脐血源性间充质干细胞向神经样细胞诱导分化的研究

目的探讨来源于人脐带血来源的间充质干细胞(MSCs)体外诱导分化成神经样细胞的可行性。方法取第5代的脐血间充质干细胞,用不同浓度的脑源性神经营养因子(BDNF)和睫状神经营养因子(CNTF)单独或联合诱导脐源血间充质干细胞向神经样细胞分化。倒置相差显微镜观察细胞形态变化,于实验第1、3、6天分别进行神经元特异性烯醇化酶(NSE)和胶质纤维酸性蛋白(GFAP)免疫细胞化学染色并计数分化为神经元样细胞及神经胶质细胞的比例。结果与对照组相比,BDNF和CNTF能显著提高人脐血源MSCs分化为神经元的比例。其中20 ng/mL的BDNF联合20 ng/mL CNTF诱导人脐血源MSCs分化为神经样细胞的比例最高。结论人脐血MSCs经BDNF和CNTF体外诱导,能够分化为神经样细胞。     

脑源性神经营养因子和睫状神经营养因子单独或联合体外诱导人脐带血来源的间充质干细胞向神经样细胞分化

背景:体外培养条件下脐血间充质干细胞可向神经样细胞诱导分化.一定浓度范围的脑源性神经营养因子和睫状神经营养因子联合体外诱导可获得较高的神经元分化比例.目的:观察脑源性神经营养因子和睫状神经营养因子单独或联合体外诱导人脐带血来源的间充质干细胞分化成神经样细胞的可行性.方法:取第5代的脐血间充质干细胞,分别用5,10,20 μJ/L的脑源性神经营养因子和5,10,20 μg/L.睫状神经营养因子单独或联合诱导脐血源间充质干细胞向神经样细胞分化,另设空白对照组无任何干预措施.倒置相差显微镜观察细胞形态变化,于实验第1,3,6天分别进行神经元特异性烯醇化酶和胶质纤维酸性蛋白免疫细胞化学染色,并计数分化为神经元样细胞及神经胶质细胞的比例.结果与结论:①向神经细胞诱导后,人脐血源间充质干细胞形态明显改变,胞体收缩,胞核部分折光性增强,出现类似于树突及轴突样结构.②与空白对照组相比,脑源性神经营养因子和睫状神经营养因子能显著提高人脐血源间充质干细胞分化为神经元的比例.其中20 μg/L.的脑源性神经营养因子联合20 μg/t.睫状神经营养因子诱导人脐血源间充质干细胞分化为神经样细胞的比例最高.提示人脐血间充质干细胞经脑源性神经营养因子和睫状神经营养因子体外诱导,均能够分化为神经样细胞.     

胶质细胞源性神经营养因子对猴骨髓间充质干细胞分化为神经元样细胞的影响

背景：鉴于骨髓间充质干细胞体外分化为神经样细胞的最终研究目的,是将诱导后的细胞移植入体内参与损伤神经系统的修复过程,因此,保证移植细胞的活性显得十分重要。目的：探讨胶质细胞源性神经营养因子对隐丹参酮体外诱导猴骨髓间充质干细胞分化为神经元样细胞的保护作用。方法：以隐丹参酮为诱导剂诱导第8代猴骨髓间充质干细胞分化为神经元样细胞,应用流式细胞仪检测不同时段诱导细胞的凋亡百分比（每间隔0.5h为1组,共12组）。选择细胞凋亡百分比较高的一个时段,观察添加不同质量浓度胶质细胞源性神经营养因子（0-100μg/L,共11组）对诱导细胞凋亡的影响。结果与结论：诱导后细胞凋亡百分比逐渐升高,约4h时达到峰值,维持约1h后下降（P〈0.05）。随着胶质细胞源性神经营养因子质量浓度由0μg/L提高到30μg/L,细胞凋亡百分比逐渐下降（P〈0.05）,当胶质细胞源性神经营养因子质量浓度超过30μg/L后,细胞凋亡水平受胶质细胞源性神经营养因子质量浓度影响不再显著。结果可见胶质细胞源性神经营养因子在隐丹参酮体外诱导猴骨髓间充质干细胞分化为神经元样细胞过程中具有保护作用。     

