术前纤维蛋白原与食管鳞状细胞癌患者预后的关系

目的:评估血浆纤维蛋白原(fibrinogen,FIB)对预测可手术食管鳞状细胞癌患者预后的价值。方法:回顾性分析郑州大学附属肿瘤医院/河南省肿瘤医院2015年6月至2016年4月334例接受手术治疗的食管鳞状细胞癌患者,以FIB指标的最佳截点值2.90 g/L为界,血浆FIB≥2.90 g/L为高FIB组,血浆FIB2.90 g/L为低FIB组。分析FIB水平与患者临床病理特征的关系,应用Kaplan-Meier生存分析及Cox比例风险回归模型分析术前FIB水平对患者总生存期(overall survival,OS)的影响。结果:食管鳞状细胞癌患者低FIB组163例(48.8%),高FIB组171例(51.2%)。食管鳞状细胞癌患者T分期与FIB水平相关(W=10 817,P=0.015)。高FIB组患者平均生存期为26.60个月,低FIB组患者平均生存期为29.17个月,低FIB组的平均生存期显著优于高FIB组,差异有统计学意义(χ~2=6.5497,P=0.011)。单因素分析显示血浆FIB水平(HR=1.994,95%CI:1.163～3.418,P=0.012),T分期(HR=2.213,95%CI:1.196-4.097,P=0.011),N分期(HR=3.883,95%CI:2.278-6.621,P0.001),TNM分期(HR=0.248,95%CI:0.139～0.443,P0.001)与OS密切相关。在α=0.1的水平,血浆FIB为食管鳞状细胞癌的独立预后因素(HR=1.680,95%CI:1.062～2.805,P=0.062),对比低FIB组,高FIB组患者的死亡风险高68%。结论:术前血浆纤维蛋白为食管鳞状细胞癌的不良生存预后因子。     

术前PLR、NLR与喉鳞状细胞癌预后的相关性分析

目的观察喉鳞状细胞癌患者术前中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)对其预后的影响及相关性分析。方法回顾性分析2008年12月至2015年10月云南省肿瘤医院头颈外科收治的经手术治疗的151例喉鳞状细胞癌患者的临床资料。收集患者术前最近一次全血细胞计数的参数并计算NLR、PLR值及其最佳临界值。将上述相关参数引入Cox比例回归模型,分析影响喉鳞状细胞癌预后的危险因素及与总生存时间的关系,并分析喉鳞状细胞癌患者中NLR、PLR与白细胞介素6(IL-6)的相关性。结果对于喉鳞状细胞癌患者术后生存,单因素及多因素的Cox回归分析显示,白细胞计数、血小板计数、中性粒细胞计数可作为其危险因素(HR=1.13,95%CI:1.04~1.24;HR=1.003,95%CI:1.000~1.007;HR=1.24,95%CI:1.14~1.35;均P<0.05),淋巴细胞可作为其保护性因素(HR=0.51,95%CI:0.36~0.73,P<0.001)。NLR及PLR高低是喉鳞状细胞癌预后的独立影响因子[HR=3.01,95%CI:1.69~5.36;HR=1.98,95%CI:1.07~3.65;均P<0.05]。IL-6水平与高NLR、PLR的相关系数分别为0.67、0.34。结论术前NLR、PLR可作为影响喉鳞状细胞癌患者术后生存的独立因素,对喉鳞状细胞癌的预后评估具有重要意义。     

