脊髓损伤对大鼠股骨骨密度与生物力学特性的影响

目的探讨脊髓损伤(spinal cord injury, SCI)对大鼠股骨生物力学和骨密度(bone mineral density, BMD)的影响. 方法将40只3月龄大鼠随机分为SCI组和对照组,SCI组于T10椎体处完全切断脊髓,对照组仅行椎板切除术.于术后3,6周分2批处死动物进行股骨骨密度和生物力学测定. 结果术后3周时SCI组大鼠股骨远端BMD较对照组显著下降(P<0.05);术后6周时SCI组股骨近端BMD与对照组比较,下降差异显著(P<0.05);股骨远端BMD较对照组下降差异非常显著(P<0.01);股骨干BMD与对照组相比有降低趋势,但无统计学意义.术后3周时股骨颈最大载荷、最大变形、结构刚度及能量吸收在2组间差异均无统计学意义.术后6周时最大变形、结构刚度和能量吸收均低于对照组(P均<0.05),最大载荷低于对照组,差异具有极显著性意义(P<0.01). 结论脊髓损伤后松质骨骨密度和生物力学性能的降低先于密质骨.脊髓损伤后6周时SCI组股骨松质骨的骨密度及生物力学参数均显著低于对照组,脊髓损伤后6周的大鼠可作为骨质疏松动物模型.     

慢性肾衰竭血清晚期糖基化终产物水平的变化及意义

目的探讨慢性肾功能衰竭患者血清晚期糖基化终产物(AGEs)水平的变化、意义及高通量血透对AGEs的清除效果. 方法应用竞争性ELISA法检测慢性肾功能衰竭(CRF)患者(非血液透析组及血液透析组)血清AGEs 水平,同时测血浆脂质过氧化物丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性. 结果 CRF患者无论血液透析与否,血清AGEs均明显高于健康组(P均<0.001),非血液透析与血液透析组AGEs水平无显著性差异(P<0.05),AGEs水平与CRE呈明显正相关(r=0.5974,P<0.01),与血糖无相关性;CRF患者血浆MDA含量明显高于健康组(P均<0.001),SOD活性明显低于健康组(P<0.05).AGEs与MDA、SOD间无相关性;常规血液透析(CHD)组,透析前后血清AGEs水平无显著性差异 (P < 0.05),而高通量血液透析(HFHD)组透析后血清AGEs水平明显降低(P<0.001),两组血浆SOD活性均明显升高(P<0.01),MDA含量明显降低(P<0.01).结论 CRF时,因肾功能受损致AGEs清除障碍,是血清AGEs水平升高的主要原因,同时CRF时氧化应激增强可能也促进了AGEs生成.高通量血液透析可以有效清除血清AGEs,并改善自由基代谢紊乱.     

利维爱对绝经后妇女骨密度及骨代谢指标的影响

目的了解利维爱对绝经后妇女骨密度及骨代谢指标的影响 . 方法将 123例自然绝经后妇女随机分 2组 研究组每日口服利维爱 1.25 mg+ 钙尔奇 D 600 mg, 对照组每日口服钙尔奇 D 600 mg, 观察 12个月 . 用药前后分别检测腰椎 (L 2～ 4)及股骨颈 (NK)骨密度 (BMD)骨代谢指标血清骨钙素 (BGP)和碱性磷酸酶 (AKP)及尿吡啶酚 /肌酐 (Pyr/cr)和钙 /肌酐 (Ca/Cr)比值 . 结果 (1)L 2～ 4、 NK两部位 BMD 研究组治疗后均增加 , 且前者上升有显著性差异 (P< 0.05);对照组均下降无显著性差异 (P >0.05);治疗后 2组间比较有显著性差异 (P< 0.01,P< 0.05). (2)生化指标血 BGP、 AKP及尿 Pyr/Cr、 Ca/Cr 治疗后研究组均上升有显著性差异 (P< 0.01,P< 0.05); 对照组变化无显著性差异 (P >0.05). 结论绝经后妇女每日服用 1.25 mg利维爱加钙尔奇 D可以提高骨量 ; 单用钙尔奇 D不能防止骨丢失 .     

洛沙坦与络活喜对老年自发性高血压鼠利钾尿肽与心钠素摩尔比值的影响

目的探讨利钾尿肽(KP)与心钠素(ANP)摩尔比值变化在老年自发性高血压鼠(SHR)治疗中的意义.方法30只老年SHR随机分为洛沙坦组(L组)、络活喜组(A组)及模型组(S组),每组10只;10只同龄Wistar-Kyoto(WKY) 大鼠(W组)作为对照组.用放射免疫分析方法分别测定模型各组治疗后老年SHR血浆、心房及主动脉组织的KP和ANP含量.结果治疗结束时,各组大鼠血浆KP、ANP水平均无差异(P均>0.05),但未经治疗的S组SHR血浆KP/ANP摩尔比值较对照组及两个治疗组水平均显著降低(P<0.05或P<0.01),S组心房中KP/ANP摩尔比值高于其它3组(P<0.05或P<0.01).结论KP与ANP比例关系的改变在老年SHR的治疗中可能发挥着重要作用.     

