慢性神经痛大鼠脊髓运动神经元缝隙连接蛋白43对运动神经元凋亡及其运动功能恢复的影响

目的：研究慢性神经痛大鼠脊髓缝隙连接蛋白43(connexin43，cx43)在运动功能调节中的作用。方法：实验于2003—01／2004—06在广州市临床医学研究中心完成。10只SD大鼠接受右坐骨神经结扎手术，模拟慢性神经痛模型。手术前以及手术后1，3，5，7，14d，观察大鼠疼痛行为学并测定右后肢热刺激回缩潜伏期(paw withdraw thermal latency，PWTL)、电刺激回缩潜伏期(paw withdraw electric threshold，PWET)的变化，然后于第14天切取大鼠L1-5脊髓采用免疫组化分析两侧脊髓运动神经元Cx43表达差异。结果：手术前，右后肢PWTL，PWET分别为(13．0&;#177;1．9)s和(12．5&;#177;0．3)mA，第14天右后肢PWTL，PWET比术前明显降低(t=9．17和27．41，P&;lt;0．01)。右侧脊髓大量运动神经元Cx43表达阳性，200倍单个视野内阳性数量为(28．9&;#177;6．7)个，而左侧仅为(9．6&;#177;4．2)个，明显少于右侧(t=7．72，P&;lt;0．01)。结论：慢性神经痛大鼠脊髓运动神经元缝隙连接蛋白43表达增加，提示缝隙连接可能对慢性神经痛后运动协调和康复起着重要作用。     

慢性神经痛大鼠脊髓运动神经元缝隙连接蛋白43对运动神经元凋亡及其运动功能恢复的影响

目的:研究慢性神经痛大鼠脊髓缝隙连接蛋白43(connexin43,Cx43)在运动功能调节中的作用。方法:实验于2003-01/2004-06在广州市临床医学研究中心完成。10只SD大鼠接受右坐骨神经结扎手术,模拟慢性神经痛模型。手术前以及手术后1,3,5,7,14d,观察大鼠疼痛行为学并测定右后肢热刺激回缩潜伏期(pawwithdrawthermallatency,PWTL)、电刺激回缩潜伏期(pawwithdrawelectricthreshold,PWET的变化,然后于第14天切取大鼠L4～5)脊髓采用免疫组化分析两侧脊髓运动神经元Cx43表达差异。结果:手术前,右后肢PWTL,PWET分别为(13.0±1.9)s和(12.5±0.3)mA,第14天右后肢PWTL,PWET比术前明显降低(t=9.17和27.41,P<0.01)。右侧脊髓大量运动神经元Cx43表达阳性,200倍单个视野内阳性数量为28.9±6.7)个,而左侧仅为((9.6±4.2)个,明显少于右侧(t=7.72,P<0.01)。结论:慢性神经痛大鼠脊髓运动神经元缝隙连接蛋白43表达增加,提示缝隙连接可能对慢性神经痛后运动协调和康复起着重要作用。     

大鼠坐骨神经慢性压迫后脊髓背角GCH1基因表达与疼痛的关系

目的:探讨大鼠坐骨神经慢性压迫(chronic constriction injury,CCI)后,脊髓背角内三磷酸鸟苷环化水解酶1 (GTP cyclohydrolase 1,GCH1)基因的表达变化与神经病理性疼痛产生的关系.方法:wistar大鼠64只被随机分为CCI组和Sham组,每组32只.对CCI组大鼠行右侧坐骨神经结扎;建立CCI模型,Sham组仅暴露坐骨神经不结扎,于术前1天及术后1、3、7、10、14、21、28天测定大鼠机械痛阈值,并分别在术后3、7、14、28天职腰4～6段脊髓,进行免疫组化和Western Blotting检测,观察脊髓背角GCH1表达的变化情况.结果:CCI组大鼠术后各时间点后肢机械痛阈值均显著低于Sham组(P＜0.05),术后第1天开始疼痛阈值便明显降低,直至术后第28天,均低于术前水平(P＜0.05).免疫组化结果显示:CCI组大鼠术后脊髓背角神经元GCH1的表达呈先升高后降低的趋势;与Sham组相比,术后各时间点GCH1的表达均明显增高(P＜0.05).Western Blotting检测与免疫组化结果基本一致,CCI组术后3天、7天、14天GCH1表达均高于Sham组(P＜0.05).结论:周围神经损伤引起的痛觉过敏随脊髓背角内GCH1表达升高而增强,随其表达降低而减轻,可以认为GCH1可能参与了神经病理性疼痛的形成.     