探讨18F-FDG PET/CT代谢参数与肺鳞状细胞癌淋巴结转移及预后的相关性

目的:分析18F-FDG PET/CT代谢参数与肺鳞状细胞癌淋巴结转移及预后的相关性。方法:选择2013年12月至2022年4月于本院收治的160例肺鳞状细胞癌患者,均接受18F-FDG PET/CT扫描检查。分析18F-FDG PET/CT代谢参数与肺鳞状细胞癌患者淋巴结转移及预后的关系,采用ROC曲线分析18F-FDG PET/CT代谢参数对肺鳞状细胞癌患者预后的预测价值。结果:根据淋巴结转移情况,将患者分为转移组(86例)和未转移组(74例)。化疗前及化疗2个周期后,转移组的标准化摄取最大值(SUV max)、标准化摄取平均值(SUV mean)、肿瘤代谢体积(MTV)、总糖酵解率(TLG)水平均高于未转移组(P<0.05)。根据预后情况,将患者分为良好组(142例)和不良组(18例)。化疗前,良好组的SUV max、SUV mean、MTV、TLG水平与不良组相比,无统计学差异(P>0.05);化疗2个周期后,良好组的SUV max、SUV mean、MTV、TLG水平均低于不良组(P<0.05)。ROC曲线结果显示,SUV max的曲线下面积为0.793,S...     

人乳头状瘤病毒阳性口咽部鳞状细胞癌治疗研究进展

临床一般认为口咽部鳞状细胞癌发病与烟草、酒精等传统危险因素相关,但20％～30％患者并无吸烟或酗酒等危险因素,人乳头状瘤病毒可能是其发生口咽部鳞状细胞癌的原因.人乳头状瘤病毒引起癌变,可能因2个病毒癌基因和非结构蛋白(E6和E7)通过对P53和视网膜母细胞瘤蛋白发挥抑制作用而引起.人乳头状瘤病毒阳性口咽部鳞状细胞癌患者较人乳头状瘤病毒阴性者预后好.目前口咽部鳞状细胞癌的标准治疗方案并不取决于人乳头状瘤病毒阴性或阳性.最近临床研究的焦点是对人乳头状瘤病毒阳性口咽部鳞状细胞癌患者降低治疗强度的意义.本文对人乳头状瘤病毒阳性口咽部鳞状细胞癌的治疗现状作一综述.     

倾向性评分匹配分析口咽癌PD-L1的表达与HPV感染及预后的相关性研究

目的探讨口咽鳞癌中程序性细胞死亡配体1(PD-L1)与HPV感染状态及患者预后的相关性。方法采用倾向性评分匹配,纳入HPV阳性及HPV阴性口咽癌各50例,对患者进行长期随访,通过免疫荧光检测PD-L1的表达,分析其与HPV感染状态及临床预后的相关性。结果 HPV阳性组及HPV阴性组5年总生存率分别为66%和40%(P=0.003),5年疾病特异性生存率分别为73%和44%(P=0.001)。PD-L1表达率在HPV阳性组较HPV阴性组明显升高(70%vs 42%,P=0.005)。PD-L1与除年龄(P=0.020)外的其他临床病理特征无明显相关性,PDL1阳性为口咽癌独立良好预后因素(DSS,P<0.001;OS,P<0.001)。进一步预后分析提示HPV+/PD-L1+患者较HPV+/PD-L1-者(DSS,P<0.001;OS,P=0.004),HPV-/PD-L1+者(DSS,P=0.010;OS,P=0.047)以及HPV-/PD-L1-者(DSS,P<0.001;OS,P<0.001)具有显著的预后优势。结论 HPV阳性口咽癌患者预后较好,PD-L1在HPV阳性口咽癌中的表达升高,PD-L1阳性可能与HPV阳性口咽癌患者较好的临床预后相关。     

