氧化亚氮吸入用于分娩镇痛的疗效及安全性研究--附180例分析

目的:探讨氧化亚氮在阴道分娩镇痛的疗效及安全性。方法:将360例足月、单胎、头位的初产妇分为观察组178例和对照组180例,观察组进入第1产程活跃期予氧化亚氮吸入,对照组除不吸入氧化亚氮外,其它处理与观察组相同。分别观察两组产妇的疼痛程度、产程时间、分娩方式、不良反应、产时及产后出血量及胎儿窘迫、新生儿窒息等情况,并进行比较。结果:观察组与对照组疼痛程度为1级的产妇分别占78.1%、23.9%(P<0.01);顺产率分别为83.1%、58.3%(P<0.01)。观察组与对照组的活跃期时间分别为(151±80)min、(229±106)min;总产程时间分别为(427±142)min、(548±187)min。观察组的活跃期及总产程均短于对照组(P<0.05),两组新生儿窒息率、产时及产后出血量、不良反应等差异无统计学意义。结论:氧化亚氮吸入能明显减轻阴道分娩产妇的疼痛,加速产程进展,降低剖宫产率及阴道难产率,对母婴无不良反应。     

足月分娩巨大儿的产妇胎盘IGF-1基因表达和启动子区CpG位点甲基化水平研究

目的研究足月分娩巨大儿的产妇胎盘胰岛素样生长因子l(IGF-1)基因表达和启动子区Cp G位点甲基化水平。方法回顾性选取邢台市第三医院收治的2017年9月至2018年6月102例正常妊娠且足月分娩的产妇和新生儿,根据新生儿出生体重进行分组,以正常体重儿为对照组(57例),以巨大儿(45例)为观察组。比较两组胎盘IGF-1基因表达水平和DNA甲基化水平等情况,并采用Pearson相关性分析胎盘IGF-1基因表达量与IGF-1甲基化水平及新生儿出生体重的关系。结果两组胎盘IGF-1基因表达水平和甲基化水平的比较,并无显著差异(P0. 05)。经Pearson相关性分析结果显示,胎盘IGF-1 mRNA相对表达量与IGF-1甲基化水平并无明显关系(P0. 05)。两组胎盘启动子区Cp G位点均呈现低甲基化水平。以所有新生儿出生体重的均值(4 257 g)为临界值,结果发现相比出生体重≥4 257 g组,出生体重4 257 g组IGF-1 mRNA相对表达量明显升高(P 0. 05)。经Pearson相关性分析结果显示,胎盘IGF-1 mRNA相对表达量与新生儿出生体重存在正相关关系(r=0. 48,P 0. 01)。结论产妇胎盘IGF-1基因表达量与新生儿出生体重存在正相关关系,其表达量的高低均与处在低甲基化程度的胎盘IGF-1中的甲基化水平并无密切关系。     

米非司酮对人早孕期绒毛中滋养细胞血管内皮生长因子表达的影响

目的:通过对比观察米非司酮对人早孕期绒毛中滋养细胞血管内皮生长因子(VEGF)表达的影响,探讨米非司酮终孕的分子免疫机制。方法:采用免疫组化二步法(即用型EnvisionTM试剂盒)检测20例米非司酮药流终孕的早孕期绒毛中滋养细胞VEGF的表达情况。20例人流终孕的正常早孕期绒毛为对照组。结果:米非司酮药流组滋养细胞中VEGF的表达较人流对照组明显减少(P<0.01),其PU值(x±s)分别为14.25±6.69,35.23±14.53。结论:米非司酮可明显降低VEGF在人早孕期绒毛滋养细胞中的表达,抑制了胎盘血管的发育,进而不利于胚胎的生存。     

任意皮瓣局部注射血管内皮生长因子对其微循环及血管再生的影响

目的:了解血管内皮生长因子(VEGF)在皮瓣抗感染中的作用机制,探讨血管内皮生长因子促进微循环及血管再生的影响。方法:实验于2003-11/2004-04在华北煤炭医学院病理学实验室完成,选用60只SD大鼠,制作背部6cm×4cm任意皮瓣的动物模型。术中VEGF组每个皮瓣局部注射VEGF1.0μg,对照组注射等量生理盐水。术后即刻注射绿脓杆菌。结果:①术后第5天VEGF组白细胞吞噬指数0.12±0.02较生理盐水组0.08±0.03高,差异有显著性意义(t=2.484,P<0.05);细胞内杀菌率VEGF组(78.58±1.63)%较生理盐水组(36.17±2.31)%高,差异有显著性意义(t=21.21,P<0.01)。②术后第11天VEGF组皮瓣存活面积为(66.06±5.05)%较生理盐水组(50.15±4.46)%大,差异有显著性意义(t=7.469,P<0.01)。③同一时相内肉眼及光镜观察,VEGF组皮瓣各段的病理改变较轻,真皮层发现较多毛细血管,炎细胞浸润较少。④术后第11天白细胞介素1β(IL-1β)阳性细胞数VEGF组皮瓣(18.42±4.21)/HP较生理盐水组皮瓣(29.63±4.65)/HP低,差异有显著性意义(t=5.650,P<0.01)。皮瓣在100倍镜视野计算血管密度VEGF组(35.64±5.41)/cm2较生理盐水对照组(16.42±4.13)/cm2高,差异有显著性意义(t=8.931,P<0.01)。结论:VEGF能改善皮瓣微循环、促进血管再生,有明显的促进任意皮瓣成     