骨髓间充质干细胞向多巴胺能神经元的诱导分化

背景:近年来研究发现,神经营养因子在骨髓间充质干细胞的分化中发挥重要作用.目前脑组织中具有再生能力的神经干细胞在体外是否具有直接诱导骨髓间充质干细胞分化为多巴胺能神经元的作用还未见报道.目的:观察大鼠间充质干细胞在胶质细胞源性神经营养因子与神经干细胞共培养两种诱导条件下体外分化成多巴胺能神经元的能力.方法:分离培养SD大鼠骨髓间充质干细胞,取第3代细胞分2组培养,一组细胞应用胶质细胞源性神经营养因子单独诱导,另一组细胞与已培养成球的神经干细胞共培养进行诱导,共培养之前行Brdu标记.诱导3 d后以免疫组织化学法检测各组贴壁细胞神经元特异性标志物神经原纤维和多巴胺能神经元特异性标志物酪氨酸羟化酶的表达,观察间充质干细胞的分化情况.结果与结论:胶质细胞源性神经营养因子单独诱导组间充质干细胞在诱导24 h后胞体回缩呈锥形,突起延长且数量增多,有神经元样形态,且细胞间相互连接成网络状,3 d后部分细胞表达神经原纤维,其中少部分同时表达酪氨酸羟化酶.与神经干细胞共培养组神经干细胞球很快解离,迅速贴壁,共培养的贴壁细胞大量增殖且多呈神经元样,胞体细长多突起,相互间连接成网,多数贴壁细胞分别单独表达神经原纤维和酪氨酸羟化酶,少数细胞可见Brdu/神经原纤维,Brdu/胶质纤维酸性蛋白,Brdu/酪氨酸羟化酶双标阳性.提示间充质干细胞在胶质细胞源性神经营养因子、神经干细胞存在的情况下可定向转化为神经元,并有向多巴胺能神经元分化的可能.在该实验条件下胶质细胞源性神经营养因子效果好于神经干细胞.     

人脐血间充质干细胞向多巴胺能神经元分化的体外诱导

背景:细胞替代治疗帕金森病成为目前研究的一个热点,如何进行体外诱导获得足量的有效多巴胺能神经元是治疗该疾病的一种策略。目的:探讨人脐血间充质干细胞体外诱导分化为多巴胺能神经元的可行性。方法:将传至第5代人脐血间充质干细胞以5×106L-1接种,先用20μg/L表皮生长因子+20μg/L碱性成纤维细胞生长因子预诱导24h后,分为4组:对照组加入含体积分数为10%胎牛血清的DMEM/F12培养液,不加任何诱导液;其余3组分别加入100μmol/L抗坏血酸,1μmol/L全反式维甲酸,50μg/L胶质细胞源性神经营养因子单独或联合进行诱导。结果与结论:各诱导组均表达酪氨酸羟化酶、多巴胺转运体、多巴胺受体D2 mRNA。诱导分化后的细胞能表达神经元、星形胶质细胞特异性抗原。与对照组相比,各诱导组巢蛋白、神经元特异性烯醇化酶、胶质纤维酸性蛋白、酪氨酸羟化酶、多巴胺转运体、多巴胺受体D2阳性细胞率均明显升高(P<0.05);且全反式维甲酸+胶质细胞源性神经营养因子组和3种物质联合诱导组升高幅度高于抗坏血酸组(P<0.05),3种物质联合诱导组升高幅度高于全反式维甲酸+胶质细胞源性神经营养因子组(P<0.05)。结果提示抗坏血酸,全反式维甲酸,胶质细胞源性神经营养因子单独或联合均能促进人脐血间充质干细胞向多巴胺能神经元分化,3种物质联合应用效果最高。     

诱导脐血间充质干细胞向神经元样细胞分化

背景:脐血来源的间充质干细胞具有与造血干细胞和骨髓间充质干细胞相似的多向分化潜能,并且可以诱导分化为神经元样细胞,但分离培养后的成功率比较低,需要寻求一种成功率较高的培养方法。目的:探讨脐血间充质干细胞的生物学特性及向神经元样细胞诱导分化的方法。方法:由作者检索CNKI数据库2002/2011收录的有关脐血间充质干细胞诱导分化为神经元样细胞的相关研究文献,中文检索词为"脐血间充质干细胞,神经细胞,诱导分化,细胞因子"。结果与结论:脐血间充质干细胞具有与造血干细胞和骨髓间充质干细胞相似的多向分化潜能,可以在体外诱导分化为神经样细胞,对CD34表达阴性,是区别于脐血造血干细胞的主要标志物。脐血间充质干细胞在体外诱导分化的方法主要有细胞生长因子法、化学诱导剂法、生长因子与诱导剂联合法,通过各种神经诱导剂的作用,使培养出的神经元样细胞数量有所增加,国内外基础研究结果显示移植脐血间充质干细胞诱导分化的神经元样细胞可以修复中枢神经系统损伤性疾病,脐血间充质干细胞是神经损伤修复的一种理想种子细胞。     

人骨髓间充质干细胞诱导向多巴胺能神经元的分化

背景:体内外研究发现人骨髓间充质干细胞分化为神经元的比率都明显低于胶质细胞,并且这为数不多的神经元会逐渐死亡,而最终存活的细胞中神经元的数量更少.目的:观察人骨髓间充质下细胞体外诱导分化为多巴胺能神经元的潜能.方法:分离纯化和扩增人骨髓间充质干细胞,在体外先用碱性成纤维细胞生长因子和表皮细胞生长因子进行预诱导后,以胶质细胞源性神经营养因子和血管紧张素Ⅱ联合诱导人骨髓间充质干细胞向神经元和多巴胺能神经元分化.观察分化过程中细胞的形态变化.利用免疫组织化学检测神绎元和多巴胺能神经元特异性标志物的表达情况.结果与结论:人骨髓间充质干细胞经诱导后的细胞呈现双极、多极和锥形的典型神经元细胞的形态,明显表达抗人神经巢蛋白[(55.7±4.3)%]和神经元特异性烯醇化酶[(78.2±6.7)%],而且大部分人骨髓间充质干细胞表达酪氨酸羟化酶[(48.5±5.6)%],不表达神经胶质细胞标记物胶质纤维酸性蛋白.提示在适宜的条件下,人骨髓间充质干细胞可分化成神经元和多巴胺能神经元样细胞.     