JUP对人口腔鳞状细胞癌生物学特性及预后的影响及机制分析

目的分析心肌桥粒盘状珠蛋白(JUP)的表达水平对人口腔鳞状细胞癌细胞的相关生物学特性和预后的影响,并对其影响机制进行探讨。方法回顾性抽取2016年12月至2018年12月格尔木市人民医院口腔科收治的65例口腔鳞状细胞癌患者癌组织及距离癌组织病灶2 cm左右的癌旁组织标本为研究对象。定量即时聚合酶链锁反应(qRT-PCR)检测口腔鳞状细胞癌患者癌组织及癌旁组织中JUPmRNA的表达情况。构建JUP干扰(对照组:未感染细胞组;shNC组:无关序列片段对照组;shJUP组:JUP沉默慢病毒组)和过表达(对照组:未感染细胞组;NC组:空载体对照组;JUP过表达组:过表达组)载体,包装成慢病毒,感染人口腔鳞状细胞癌Tca8113细胞,建立该基因沉默和过表达的稳转细胞株,并通过qRT-PCR和Western blot分别检测JUP在基因和蛋白水平上的表达情况。CCK-8和细胞划痕实验分别检测两种稳转细胞株的增殖、迁移以及侵袭能力。利用K-M曲线数据库资料分析JUP的表达与口腔鳞状细胞癌病人的预后相关性。结果 JUP基因在口腔鳞状细胞癌中的表达量较癌旁组织显著降低(P <0. 01)。与对照组细胞(sh NC)相比,稳定沉默JUP的人口腔鳞状细胞癌细胞Tca8113,其增殖能力无显著差异(P> 0. 05);与对照组细胞(shNC)相比,稳定沉默JUP的人口腔鳞状细胞癌细胞Tca8113(shJUP),其细胞凋亡能力明显降低(P <0. 05);与对照组(NC)相比,划痕愈合实验显示,外源性导入JUP的Tca8113细胞其迁移、侵袭能力显著下降(P <0. 05);K-M曲线结果显示低表达JUP与人口腔鳞状细胞癌病人的不良预后相关。结论 JUP的低表达与口腔鳞状细胞癌病人的转移密切相关,且与口腔鳞状细胞癌病人的不良预后相关。     

急性缺血性卒中患者静脉溶栓效果的影响因素分析

目的观察和分析急性缺血性卒中(AIS)患者静脉溶栓治疗的临床预后影响因素。方法选取100例行重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的AIS患者作为研究对象,发病后90 d行改良Rankin量表(mRS)评价,并根据mRS评分将其分为预后良好组(53例)和预后不良组(47例),对两组患者的临床资料、治疗安全性及发病90 d时的病死率进行观察和比较。结果溶栓治疗后,有8例患者发生颅内出血,其中,5例为症状性颅内出血;发病后90 d,共有5例患者死亡;预后良好组患者与预后不良组患者在年龄、糖尿病史、溶栓前NIHSS评分、起病至治疗时间、溶栓前收缩压、溶栓前血糖等方面的差异均有统计学意义(t=4.727、5.126、2.715、4.249、3.918,χ2=7.868,P0.05),Logistic多元回归分析结果显示,患者溶栓治疗后出现不良预后与糖尿病史(OR=1.567)、溶栓前NIHSS评分(OR=1.916)、溶栓前收缩压(OR=1.269)、溶栓前血糖(OR=2.206)具有相关性(P0.05)。结论 AIS患者静脉溶栓治疗后的近期预后与其神经功能损害程度、糖代谢异常、血压异常等因素有关,临床医生应对这些高危因素给予准确的识别和有效的干预,以达到提高治疗效果、改善患者预后的目的。     

