沙利度胺治疗急性白血病的临床疗效及抗血管形成的观察

目的:观察沙利度胺联合化疗治疗急性白血病临床疗效及对血浆血管内皮生长因子(VEGF)、血管内皮生长因子受体(VEGFR)、碱性成纤维细胞生长因子(bFGF)、骨髓微血管密度(MVD)的影响.方法:急性白血病36 例,分为实验组及对照组各18 例.每组均常规化疗,实验组同时口服沙利度胺100 mg/d.治疗前及治疗后8 周采集外周血双抗体夹心酶联免疫吸附法(ELISA)检测血浆VEGF、VEGFR、bFGF 及MVD 测定.结果:实验组与对照组治疗的有效率分别为88.9%(16/18)、77.8%(14/18),差异有统计学意义(P ＜ 0.05).实验组与对照组治疗后血浆VEGF、VEGFR、MVD [(211.74 ± 36.72)pg /mL vs.(288.02 ± 31.77)pg /mL;[(1 359.71 ±390.24)pg/mL vs.(1 753.89 ± 337.04)pg/mL;(8.30 ± 4.57)n/HP vs.(14.78 ± 2.76)n/HP]相比差异有统计学意义(均P ＜ 0.05),血浆[bFGF(2.09 ± 0.17)ng/mL vs.(2.11 ± 0.31)ng/mL]相比差异无统计学意义(P ＞ 0.05).结论:沙利度胺联合化疗可提高急性白血病的缓解率,可能通过抑制血浆VEGF 及其受体表达、减少MVD而发挥抗白血病作用.     

沙利度胺治疗小肠血管发育不良所致消化道出血的临床疗效评价

对沙利度胺治疗小肠血管发育不良引起的消化道出血临床疗效进行探讨。选取2015年1~12月于我院消化内科收治的32例小肠血管发育不良所致消化道出血患者作为研究对象,口服沙利度胺进行治疗,共4个月,随访8个月,观察疗效。32例患者治疗后临床症状持续时间(0.49±0.37)分、症状表现程度(0.83±0.28)分、出血持续时间(0.61±0.68)分、出血次数(0.81±0.46)分相较于治疗前差异显著(P0.05);治疗后出血次数(1.01±1.28)次、血红蛋白含量(96.7±20.2)g/L、输血量(108.32±219.36)ml相较于治疗前(10.69±5.28)次、(53.7±15.2)g/L、(1382.09±1428.25)ml差异显著(P0.05,t=10.079、9.622、4.987);治疗后VEGF浓度(111±25.3)pg/ml相较于治疗前(181±29.6)pg/ml差异显著,具有统计学意义(P0.05,t=10.169);共发生12例(37.5%)不良反应,经对症治疗后不良反应均消失(未停药)。沙利度胺治疗小肠血管发育不良引起的消化道出血疗效显著,可较好改善患者头晕、乏力等症状,不良反应发生率较低,安全可靠,值得临床推广应用。     

沙利度胺在局部晚期非小细胞肺癌中抗血管生成作用的研究

目的探讨沙利度胺在治疗局部晚期非小细胞肺癌中的抗血管生成作用。方法以该院2012年10月至2014年1月收治的40例局部晚期非小细胞肺癌患者作为研究对象,分为对照组(单纯同步放、化疗)和治疗组(在对照组基础上联合沙利度胺),每组各20例。同步放疗剂量60Gy,6周30次;化疗方案为PC(紫杉醇45~50mg/m~2,1次/周+卡铂AUC=2,1次/周)/EP(顺铂50mg/m~2第1、8、29、36天+VP16 50mg/m~2第1~5天、第29~33天);沙利度胺每日200mg口服,第1天起持续10周。采用酶联免疫吸附试验检测全部患者0、6、10周血清血管内皮细胞生长因子(VEGF)水平。结果治疗后第10周,治疗组VEGF水平[(220.35±82.61)pg/mL]明显低于对照组[(292.76±152.06)pg/mL],差异有统计学意义(P0.05)。治疗组近期疗效有效率(55%)高于对照组(40%),但差异无统计学意义(P0.05)。治疗组睡眠改善、体质量增加、食欲增加和疼痛缓解情况均优于对照组,差异均有统计学意义(P0.05)。对照组受益4例,治疗组受益17例,差异有统计学意义(χ~2=16.942,P=0.000)。对照组和治疗组治疗后在非血液学毒性和血液学毒性方面差异均无统计学意义(P0.05)。结论沙利度胺联合EP/PC方案同步放、化疗可显著降低血清VEGF水平,提高局部晚期非小细胞肺癌患者临床受益率,且未增加毒副作用。     

