二甲双胍对小鼠激素性股骨头坏死影响的实验研究

目的：探讨二甲双胍对小鼠激素性股骨头坏死的防治效应。方法：昆明小鼠36只,随机分为3组（n＝12）：空白对照组A,模型组B,二甲双胍组C,B、C组按10 mL／kg腹腔注射马血清,间隔2周后按5 mL／kg再次腹腔注射马血清,第2次注射马血清同时肌肉注射醋酸泼尼松龙45 mL／（kg·d）,共5 d,制备股骨头坏死模型。应用激素同时B组灌服生理盐水10 mL／（kg·d）,C组按0．2 g／（kg·d）的剂量餐后灌服二甲双胍。A组不制备模型,于同时间点肌肉注射和灌服等量生理盐水。各组于造模前、造模后2、4、6周行血清总胆固醇（TC）、甘油三酯（TG）、血管性血友病因子（VWF）、纤溶酶原激活物抑制剂－1（PAI-1）含量检测,于造模后2、4、6周各组随机取4只小鼠处死,组织形态学观察股骨头情况。结果：3组各时间点股骨头外观、形态及关节软骨面均正常。B组较C组空骨陷窝率明显增高（P＜0．05）,A、C组间无明显差异（P＞0．05）。TC、TG测定结果显示C组2、4、6周显著低于B组（P＜0．05）,但高于A组（P＜0．05）。VWF、PAI-1测定结果显示C组2、4周明显低于B组（P＜0．05）,6周差异无统计学意义（P＞0．05）,A、C组间比较差异均无统计学意义。结论：二甲双胍可减轻激素所致的高脂、高凝、低纤状态,从而有效预防小鼠激素性股骨头缺血坏死。     

骨蚀宁胶囊对激素性股骨头坏死模型兔凝血机制的影响

背景：骨蚀宁胶囊是丁锷教授在长期治疗激素性股骨头缺血性坏死的临床实践中,总结出的有效方剂。目的：观察骨蚀宁胶囊对激素性股骨头坏死动物模型相关凝血指标的影响。方法：随机选取6只白兔为正常对照组,余90只白兔利用大肠杆菌内毒素加甲强龙的方法成功制备兔激素性股骨头坏死的动物模型后随机分为骨蚀宁低剂量组[0.47g/（kg·d）]、中剂量组[1.41g/（kg·d）]、高剂量组[4.23g/（kg·d）]及模型组和对照组[仙灵骨葆1.92g/（kg·d）],分别于用药后4,8,12周检测各项指标。结果与结论：模型组各时段血浆血栓素B2、GMP-140和血栓调节蛋白水平与均显著高于其他组,6-keto-PGF1α显著低于其他组（P〈0.01,或P〈0.05）。随骨蚀宁治疗时间的延长,血栓素B2、GMP-140和血栓调节蛋白水平逐渐降低6-keto-PGF1水平逐渐升高;中剂量组较低、高剂量组及对照组作用更加明显（P〈0.01,或P〈0.05）。提示1.41g/（kg？d）剂量骨蚀宁胶囊改善兔股骨头局部组织瘀血状态,防治激素性股骨头坏死效果较好。     

激素性兔股骨头坏死模型的建立

背景：激素的应用已经成为激素性股骨头缺血坏死发病的首要原因。目的：拟应用马血清与皮质醇激素联合制备兔股骨头缺血性坏死早期模型,探讨激素性股骨头坏死的发病机制。方法：新西兰大白兔随机分成3组。激素联合马血清组静脉注射马血清10mL/kg,3周后再次注射马血清6mL/kg,再2周后注射甲强龙45mg/kg,1次/d,连续5d。激素组注射甲强龙45mg/kg,1次/d,连续5d。正常对照组不做任何处理。于激素给予前及激素注射后1,3,7和14d检测定血胆固醇、三酰甘油水平;于激素注射后第2、4、8周行股骨头MRI和组织病理学检测。结果与结论：与对照组比较,激素联合马血清组和激素组大白兔血清三酰甘油和总胆固醇分别于激素注射后1d和3d明显高于对照组（P〈0.01）。MRI检测结果显示,激素联合马血清组大白兔股骨头于激素注射后第4周出现坏死信号;激素组第8周出现坏死信号。组织学检测结果显示,激素联合马血清组大白兔于激素注射第4周时股骨头出现骨小梁部分变细、断裂,空骨陷窝增加;第8周骨小梁稀疏、破碎,脂肪细胞增大,空骨陷窝明显增大。激素组病理坏死程度各时段均较激素联合马血清组轻。结果表明,激素联合马血清方法可成功制备股骨头坏死早期模型。     