食管鳞状细胞癌组织PTOV1，IGBP1的表达与临床病理特征和预后相关性研究

目的　探讨食管鳞状细胞癌组织前列腺肿瘤过表达蛋白 1(prostate tumor overexpressed 1,PTOV1)、免疫球蛋白结合蛋白 1(immunoglobulin binding protein,IGBP1)的表达及与临床病理特征和预后不良的关系。方法　应用免疫组织化学 SP法检测 70例食管鳞状细胞癌组织及其癌旁组织 PTOV1,IGBP1蛋白表达,分析 PTOV1,IGBP1蛋白表达与患者临床病理特征的关系,所有患者随访 5年,比较不同 PTOV1,IGBP1蛋白表达患者的预后情况,并分析患者预后不良的影响因素。结果　食管鳞状细胞癌组织 PTOV1,IGBP1蛋白阳性率分别为 72.86%,67.14%,显著高于癌旁组织的12.86%,11.43%,差异均有统计学意义（ χ2=51.450,45.549,均 P＜ 0.05）。组织学低分化, TNM分期Ⅲ期食管鳞状细胞癌组织 PTOV1,IGBP1蛋白阳性率分别为 92.11%,86.84%及 87.50%,93.75%,显著高于组织学中高分化, TNM分期Ⅰ～Ⅱ期食管鳞状细胞癌组织的 50.00%,43.75%及 60.53%,44.74%,差异均有统计学意义（ χ2=6.391～ 15.573,均 P＜ 0.05）。随访 5年,患者存活 36例,死亡 34例。PTOV1蛋白阳性表达患者 5年生存率低于 PTOV1蛋白阴性表达患者,IGBP1蛋白阳性表达患者 5年生存率低于 IGBP1蛋白阴性表达患者（ Log-rankχ2=8.122,6.987,均 P＜ 0.05）。 COX比例风险回归模型分析结果显示:组织学低分化, TNM分期Ⅲ期, PTOV1蛋白阳性, IGBP1蛋白阳性均是食管鳞状细胞癌患者预后不良的危险因素（ HR=2.853,2.026,1.829,1.563,均 P＜ 0.05）。结论　PTOV1,IGBP1蛋白表达与食管鳞状细胞癌的组织分化程度、 TNM分期及预后有一定关系,组织学分级、 TNM分期、 PTOV1蛋白阳性、 IGBP1蛋白阳性是食管鳞状细胞癌患者预后不良的危险因素。     

术前C-反应蛋白和鳞癌相关抗原检测对结肠鳞状细胞癌疾病预后意义研究

目的探讨结肠鳞状细胞癌患者术前C-反应蛋白(CRP)和鳞癌相关抗原(SCC-Ag)表达水平与患者临床病理学特征的关系及其对疾病预后的影响。方法研究纳入2008-2013年湖北省天门市第一人民医院收治的结肠鳞状细胞癌患者124例,用受试者工作特征曲线(ROC曲线)评价联合检查CRP和SCC-Ag对疾病预后的敏感度和特异度,数据统计采用非参检验和Cox比例风险模型进行生存分析。结果在CRP≥4.5mg/L和SCC-Ag≥1.4ng/mL时与患者淋巴结转移(LNM)、淋巴结外转移(ENE)、肠系膜淋巴结转移、肿瘤病理学状态和疾病特异性生存期(DSS)密切相关,差异有统计学意义(P0.05)。此外,在矫正吸烟史、肿瘤状态、肿瘤细胞分化和淋巴结状态后,术前CRP和SCC-Ag水平显著影响结肠鳞状细胞癌患者DSS(P=0.033,HR=3.390,95%CI:1.104~10.411)。结论联合检测术前CRP和SCC-Ag可以作为结肠鳞状细胞癌患者LNM、肿瘤晚期和DSS的独立预后因素。     

肺鳞状细胞癌血清CCL11表达及临床意义研究

目的探讨CC修饰趋化因子11(CCL11)在肺鳞状细胞癌(LSCC)患者血清中的表达情况及临床意义。方法分别采用逆转录定量PCR(qRT-PCR)和酶联免疫吸附(ELISA)法检测90例术前肺鳞状细胞癌及30例健康志愿者血清样本中CCL11 mRNA及蛋白的表达,分析血清CCL11蛋白表达与患者临床特征及预后间的相关性。结果CCL11在肺鳞状细胞癌患者血清中高表达(P0.05),并与肿瘤淋巴结转移(t=1.871,P=0.022)及高TNM分期(III+IV期,t=2.219,P=0.015)呈显著正相关;血清CCL11蛋白高表达的患者3年生存率低于CCL11蛋白表达阴性患者(P0.05)。结论 CCL11在肺鳞状细胞癌患者血清中表达上调,血清高水平CCL11蛋白表达与肿瘤恶性临床病理特征及不良预后有关。     

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.