沙利度胺联合化疗治疗急性白血病对血浆VEGF及其受体水平的影响

目的 观察沙利度胺联合化疗治疗急性白血病的临床疗效及其对血浆血管内皮生长因子(VEGF)、血管内皮生长因子受体(VEGFR)水平的影响.方法 急性白血病患者36例,随机分为实验组及对照组各18例.每组均予以常规化疗方案标准剂量化疗,实验组同时长期口服沙利度胺100 mg/d.治疗前及治疗后8周分别采集外周血用双抗体夹心酶联免疫吸附法(ELISA)检测血浆VEGF和VEGFR含量.结果 实验组与对照组的有效率分别为88.9%和77.8%,差异有统计学意义(χ2=4.103,P<0.05).血浆VEGF水平实验组与对照组治疗前结果(389.78±249.94 pg/ml,318.54±125.78 pg/ml)分别与健康组(132.91±26.66 pg/ml)相比差异有统计学意义(t=3.141,t=3.024,P<0.01,P<0.01);实验组与对照组治疗后结果(211.74±36.72 pg/ml,288.02±31.77 pg/ml)分别与健康组相比差异有统计学意义(t=2.413,t=2.324,P<0.05,P<0.05);实验组与对照组治疗前相比差异无统计学意义(t=1.384,P>0.05);实验组与对照组治疗后相比差异有统计学意义(t=2.793,P<0.05).血浆VEGFR水平实验组与对照组治疗前结果(2 490.75±1 695.9 pg/ml,2 322.78±1 105.87 pg/ml)分别与健康组(1 134.98±378.45 pg/ml)相比差异有统计学意义(t=2.914,t=2.783,P<0.01,P<0.01);实验组与对照组治疗后结果(1359.71±390.24 pg/ml,1753.89±337.04 pg/ml)分别与健康组相比差异有统计学意义(t=2.572,t=2.447,P<0.05,P<0.05);实验组与对照组治疗前相比差异无统计学意义(t=1.276,P>0.05);实验组与对照组治疗后相比差异有统计学意义(t=2.486,P<0.05).直线相关分析发现血浆VEGF及VEGFR水平与临床疗效间具有一定的相关性(r=0.613,r=0.575,P<0.05).结论 沙利度胺联合化疗可提高急性白血病患者的缓解率,其作用机制可能通过抑制血浆VEGF及其受体水平的表达而发挥其抗血管增殖的抗白血病作用.     

沙利度胺联合去甲基化治疗方案治疗老年人急性髓系白血病临床效果观察

目的探讨沙利度胺联合去甲基化治疗方案治疗老年人急性髓系白血病的临床效果。方法选择2012年7月至2014年12月诊治的老年急性髓性白血病患者80例,根据随机抽签法分为治疗组与对照组各40例。对照组给予基于去甲基化的半量预激方案治疗,治疗组在对照组治疗的基础上给予加用沙利度胺治疗,治疗3个疗程。观察两组的治疗效果;血清碱性成纤维细胞成长因子(b FGF)、血管内皮生长因子(VEGF);预后生存时间。结果治疗后治疗组与对照组的总有效率分别为70.0%和45.0%,治疗组的总有效率高于对照组(P0.05)。治疗组治疗后的血清b FGF和VEGF含量为213.33±35.33 pg/ml和2.04±0.21 ng/ml,而对照组分别为297.34±32.14 pg/ml和2.29±0.42ng/ml。治疗后两组血清b FGF和VEGF含量均较治疗前明显降低(P0.05),且治疗组的血清VEGF和b FGF含量降低更明显(P0.05)。随访至今,治疗组的生存期为28.45±11.73个月,明显长于对照组的19.87±12.45个月(P0.05)。结论沙利度胺联合去甲基化治疗方案治疗老年人急性髓系白血病可有效调节血清VEGF和b FGF的水平,提高临床疗效,从而延长患者的生存时间。     