激素性兔股骨头坏死模型的建立(英文)

背景:激素的应用已经成为激素性股骨头缺血坏死发病的首要原因。目的:拟应用马血清与皮质醇激素联合制备兔股骨头缺血性坏死早期模型,探讨激素性股骨头坏死的发病机制。方法:新西兰大白兔随机分成3组。激素联合马血清组静脉注射马血清10mL/kg,3周后再次注射马血清6mL/kg,再2周后注射甲强龙45mg/kg,1次/d,连续5d。激素组注射甲强龙45mg/kg,1次/d,连续5d。正常对照组不做任何处理。于激素给予前及激素注射后1,3,7和14d检测定血胆固醇、三酰甘油水平;于激素注射后第2、4、8周行股骨头MRI和组织病理学检测。结果与结论:与对照组比较,激素联合马血清组和激素组大白兔血清三酰甘油和总胆固醇分别于激素注射后1d和3d明显高于对照组(P<0.01)。MRI检测结果显示,激素联合马血清组大白兔股骨头于激素注射后第4周出现坏死信号;激素组第8周出现坏死信号。组织学检测结果显示,激素联合马血清组大白兔于激素注射第4周时股骨头出现骨小梁部分变细、断裂,空骨陷窝增加;第8周骨小梁稀疏、破碎,脂肪细胞增大,空骨陷窝明显增大。激素组病理坏死程度各时段均较激素联合马血清组轻。结果表明,激素联合马血清方法可成功制备股骨头坏死早期模型。     

普伐他汀对激素性坏死股骨头内血管内皮细胞生长因子表达的影响

目的 研究普伐他汀对激素性坏死股骨头内血管内皮细胞生长因子（VEGF）表达的影响。方法 54只新西兰白兔随机分为正常组（A组）、模型组（B组）和普伐他汀治疗组（C组），每组18只。B、C2组应用大肠杆菌内毒素及甲泼尼龙琥珀酸钠造成激素性股骨头坏死模型，C组于造模后4周开始应用普伐他汀灌胃，A、B2组灌服等容量的蒸馏水。分别于喂药后4、8、12周分批处死动物，实时定量逆转录聚合酶链反应检测股骨头内VEGF mRNA的表达。结果 B、C2组各期VEGF的mRNA表达水平均低于A组，但C组喂药后第8、12周VEGF mRNA的表达量明显高于B组，差异有显著性（P〈0．01）。结论 普伐他汀可诱导激素性坏死股骨头内VEGF mRNA表达的上调，有可能成为临床治疗激素性股骨头坏死的有效药物。     