COX-2与VEGF在急性白血病中的表达及其意义

目的观察急性白血病骨髓血血浆中环氧合酶-2(COX-2)和血管内皮细胞生长因子(VEGF)的表达水平,探讨其在急性白血病中表达的意义以及二者之间相关性。方法54例急性白血病患者分为3组,其中初治组33例,缓解组15例,复发组6例。用ELISA法检测骨髓血血浆中COX-2和VEGF的表达。结果①急性白血病初治组COX-2和VEGF表达分别为(6.33±2.01)ng/mL和(132.32±16.41)pg/mL;缓解组分别为(4.09±1.47)ng/mL和(114.47±7.06)pg/mL;复发组分别为(6.45±1.07)ng/mL和(125.84±8.68)pg/mL。COX-2和VEGF在初治组及复发组表达均明显高于缓解组(P<0.01)。②COX-2和VEGF在急性白血病中的表达呈正相关(P<0.01),同时都与骨髓原始幼稚细胞比例呈正相关(P<0.01)。结论COX-2和VEGF在初治及复发急性白血病表达水平高于缓解期,二者之间呈协同表达,且COX-2和VEGF表达水平与骨髓原始幼稚细胞比例呈正相关。为以COX-2为靶点的抗血管新生治疗急性白血病,提供了新的思路和实验依据。     

孕11～13+6周三维超声测量胎盘体积与新生儿出生体重及胎盘重量和体积的相关性

目的研究早中孕期胎盘体积与新生儿出生体重、胎盘体积及胎盘重量等各项指标之间的相关性。方法对2011年6月至2012年7月在北京协和医院就诊的孕11~13+6周孕妇留取胎盘容积数据,离线采用4Dview软件中三维超声体积测量技术VOCAL法计算出胎盘体积,并以相应头臀长区间相对应的胎盘体积的对数均值比较得出胎盘体积的中位倍数值。选取无合并症及胎儿畸形的孕产妇,记录其年龄及基础体重指数(BMI),随访至足月胎儿出生,记录新生儿出生体重、胎盘重量及胎盘长径、宽径、厚度并计算出体积。结果相关性分析显示:(1)早中孕期胎盘体积中位倍数值与新生儿出生体重具有显著相关性:斯皮尔曼秩相关系数为0.200(P<0.05);但与出生时胎盘重量及胎盘体积关系不大:斯皮尔曼秩相关系数为0.164,0.112(P>0.05)。(2)新生儿出生体重与胎盘重量、胎盘体积及孕妇基础体重显著相关:斯皮尔曼秩相关系数分别为0.478,0.361,0.259(P<0.01)。(3)胎儿出生时胎盘重量与胎盘体积及孕妇体重指数显著相关:斯皮尔曼秩相关系数分别为0.467(P<0.01),0.198(P<0.05)。多元回归分析显示:(1)新生儿出生体重(g)=1136.9+1530.9×MOM+45.3×BMI-15.0×孕妇年龄(r=0.29,P=0.01<0.05)。(2)胎盘重量(g)=88.1+315.3×MOM+10.0×BMI+0.1×孕妇年龄(r=0.27,P=0.02<0.05)。结论早中孕期11~13+6周胎盘体积与新生儿出生体重、胎盘重量具有一定相关性,可以进行线性拟合。该研究结果为通过早中孕期胎盘体积进一步预测小于或大于胎龄儿具有一定的参照价值。     

VEGF在妊娠期糖尿病产妇分娩新生儿脐血中的表达

目的:探讨血管内皮生长因子(VEGF)在新生儿脐静脉、脐动脉血中的表达及作用。方法:采用放射免疫分析法检测VEGF水平对40例妊娠期糖尿病产妇分娩的新生儿(研究组)与40例正常产妇所分娩的新生儿(对照组)的脐静脉、动脉血的VEGF水平进行检测,其中对新生儿进行血糖测定发现对照组新生儿的血糖均正常,而研究组则有24例正常,16例低血糖。结果:研究组脐静、动脉血中的VEGF水平明显高于对照组(P<0.01)。而对照组中脐静脉血VEGF水平明显高于脐动脉(P<0.05)。研究组中16例低血糖患者脐动脉血中的VEGF水平明显比血糖正常(24例)和对照组高(P<0.05,P<0.01)。结论:研究结果显示在妊娠期糖尿病产妇新生儿脐静脉、动脉血的VEGF水平比健康产妇新生儿高,且脐动脉血中VEGF水平是妊娠期糖尿病对新生儿的宫内造成损伤程度的反映。     