不同亚型轻度认知功能障碍听觉事件相关电位随访研究

目的探讨听觉事件相关电位在不同亚型轻度认知功能障碍(MCI)诊断及转归预测中的作用。 方法对37例遗忘型-单领域MCI（SD-MCI）患者、19例遗忘型-多领域MCI（MD-MCI）患者及50例健康老年对象（纳入对照组）进行神经心理学测试和听觉事件相关电位（AERPs）检测。对各组对象神经心理学测试评分及P50、N100、P200、N200及P300波潜伏期和波幅进行分析比较。并于随访2年后再次进行相同测试。 结果入选时与对照组比较,SD-MCI组逻辑记忆即刻回忆得分及逻辑记忆延迟回忆得分均显著低于对照组（P<0.05）;MD-MCI组韦氏逻辑记忆亚测验、Boston命名、连线试验和韦氏成人智力量表积木试验得分均较显著低于SD-MCI组（P<0.05）。与对照组比较,SD-MCI组P50波幅明显增高(P<0.05),P300潜伏期明显延长(P<0.05),波幅明显降低(P<0.05)。MD-MCI组与SD-MCI组比较,前者P50波幅明显增高(P<0.01),P300潜伏期明显延长(P<0.05),波幅显著降低(P<0.05)。2年后随访时发现,转化为阿尔茨海默病（AD）的患者其韦氏逻辑记忆亚测验、Boston命名、连线试验和韦氏成人智力量表积木试验得分均显著低于稳定型MCI患者（P<0.01）。与对照组比较,AD组患者P300潜伏期明显延长(P<0.05),波幅显著降低(P<0.05)。AD组与稳定型MCI患者比较,前者P50波幅明显降低(P<0.001),P300潜伏期明显延长(P<0.05),波幅显著降低(P<0.05)。通过比较AD组与稳定型MCI患者入选时AERPs结果发现,前者入选时P50波幅明显增大(P<0.05)。 结论AERPs的P50波幅和P300潜伏期、波幅可作为诊断不同亚型MCI的重要指标,P50波幅可作为预测不同亚型MCI转归的重要参考依据。     

心肺复苏后血浆可溶性选择素及基质金属蛋白酶-9测定的临床意义

目的探讨心肺复苏(CPR)后是否会出现血浆可溶性P-选择素(sP-选择素)、E-选择素(sE-选择素)及基质金属蛋白酶-9(MMP-9)增高,并评价其临床意义.方法对CPR后存活≥48 h的82例患者于CPR后次日取血标本测定血浆sP-选择素、sE-选择素及MMP-9;按是否发生全身炎症反应综合征(SIRS)及脓毒症而进行分组;并选择65例非危重病患者作为对照.结果 CPR后SIRS发生率为68.3%(56/82例),SIRS组患者血浆sP-选择素水平明显高于非SIRS组患者及对照组(P均<0.01), SIRS组与非SIRS组血浆Se-选择素和MMP-9水平虽无明显差异(P>0.05),但却均高于对照组(P均<0.01).CPR后1周内43.9%(36/82例)的患者发展为脓毒症,脓毒症组患者血浆sP-选择素水平明显高于无脓毒症组患者(P<0.05),两组血浆sE-选择素和MMP-9水平无明显差异(P>0.05).CPR后死亡患者的血浆sE-选择素和MMP-9水平显著高于存活患者(P均<0.01),但两组的血浆sP-选择素水平无明显差异(P<0.05).结论 SIRS是CPR后一种常见的非特异性反应,对预后几乎无明显影响;血浆sP-选择素水平可能帮助识别脓毒症高危患者,而血浆sE-选择素和MMP-9水平可能有助于CPR后不良预后的判断.     

2型糖尿病肾病与无肾病患者骨密度研究

目的探讨2型糖尿病肾病与骨质疏松(OP)的关系.方法应用双能X线吸收仪测定48例2型糖尿病(DM)患者椎体、左髋部、左前臂的骨密度(BMD).根据白蛋白尿排泄率(AER)将DM(2型)分为肾病组(AER≥20μg/min)和无肾病组(AER<20μg/min),测定糖基化血红蛋白(HbAic)、C肽(空腹及餐后2h)并做相关性分析.结果肾病组各部位BMD均低于无肾病组,以股骨颈处有显著性差异(P<0.05),肾病组OP发生率显著大于无肾病组(P<0.05),肾病组中随AER增高,BMD减少.结论肾脏损害是加重OP的重要因素.     