不同剂量内毒素联合激素建立兔股骨头缺血性坏死模型的影像学评估

目的：目前，国内外有很多制备ANFH动物模型的方法，但都存在建立时间长、成功率低、动物死亡率高的问题。实验旨在建立安全、有效的兔激素性股骨头缺血性坏死模型。 方法：实验于2006-05／2007-08在解放军北京军区总医院骨科实验室完成。①实验材料及分组：健康成年日本大白兔30只，雌雄不限，体质量（3．0±0．2）kg。采用随机数字表法将其分为3组，即内毒素100，50，20μg／kg组，每组10只。②实验过程：3组于兔耳缘静脉分别静推内毒素100，50，20μg／kg，1/d，共2次。3组都于第2次注射完内毒素后臀肌注射甲基强的松龙20mg／kg，1次／d，共3次。③实验评估：分别于注射完后2，4，6周时观察股骨头X射线片、MRI、病理组织以及造模动物死亡情况。 结果：30只兔全部进入结果分析。①造模结果：4周后经摄片、MRI、病理组织切片检查后，3组所有存活兔子的股骨头部存在不同程度的坏死。②X射线观察：4周后，3组X射线片大多可见股骨头密度不均一。③MRI观察：4周后，3组MRI可见典型的股骨头坏死表现，T2W1出现不均匀高信号，股骨头出现斑点状、硬化透明区等表现。④病理组织学观察：4周后，3组病理组织切片出现骨小梁稀疏变细结构紊乱，骨髓腔内造血组织明显减少，脂肪细胞体积增大，有的融合成泡状等表现。⑤死亡率：3组的死亡率分别为70％，50％，20％。 结论：小剂量（20μg／kg）内毒素联合激素4周可以成功诱导股骨头缺血性坏死动物模型，而且明显降低实验动物的死亡率。     

激素性股骨头坏死早期细胞凋亡相关基因表达及阿仑磷酸钠的干预

背景：近年研究发现激素性股骨头坏死病例中凋产的骨细胞增多，因此认为激素性股骨头坏死是骨细胞凋亡所致，而并非缺血性坏死。目的：观察大鼠激素性股骨头坏死早期bcl-2、半胱氨酸天冬氨酸蛋白酶3（cysteinyl aspartate specific protease3，caspase-3）的表达，以及阿仑磷酸钠的干预效果。设计、时间及地点：随机对照动物实验，于2006—03／200702在吉林大学基础医学院病理实验室完成。材料：健康Wister大鼠100只，随机分为正常对照组、激素模型组、藻酸双酯钠组、阿仑磷酸钠组、联合用药组，20只，组。藻酸双酯钠片为吉林东丰制药厂产品，阿仑磷酸钠为杭州默沙东制药有限公司产品。方法：除正常对照组外，其余4组大鼠均给予醋酸泼尼松龙臀肌注射建立激素性股骨头坏死模型。藻酸双酯钠组、阿仑磷酸钠组分别灌服对应药物，联合用药组灌服藻酸双酯钠＋阿仑磷酸钠。各组肌注用药1次／周，灌服药1次，d，实验持续6周。所有大鼠均强迫间断站立，4h／d。主要观察指标：光镜观察股骨头病理变化。S．P免疫组织化学染色法检测股骨头组织bcl-2、caspase．3的表达。结果：给药第4周与正常对照组比较，激素模型组股骨头坏死现象明显，骨小梁变细甚至断裂，空骨陷窝数量明显增多（t=-2．629，P〈0．01）；藻酸双酯钠组骨小梁和空骨陷窝数量介于前2组之间（t-=1．713，P〈O．01）；阿仑磷酸钠组、联合用药组骨小梁和空骨陷窝数量接近正常对照组忙1．462，t=-1．657，P〉0．05）。与激素模型组比较，藻酸双酯钠组、阿仑磷酸钠组、联合用药组股骨头组织bcl-2阳性细胞率均明显升高（t=-2．146，P〈0．05；t=-2．815，P〈0．01；t=-2．947，P〈0．01），caspase、3阳性细胞率均明显降低（t=-2．97，P〈0．叭；t=-2．462，P〈0．01；t=-I．854，P〈0．05），其中阿仑磷酸钠组圾联合用药组升高尤为明显（t=2．503，t=-1．959，P〈0．051。结论：大剂量激素可能通过抑制bcl-2表达和促进caspase-3表达引起股骨头坏死。阿仑磷酸钠可能通过与其相反的途径来防止骨细胞凋亡，从而预防早期激素性股骨头坏死。     