血管内皮生长因子在喉癌组织中的表达及其意义

目的 :研究血管内皮生长因子 (VEGF)在喉癌组织中的表达及微血管密度 (MVD)与喉癌生物学特性的关系。方法 :应用免疫组化技术 ,检测 30例喉癌组织、 11例喉上皮单纯性增生及 4例非典型增生组织中VEGF及CD34的表达 ,并计算微血管密度 ,分析VEGF表达与微血管密度的关系。结果 :在喉上皮单纯性增生、非典型增生及喉癌组织中 ,VEGF表达阳性率及MVD分别为 36 36 %、 5 0 0 0 %、 80 0 0 % ;2 19± 3 2 2、 17 83±8 10、 5 9 13± 2 4 82 ,差异显著 (P <0 0 5 )。在喉癌组织中 ,低表达VEGF组与强表达组的MVD平均值分别为38 31± 38 30、 6 4 33± 2 0 6 0 ,有统计学差异 (P <0 0 5 )。结论 :VEGF表达与肿瘤微血管密度有密切关系 ,VEGF促进肿瘤血管的形成 ,在喉癌的生长、转移过程中可能具有重要的作用     

妊娠高血压综合征血管内皮生长因子表达与围产儿结局的关系

目的　探讨在妊娠高血压综合征 (简称妊高征 )发病中血管内皮生长因子 (VEGF)对围产儿结局的影响。方法　分别采用酶联免疫吸附试验检测 4 0例妊高征孕妇的静脉血VEGF水平 ,免疫组化检测胎盘及蜕膜组织VEGF及CD34表达情况 ,详细记录围产儿的情况。并以 35例正常孕妇作对照。结果　①妊高征组孕妇的外周血VEGF水平及胎盘组织微血管密度 (MVD)明显低于正常妊娠组 (P <0 . 0 5 ) ;②两组胎盘绒毛滋养叶细胞和蜕膜组织中均有VEGF阳性表达 ,胎盘组织强阳性表达高于蜕膜。轻度妊高征与对照组比较 ,其胎盘组织VEGF强阳性表达的差异无显著性意义 ;而中度和重度妊高征与对照组相比 ,VEGF强阳性表达明显降低 ,其差异有显著性意义 (P <0 .0 5 )。各组孕妇蜕膜组织中的VEGF的表达强度的差异无显著性意义 ;③孕妇外周血VEGF水平与新生儿评分有关 ,与新生儿出生体重 (r =0 . 2 9;P <0 . 0 5 )和胎盘重量 (r =0 34;P <0 . 0 1)均存在直线正相关关系 ;与胎儿胎龄无明显关系。结论　妊高征孕妇血清VEGF水平和胎盘组织MVD降低 ,胎盘组织VEGF表达明显下降 ,VEGF可能对围产儿的结局有一定影响。     

硬脑膜血管内皮细胞生长因子表达及增殖活性与慢性颅内静脉压增高状态

目的:探讨慢性颅内静脉压增高状态下硬脑膜血管内皮细胞血管内皮细胞生长因子(vascularendothelialgrowthfactor,VEGF)表达及增殖活性的变化。方法:实验在解放军沈阳军区总医院动物实验中心完成。选择Wistar雄性大鼠65只,造模成功24只,随机分为实验组12只,对照组12只,右侧颈总动脉和颈外静脉端-端吻合,同时结扎上矢状窦,建立慢性颅内静脉压增高的动物模型;90d后采用免疫组化方法检测硬脑膜血管内皮细胞中VEGF及增殖细胞核抗原(proliferatingcellnuclearantigen,PCNA)的表达情况。结果:对照组的硬脑膜血管中VEGF仅呈微弱表达,其吸光度值(A)为2.12±0.59,实验组硬脑膜中血管内皮细胞VEGF表达A值为8.66±1.75,两者相比实验组微血管生成数量显著增高(P<0.05);微血管密度(×200倍计数)对照组为(3.04±0.31)/视野,实验组为(11.70±2.36)/视野,两者相比实验组微血管生成密度显著增高(P<0.05)。对照组的硬脑膜血管中PCNA仅呈微弱表达,其A值为1.12±0.19,实验组硬脑膜血管内皮细胞中PCNA表达A值为6.46±1.02。两者相比实验组血管内皮细胞增殖活性显著增高(P<0.05)。结论:慢性静脉压增高状态下硬脑膜血管内皮细胞VEGF表达升高,PCNA增殖活跃,可能与血管生成及动静脉畸形的发生发展有关。     

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.