慢性坐骨神经结扎神经痛大鼠脊髓nNOS阳性神经元的表达

目的:探讨慢性坐骨神经结扎(CCI)神经病理性疼痛大鼠脊髓背角nNOS阳性神经元的表达。方法:SD大鼠40只,随机分为五组,每组8只,即naive组、sham组、CCI5d组、CCI10d组;CCI15d组;测定各组大鼠机械缩腿阈值(MWT)和热缩腿潜伏期(TWL);同时sham组大鼠在术后5d、CCI各组分别在术后5d、10d、15d断头处死取脊髓腰膨大,采用免疫组化法测定脊髓背角nNOS阳性神经元的表达。结果:CCI大鼠在手术后形成稳定的痛敏,与naive组和sham组大鼠比较有显著差异;naive组大鼠和sham组大鼠脊髓背角仅见少量nNOS阳性神经元的表达,且两组间无统计学意义;CCI各组大鼠脊髓背角nNOS阳性神经元的表达明显增多,与naive组和sham组比较差异显著。结论:慢性坐骨神经结扎(CCI)神经痛大鼠脊髓背角nNOS阳性神经元的表达增加,脊髓背角nNOS可能参与了CCI大鼠神经病理性疼痛的形成。     

慢性坐骨神经痛大鼠脊髓和海马组织脑源性神经生长因子表达的改变

目的：探讨慢性坐骨神经挤压损伤(chronic constriction injujry，CCI)大鼠脊髓和海马组织中脑源性神经生长因子(brain—derived neurotrophic factor，BDNF)表达的改变。方法：雄性SD大鼠12只，随机分为2组，按Bennett和Xie法制作CCI模型，以von-Frey filament和冰水测定触痛及冷水阈值，采用免疫组化法测定CCI大鼠脊髓和海马组织中BDNF表达。结果：术后14d，CCI大鼠脊髓背角(手术侧)BDNF免疫阳性表达增加153.3％，双侧海马CA3区锥体细胞BDNF表达均有增加，手术同侧增加65．7％，手术对侧增加203．8％。结论：慢性坐骨神经损伤后，脊髓和海马CA3区BDNF表达增加，提示内源件BDNF可能参与了慢性半骨神经痛的发病过程。     

鞘内注射右美托咪定对坐骨神经慢性缩窄性损伤大鼠脊髓背角肿瘤坏死因子α蛋白表达的影响

目的探讨鞘内注射右美托咪定（ DEX）对坐骨神经慢性缩窄性损伤（ CCI）大鼠脊髓背角肿瘤坏死因子α（ TNF-α）蛋白表达的影响。方法成年Sprague-Dawley雄性大鼠44只随机分为四组（ n＝11）：假手术组（ sham组）,坐骨神经慢性缩窄性损伤组（ CCI组）,生理盐水组（ CCI＋NS组）和右美托咪定组（ CCI＋DEX组）。采用von Frey纤毛分别测定了sham组和CCI组术前及术后1、3、5、7、14 d,以及CCI＋NS组和CCI＋DEX组术后第7天鞘内给药前和给药后1、2、3 h的机械刺激抬腿反应阈值（ PWT）。 sham组和CCI组在术后第7天,CCI＋NS组和CCI＋DEX组在术后第7天鞘内给药后1 h时间点分别余5只大鼠处死取脊髓背角,采用Werstern blot法测定TNF-α蛋白表达。结果与sham组相比,CCI组PWT自术后第3天开始出现下降,并持续至第14天（ P＜0.001）;与CCI＋NS组相比,CCI＋DEX组在给药后1 h即出现明显镇痛作用,且持续至给药后2 h（P＜0.01或P＜0.001）。 Werstern blot结果显示,和sham组比较,CCI组和CCI＋NS组大鼠脊髓背角TNF-α蛋白表达上调（ P＜0.05）;与CCI＋NS组比较,CCI＋DEX组TNF-α蛋白表达下调（ P＜0.05）。结论鞘内注射右美托咪定可通过抑制CCI大鼠脊髓背角TNF-α蛋白表达减轻神经病理性疼痛。     