激素性股骨头缺血性坏死免模型的构建

背景:成人股骨头缺血性坏死可导致股骨头塌陷和髋关节破坏,但其真正的病因和发病机制尚未完全明了.因此建立实验性动物模型是目前研究激素性股骨头缺血性坏死的重要手段之一.目的:建立兔激素性股骨头缺血性坏死模型,探讨其可能的发病机制.方法:将健康成年新西兰白兔以抽法随机分成4组.对照组,注射生理盐水;激素组,注射甲基泼尼松龙3次;单次内毒素组,静脉注射大肠杆菌内毒素24h后,立即注射甲基泼尼松龙3次;双次内毒素组,大肠杆菌内毒素注射24h后重复给药1次,随后注射甲基泼尼松龙次.造模前及造模后行射线片、MRI 检查及组织学检查、透射电镜观察,并计算空骨陷窝率.结果与结论:造模第8周时激素组、单次内毒索组、双次内毒素组空骨陷窝率较对照组明显增高(P<0.01),并且双次内毒素组空骨陷窝率明显高于激素组和单次内毒素组(P<0.01).双次内毒素组较激素组及单次内毒素组股骨头出现坏死的时间更早、坏死的效果更显著,并且随着时间的推移股骨头坏死的效果越来越明显.说明在相同的实验条件下,实施双次内毒素与激素联合诱发股骨头坏死出现最早、坏死效果最明显,且骨陷窝空虚率随时间的延长而增加.     

普伐他汀干预激素性股骨头坏死兔模型的组织学变化:大体和光镜下比较和印证

背景:研究表明普伐他汀可通过上调内源性骨形成蛋白2、核心结合因子α1和血管内皮生长因子等基因的表达从而产生促进激素性股骨头坏死兔模型坏死股骨头修复的作用.目的:验证性观察普伐他汀干预激素性股骨头坏死兔模型大体和光镜下的组织学改变,并进行相互比较和印证.方法:将80只新西兰白兔按随机数字表法分为对照组18只,实验组62只.向实验组耳缘静脉注射大肠杆菌内毒素(10μg/kg)2次,注射间隔24h.并于第2次注射大肠杆菌内毒素后,臀肌注射甲强龙(20 mg/kg)3次,注射间隔24 h,制备兔激素性股骨头缺血坏死模型.造模第5周,将造模成功的39只新西兰白兔以随机数字表法分配其中的36只至模型组和他汀组,每组18只.他汀组以普伐他汀(1.2 mg/kg)灌胃,1次/d:模型组和对照组以等体积的蒸馏水灌胃.造模后8,12,16周,取股骨头,分别进行大体和光镜观察.结果与结论:大体观察及光镜观察显示模型组出现明显的骨坏死灶,骨髓腔内可见大量脂肪细胞增生;与模型组比较,他汀组骨细胞受损程度较轻,骨小梁密度较高,空骨陷窝比率较少,骨坏死面积和髓腔内脂肪细胞数量明显减少,骨坏死修复迹象明显.说明普伐他汀可有效促进早期激素性股骨头坏死兔模型坏死股骨头的修复.     

施他宁对急性重症胰腺炎患者的疗效观察及对血浆内毒素和TNF-α水平的影响

目的 :观察施他宁 (生长抑素 )对急性重症胰腺炎的治疗效果及其对患者血浆内毒素和TNF α水平的影响。方法 :40例急性重症胰腺炎患者随机分为A、B两组 ,A组采用施他宁治疗 (治疗组 ) ,B组给予一般治疗 (对照组 ) ,于入院第 1～ 7天抽血测定血清淀粉酶、血浆内毒素和TNF α。结果 :急性重症胰腺炎患者入院第一天的血浆内毒素 (A/B组 ,0 94± 0 2 1/0 96± 0 2 7EU/ml)和TNF α水平 (A/B组 ,0 87± 0 2 6 / 0 86± 0 31ng/ml)均明显高于健康人(内毒素 0 12± 0 0 4EU/ml,TNF a 0 0 4± 0 0 2ng ml,P值均 <0 0 0 1) ;施他宁治疗组患者血清淀粉酶、血浆内毒素和TNF α水平下降速度明显较对照组快。结论 :急性重症胰腺炎患者早期均存在不同程度的内毒素血症及血浆TNF α水平升高 ,治疗组患者血浆内毒素和TNF α水平下降较快的原因可能是由于施他宁治疗对急性胰腺炎具有较好的疗效 ,胰腺水肿及坏死的病程恢复较快。施他宁的治疗效果明显优于对照组     

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.