脉冲电磁场干预去势雌性大鼠骨代谢的强度窗效应

目的研究不同强度脉冲电磁场（PEMFs）对去势雌性大鼠骨代谢的影响。 方法将60只10月龄雌性Sprague Dawley大鼠随机分为空白组、去势组、0.14 mT组、0.16 mT组、0.18 mT组和雌激素组,除空白组行假手术外,其余均切除双侧卵巢以建立骨质疏松模型。术后1周,将0.14 mT组、0.16 mT组、0.18 mT组大鼠暴露于相应的PEMFs下,每日1次,每次60 min,为期3个月;雌激素组行雌激素皮下注射。实验期间动态测定大鼠全身骨密度(BMD),第3个月末处死大鼠并测定相关生化指标和局部骨密度。 结果与空白组相比,其余5组碱性磷酸酶(ALP)活性均显著上升（P<0.01）,去势组、0.14 mT组抗酒石酸酸性磷酸酶5b(TRAP5b)水平显著升高（P<0.01）;干预至第2个月末,0.14 mT组全身骨密度明显低于空白组（P<0.05）,第3个月末,去势组、0.14 mT组全身骨密度均明显低于空白组（P<0.05）,0.16 mT组、0.18 mT组和雌激素组全身骨密度均明显高于去势组（P<0.05）;第3个月末,各组腰椎骨密度变化趋势与全身骨密度变化基本一致,去势组、0.14 mT组股骨骨密度明显低于空白组,但其余各组间比较,差异无统计学意义。 结论频率为50 Hz,磁感应强度为0.16 mT和0.18 mT的PEMFs刺激能够促进骨形成,可作为治疗骨质疏松症的参考参数;而频率为50 Hz,磁感应强度为0.14 mT的PEMFs可能具有刺激骨吸收的作用。PEMFs对去势雌性大鼠骨代谢的影响存在较为明显的“强度窗”效应。     

再灌注损伤大鼠心肌细胞核3H-Ryanodine结合特性的变化

目的观察缺血-再灌注损伤(IRI)心肌细胞核兰尼定受体(RyR)结合特性改变.方法雄性Wistar大鼠随机分为IRI组和假手术(Sham)组,结扎冠状动脉左主干建立IRI模型,3H-Ryanodine饱和结合法分析分离的心肌细胞核上RyR最大结合容量(Bmax)和解离常数(Kd).结果大鼠心肌细胞核存在高亲和力的RyR,IRI组较Sham组Bmax降低29%(P<0.01),Kd差异无显著性(P>0.05).IRI组和Sham组心肌细胞核经佛波酯(PMA)+磷脂酰丝氨酸(PS)处理后,Bmax均显著增加(P均<0.01),但IRI组的增加幅度较小(P<0.01);IRI组和Sham组心肌细胞核经Ca2+-钙调素(CaM)处理后,Bmax均降低(P均<0.05),但IRI组降低幅度较小(P<0.01);上述处理对两组Kd均无显著影响(P均>0.05).结论 IRI心肌细胞核RyR的Bmax呈降低趋势;经PMA+PS和Ca2+CaM处理后,Bmax的改变削弱,而Kd无改变.     

不同波形低频脉冲磁场对大鼠心肌微血管内皮细胞的影响

目的研究在固定时间和频率的情况下不同波形的低频脉冲磁场(LF PMFs)对大鼠心肌微血管内皮细胞（CMECs）增殖、细胞周期、凋亡、迁移、细胞骨架以及一氧化氮（NO）分泌能力的影响。 方法磁场频率为15 Hz,磁场强度分别为0.6 mT、1.2 mT、1.8 mT、2.4 mT,作用时间为4 h/d,连续作用5 d的情况下,以矩形和三角形2种波形磁场分别作用于离体大鼠心肌微血管内皮细胞,对照组不加干预。 结果矩形波磁场促进内皮细胞增殖(P<0.01),使其细胞周期分布发生改变(P<0.01),DNA合成期(S期)和合成后期（G2期）细胞比例增加,凋亡率降低(P<0.05),细胞迁移能力显著增强(P<0.01),曝磁后细胞骨架结构发生重构,应力纤维增多, NO分泌能力增加(P<0.01);三角波磁场0.6 mT组和2.4 mT组促使CMECs增殖(P<0.05),细胞周期改变(P<0.05),凋亡率降低(P<0.05),迁移能力增强(P<0.05),细胞骨架重构,NO分泌能力提高(P<0.05)。而三角波磁场1.2 mT组和1.8 mT组上述效果均不明显(P＞0.05)。 结论大鼠CMECs的增殖、细胞周期、凋亡、迁移、细胞骨架以及NO分泌能力除受LF PMFs频率和强度影响外,还受磁场波形的影响。【关键词】低频脉冲磁场;心肌微血管内皮细胞;增殖;细胞周期;凋亡;迁移;细胞骨架;一氧化氮     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.