疼痛应对策略测量工具的研究概况

摘要 目的：探讨缝隙连接蛋白Cx43在炎性镜像痛大鼠脊髓背角的表达。方法：1、行为学研究：鞘内置管成功的雄性SD大鼠24只,随机分为3组（n＝8）。CFA模型组：于大鼠左后肢踝关节外侧皮下注射完全弗氏佐剂（CFA）50μl建立佐剂性关节炎性痛模型,鞘内注射NS 10μl;CBX处理组：皮下注射CFA50μl,鞘内注射缝隙连接阻滞剂甘珀酸（CBX）100μg（10μl）;NS对照组：皮下注射NS 50μl,鞘内注射NS 10μl。分别于CFA致炎前1d(基础值)和致炎后0.5h、1d、3d、5d、7d、10d、14d每次鞘内注射后2h测定双侧的热缩足反射潜伏期（PWTL）。2、形态学研究：雄性SD大鼠20只,随机分为4组（n＝5）：NS生理盐水组、C1d组、C3d组和C7d组。分别在CFA致炎后相应时间点取腰段脊髓行Cx43免疫组织化学染色分析,测定双侧脊髓背角积分光密度值。结果：1、单侧踝关节外侧皮下注射CFA可以在致炎后2h～7d诱导出双侧的热痛觉过敏,呈现明显的镜像痛和域外痛现象(P<0.01或0.05),鞘内注射CBX可以在炎性痛的不同阶段逆转上述改变。2、单侧CFA致炎后,大鼠脊髓双侧Cx43的表达与对照组相比均显著增加(P<0.01或0.05),主要集中于Ⅰ～Ⅱ层和Ⅹ层,其时程变化与行为学变化基本一致。结论：大鼠单侧CFA致炎诱导的佐剂性关节炎性痛模型,具有显著的镜像痛特征。脊髓双侧背角Cx43表达增加,鞘内应用缝隙连接阻滞剂可以逆转镜像痛现象,提示脊髓缝隙连接可能在疼痛中枢敏感化中扮演重要角色。 关键词 佐剂性关节炎;镜像痛;缝隙连接;连接蛋白43;脊髓背角;甘珀酸     

缝隙连接细胞间通讯在丙戊酸 诱导大鼠脂肪源干细胞向许旺细胞分化中的作用

目的：探讨缝隙连接细胞间通讯在丙戊酸诱导大鼠脂肪源干细胞（ADSCs）向许旺细胞分化中的作 用。方法：体外分离培养大鼠ADSCs并传至第3代，将ADSCs分别用不含丙戊酸（A组）、含1.0 mmol/L 丙 戊酸（B组）、1.0 mmol/L丙戊酸+2.5 μmol/L油酸酰胺（C组）的诱导液培养。显微镜下观察细胞形态变化， 分别用免疫细胞化学法和实时荧光定量PCR法检测各组中枢神经组织蛋白S100、神经元特异性烯醇化酶 （NSE）、巢蛋白（Nestin）、缝隙连接蛋白43（Cx43）的蛋白表达水平和mRNA转录水平。结果：B、C组S100、 NSE、Nestin蛋白表达水平和mRNA转录水平均显著高于A组（P＜0.01），C组低于B组（P＜0.01）；B、C组 Cx43蛋白表达水平和mRNA转录水平均显著高于A组，B、C组之间差异无统计学意义（P＞0.05）。结论： Cx43介导的缝隙连接细胞间通讯在丙戊酸诱导ADSCs向许旺细胞分化的过程中可能有重要作用。     