心肌损伤标志物在脓毒血症患者急救中的作用研究

目的探讨分析心肌损伤标志物水平在脓毒血症患者急救中的临床价值。方法选取2014年2月至2016年10月收治的急性脓毒血症患者62例,对其临床资料进行回顾性分析。分别以住院2周内是否存活以及左室射血分数(LVEF)将患者分为存活组与死亡组以及高射血分数组与低射血分数组,分别对上述患者血清心肌钙蛋白(cTnI)以及B型脑钠肽(BNP)进行检测比较,同时采取急性生理与慢性健康评分系统(acute physiology and chronic health evaluation,APACHE-Ⅱ)对患者身体状况进行评分。结果入院2周内存活患者中,在治疗0、5 d时以及治疗10 d时其APACHE-Ⅱ评分分别为(30.7±4.6)分、(26.5±5.2)分以及(23.2±4.7)分,cTnI水平分别为(0.6±0.2)ng/mL、(0.8±0.2)ng/mL以及(0.4±0.2)ng/mL,BNP水平分别为(80.3±9.3)pg/n L、(413.6±28.9)pg/n L以及(112.4±12.5)pg/n L;而死亡组患者在治疗初始阶段、治疗5 d时以及治疗10 d时其APACHE-Ⅱ评分分别为(30.3±4.2)分、(32.5±6.3)分以及(34.2±6.9)分,cTnI水平分别为(0.6±0.2)ng/mL、(0.9±0.3)ng/mL以及(1.2±0.3)ng/mL,BNP水平分别为(82.3±9.1)pg/n L、(574.6±32.6)pg/n L以及(582.7±38.3)pg/n L;经比较,存活组与死亡组在治疗初始时心肌损伤标志物水平以及APACHE-Ⅱ差异无统计学意义(P0.05),而在治疗后的不同时间点差异均有统计学意义(P0.05)。高射血分数组与低射血分数组上述指标差异也具有统计学意义(P0.05)。结论 cTnI以及BNP可对心肌损伤状况进行体现,进而可对患者心脏功能进行评估。监测上述指标可对急性脓毒血症患者的预后进行初步预测。     

超声造影击破-再灌注法定量分析组织血流量评价抗血管生成治疗小鼠肝癌的疗效

目的探讨超声造影击破-再灌注法测定组织血流量改变在评价抗肿瘤血管生成治疗中的作用。方法建立小鼠H22肝癌皮下移植瘤模型,随机分为对照组、沙利度胺低剂量组和沙利度胺高剂量组3组,各模型自建立次日起分别经腹腔注射0.5%羧甲基纤维素钠、沙利度胺100mg/kg体重和沙利度胺200mg/kg体重,每天1次,连续给药7d。末次给药24h后采用击破-再灌注法行超声造影检查,然后采用指数函数进行拟合分析,计算血流量。超声检查完成后完整剥离肿瘤,免疫组化法检测肿瘤CD34表达情况,计算肿瘤微血管密度。结果与对照组相比,沙利度胺低剂量组和沙利度胺高剂量组小鼠的体重和肿瘤体积均明显减少(P0.05),但两治疗组小鼠体重和肿瘤大小之间差异无统计学意义(P0.05)。沙利度胺低剂量组和高剂量组的血流量明显低于对照组(P0.01);沙利度胺高剂量组的血流量明显低于低剂量组(P0.05)。沙利度胺低剂量组和高剂量组的微血管密度明显低于对照组(P0.01)。但微血管密度在两治疗组之间的差异无统计学意义(P0.05)。结论超声造影击破-再灌注定量测定肿瘤血流量的方法可以有效监测肿瘤抗血管生成药物的治疗效果。     

