固酮和CVF，PVCA均明显高于正常对照组(P&;lt;0．01)。依那普利、中、大剂量药物组AngⅡ明显低于空白对照组(P&;lt;0．01)；依那普利组醛固酮明显低于空白对照组(P&;lt;0．01)，小剂量药物组有所降低(P&;lt;0．05)，中剂量药物组，大剂量药物组亦有明显降低(P&;lt;0．01)，且各复方鳖甲软肝方组比较，差异有显著性意义(P&;lt;0．05)；依那普利组CVF明显低于空白对照组(P&;lt;0．01)，中、大剂量药物组亦有明显低于空白对照组(P&;lt;0．01)；依那普利组、各剂量复方鳖甲软肝方组大鼠PVCA明显低于空白对照组(P&;lt;0．05-0．01)。结论：复方鳖甲软肝方无明显降压、逆转左室肥厚等功能，但可能通过影响肾素血管紧张素-醛固酮系统的机制，抑制心肌纤维化。     

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.