新生大鼠骨源性间充质干细胞向多巴胺能神经元样细胞的分化

目的 探讨体外培养的骨源性间充质干细胞向神经元样细胞的分化。方法 采用体外骨植块法培养骨源性的间充质干细胞（mesenchymal stem cells，MSCs），传代。用含0．5mmol／L IBMX，GDNF（10nG/ml）和IL-1β（100gpg／ml），中脑神经胶质细胞条件培养基和中脑神经膜碎片诱导其向多巴胺能神经元样细胞分化，免疫细胞化学检测神经细胞的表面标志NSE、MAP-2和TH。结果 原代骨源性间充质干细胞含有多种细胞形态，传代后细胞成均一的梭形。诱导前，对照组少量细胞表达NSE，不表达MAP-2和TH。诱导后间充质干细胞分化成表达NSE、MAP-2和TH的细胞。结论 骨源性间充质干细胞分化成神经元样细胞，表明其可跨胚层分化，同时为细胞移植治疗中枢神经系统疾病提供一种新的细胞来源。     

人胚胎脑组织蛋白提取物诱导人胎盘间充质干细胞向神经细胞的分化

背景：选择合适的诱导方法诱导人胎盘间充质干细胞分化为神经元样细胞是临床治疗神经损伤的关键。目的：在人胎盘间充质干细胞中加入商品化的人胚胎脑组织蛋白提取物,观察其诱导分化为神经元样细胞的可行性。方法：采用酶消化法分离培养人胎盘间充质干细胞,传至第3代,将人早期胚胎脑组织蛋白提取物加入诱导培养基培养6 d,加入浓度为20 nmol/L全反式维甲酸和500μg/L音猬因子培养3 d,换新的培养液,包含体积分数为10%胎牛血清,10μg/L脑源性神经营养因子,20μg/L神经胶质细胞源性神经营养因子,50μg/L胰岛素样生长因子Ⅱ型继续培养3 d。结果与结论：胎盘组织经酶消化后获得贴壁细胞,传至第2代细胞形态为梭形,成漩涡样生长,传至第3代细胞形态较均一。诱导后细胞经免疫细胞化学法检测均表达神经元特异性烯醇化酶、巢蛋白、胶质纤维酸性蛋白、神经丝蛋白、神经生长相关蛋白43;ELISA法检测细胞培养上清脑源性神经营养因子、神经营养因子3、神经营养因子4为阳性表达;RT-PCR检测细胞微管相关蛋白、神经元特异性烯醇化酶、神经丝蛋白、神经生长相关蛋白43均为阳性表达。结果表明人胚胎脑组织蛋白提取物使人胎盘间充质干细胞诱导分化为神经元样细胞。     

人羊膜上皮细胞分泌神经营养因子诱导人脐血间充质干细胞向神经元样细胞的分化:可能性验证

背景:课题组前期实验已证实人羊膜上皮细胞条件培养液可以诱导人脐血间充质干细胞分化为多巴胺能神经元样细胞,在此过程中人羊膜上皮细胞分泌的神经营养因子及其受体可能起到了重要作用.目的:探讨人羊膜上皮细胞分泌的神经营养因子对人脐血间充质干细胞神经分化的作用.方法:将P1代人脐血间充质干细胞按2×10~8 L~(-1)密度接种,分为3组:对照组加入HG-DMEM培养基;诱导组加入人羊膜上皮细胞条件培养液;阻断剂组预先加入阻断剂K252a工作液,36 ℃孵育40 min后更换为羊膜上皮细胞条件培养液.免疫荧光化学检测诱导后人脐血间充质干细胞神经元特异性烯醇化酶及多巴胺转运体的表达,实时定量PCR法检测诱导后人脐血间充质干细胞中神经元特异性烯醇化酶、多巴胺转运体及酪氨酸羟化酶的表达.结果与结论:人羊膜上清中有神经生长因子和脑源性神经营养因子的表达,且P1代人脐血间充质干细胞表达神经营养因子高黏附性受体Trka及Trkb.诱导48 h后与对照组比较,诱导组及阻断剂组神经元特异性烯醇化酶、多巴胺转运体阳性细胞数均明显增加(P < 0.05),且诱导组阳性细胞数最多(P < 0.05).诱导组、阻断剂组神经元特异性烯醇化酶、多巴胺转运体及酪氨酸羟化酶mRNA含量均显著高于对照组(P < 0.01),且诱导组各基因mRNA含量明显高于阻断剂组(P < 0.01).结果证实人羊膜上皮细胞分泌的神经营养因子对人脐血间充质干细胞的神经分化有重要作用,其促神经分化作用是通过酪氨酸激酶受体介导的.     

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.