丁苯酞对急性脑梗死患者的疗效及对睡眠质量的影响观察

目的：探究丁苯酞对急性脑梗死患者的疗效及对睡眠质量的影响作用。方法：选取2020年2月至2021年8月收治的急性脑梗死患者120例作为研究对象,按照随机数字表法随机分为观察组和对照组,每组60例。观察组患者给予丁苯酞治疗,对照组患者未给予丁苯酞治疗,其余治疗方法相同。比较分析2组患者治疗效果、神经功能及睡眠质量等的改善情况。结果：观察组治疗有效率为96.67%,明显高于对照组的83.33%,差异有统计学差意义(P<0.05)。2组患者治疗后睡眠质量均得到显著性改善,但观察组治疗后的睡眠质量评分为(5.17±1.29)分,显著低于对照组的(8.83±2.06)分,差异有统计学意义(P<0.05)。2组患者治疗后神经功能均得到显著性改善,但观察组治疗后的神经功能评分为(5.17±1.16)分,明显低于对照组的(8.38±2.04)分(P<0.05)。治疗后,观察组患者的炎性水平指标IL-6、CRP、TNF-α分别是(4.41±1.12)pg/mL、(5.08±1.16)ng/mL和(6.15±2.44)ng/mL,均明显小于对照组的(6.12±1.01)pg/mL、(7....     

沙利度胺对实验性关节炎大鼠滑膜细胞凋亡的影响

目的 研究不同浓度沙利度胺对体外培养成纤维细胞样滑膜细胞(FLS)凋亡的影响.方法 体外培养及纯化FLS,分为6组:对照组,脂多糖(LPS)组,LPS+高剂量沙利度胺(50 mg/L)组,LPS+中剂量沙利度胺(5 mg/L)组,LPS+低剂量沙利度胺(0.5 mg/L)组,LPS+甲氨蝶呤(MTX)组.48小时后显微镜及电镜观察不同处理组FLS形态,膜黏连蛋白-5/碘化丙啶(Annexin- V/PI)联合标记法测定FLS凋亡率及坏死率.结果 ①原代滑膜细胞培养3代后以梭形且呈极向排列FLS为主;②沙利度胺及MTX处理后FLS渐呈不规则形,细胞变圆缩小,透射电镜下可见典型细胞凋亡.③中、高剂量沙利度胺及MTX组凋亡率和坏死率均高于对照组、LPS组及低剂量沙利度胺组,凋亡率分别为(5.72±1.42)％、(8.07±1.45)％、(11.28±2.48)％vs (0.30±0.09)％、(0.24±0.05)％、(0.40±0.04)％(P＜0.05),坏死率分别为(12.96±4.32)％、(20.34±4.43)％、(18.11±1.17)％ vs (0.22±0.08)％、(0.13±o.09)％、(1.94±1.16)％(P＜o.05);低、中、高剂量沙利度胺及MTX组凋亡率均依次升高(P＜0.05);低、中、高剂量沙利度胺组及MTX组坏死率均依次升高(P＜0.05);高剂量沙利度胺组与MTX组坏死率之间比较差异无统计学意义(P＞0.05).结论 沙利度胺能够诱导FLS凋亡,在一定浓度范围内该作用呈剂量依赖性.沙利度胺对FLS早期凋亡作用弱于MTX,对晚期凋亡作用与MTX相同.     

肌钙蛋白Ⅰ和氨基末端脑钠肽前体在血栓抽吸疗效评价中的应用与研究

目的探讨血栓抽吸对急性心肌梗死患者肌钙蛋白I(cTnI)和氨基末端脑钠肽前体(NT-proBNP)的影响。方法根据是否行血栓抽吸治疗,106例急性心肌梗死患者分为血栓抽吸组51例和直接支架组55例。对比分析两组患者治疗前后cTnI和NT-proBNP变化情况,同时对比两组患者术中并发症和术后心血管事件发生率。结果血栓抽吸组的cTnI峰值时间[(10.2±2.9)h]比直接支架组cTnI峰值时间[(18.3±3.6)h]提前(P0.05);血栓抽吸组cTnI峰值[(21.9±8.8)ng/mL]比直接支架组cTnI峰值[(40.3±11.8)ng/mL]降低,差异有统计学意义(P0.05)。术前两组患者NT-proBNP水平均增高,血栓抽吸组术后第1天检测的NT-proBNP水平[(7 084.6±735.2)pg/mL)]比直接支架组低[(14 109.7±849.1)pg/mL],差异有统计学意义(P0.05)。直接支架组术发生慢血流5例,血栓抽吸组无慢血流或无血流现象发生,差异有统计学意义(P0.05)。术后随访半年,直接支架组4例发生心力衰竭,血栓抽吸组1例发生心力衰竭,差异有统计学意义(P0.05)。结论血栓抽吸可以降低介入治疗中慢血流或无血流现象的发生,cTnI和NT-proBNP动态检测可以为预后判断提供依据。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.