Cx43及GLT-1对三叉神经痛大鼠疼痛行为学变化的调控作用

目的:研究大鼠三叉神经痛模型中缝隙连接蛋白43(connexin-43,Cx43)和谷氨酸转运体-1(glutamate transporter-1,GLT-1)表达的变化,探讨Cx43和GLT-1与三叉神经痛大鼠疼痛行为的关系。方法:将42只SD大鼠随机分为正常组(N)、假手术组(S)、模型组(ION-CCI)、ION-CCI+生理盐水1组(NS1)、ION-CCI+Gap26组(Gap26)、ION-CCI+生理盐水2组(NS2)、ION-CCI+头孢曲松组(Cef),每组6只。用铬肠线疏松结扎大鼠眶下神经建立三叉神经痛动物模型;造模成功后,相应组于术后第8天分别腹腔注射Gap26、头孢曲松或生理盐水;假手术组仅暴露神经,不结扎。于术前1天,术后1、3、5、7、9、11、14天行机械痛阈值及视频行为学检测。术后第15天取三叉神经脊束核,应用蛋白质印迹检测Cx43和GLT-1蛋白表达水平。结果:腹腔注射Gap26或头孢曲松可提高三叉神经痛大鼠的机械痛阈值(P<0.001),减少其抓脸次数(P<0.001)。术后第15天,ION-CCI、NS1及NS2组大鼠较N组及S组大鼠相比,Cx43表达明显增加(P<0.01),GLT-1表达明显减少(P<0.001);Gap26组大鼠较ION-CCI、NS1组大鼠相比,Cx43表达减少(P<0.05),GLT-1表达增加(P<0.01);Cef组大鼠较ION-CCI、NS2组大鼠相比,GLT-1表达增加(P<0.001),Cx43表达无明显差异。结论:腹腔注射Gap26或头孢曲松可改变三叉神经痛大鼠疼痛行为并改变三叉神经脊束核中Cx43和GLT-1的表达,提示Cx43和GLT-1参与了三叉神经痛大鼠疼痛行为的变化。     

氧化苦参碱对大鼠急性心肌梗死诱发室性心律失常的影响

目的探讨氧化苦参碱（OMT）对急性心肌梗死（MI）大鼠诱发室性心律失常（VA）的影响及其可能机制。 方法健康雄性SD大鼠75只,使用数字表法随机分为假手术组（Sham组）、MI组和OMT干预组（OMT组）,每组25只。MI组和OMT组通过结扎冠状动脉左前降支建立MI模型,假手术组开胸但不结扎冠状动脉。OMT组在模型建立前2周及模型建立后2周连续给予OMT（100 mg/kg）灌胃处理。模型建立后2周,行心脏超声检查评估左心功能,酶联免疫吸附法检测血浆N-末端脑钠肽前体（NT-proBNP）和超敏肌钙蛋白T（hs-TnT）水平,分别使用RT-PCR和Western blotting检测心肌缝隙连接蛋白43（Cx43）mRNA和蛋白的表达,采用Burst刺激诱发VA。 结果OMT组NT-proBNP、hs-TnT水平［（256.45±38.55）、（89.55±13.39）ng/L］与MI组［（371.93±41.23）、（132.63±20.12）ng/L］比较明显降低（P＜0.01）。Sham组、MI组与OMT组Cx43 mRNA相对表达量依次为0.93±0.16、0.47±0.06和0.71±0.12,3组Cx43蛋白相对表达量依次为0.77±0.11、0.50±0.07和0.61±0.08,3组p-Cx43蛋白相对表达量依次为0.62±0.09、0.32±0.05和0.50±0.07,差异均有统计学意义（P均＜0.05）。此外,OMT组与MI组比较VA诱发率明显降低（21.4% vs 64.3%,P＜0.05）。 结论OMT可降低MI大鼠心肌的损伤和VA的发生率,其机制可能与OMT调整MI后心肌的Cx43表达有关。     

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.