长链非编码RNA ZFAS1在非小细胞肺癌患者组织中表达及作用

目的检测非小细胞肺癌(NSCLC)患者癌组织中锌指结构反义转录本1(zinc finger antisense 1,ZFAS1)表达水平,探讨ZFAS1在NSCLC进展中的生物学作用。方法实时荧光定量RT-PCR检测ZFAS1在NSCLC患者癌组织和癌旁组织中的表达水平。RNA干扰ZFAS1在A549细胞中表达,细胞计数和克隆形成实验检测细胞增殖情况,流式分析检测细胞周期和细胞凋亡,Transwell迁移和基质胶侵袭实验检测细胞迁移和侵袭能力,实时荧光定量RT-PCR检测Cyclin D1、Bcl2、N-cadherin、ZEB1、Slug和Twist基因表达水平变化。结果 ZFAS1在NSCLC患者癌组织中的平均表达水平[0.01(0.002,0.054)]较癌旁组织[0.002(0.001,0.012)]明显升高(Z=-2.638,P0.01)。ZFAS1基因敲减后,A549细胞增殖能力明显减弱(P0.01);A549细胞周期G1期比例升高,S期比例下降(P0.01);A549细胞凋亡比例明显增加(P0.01);A549细胞迁移和侵袭能力明显下降(P均0.01);A549细胞中Cyclin D1、Bcl2、N-cadherin、ZEB1、Slug和Twist基因表达水平均降低(P均0.05)。结论 ZFAS1在NSCLC患者癌组织中呈高表达。ZFAS1基因敲减诱导细胞周期阻滞、凋亡和抑制上皮-间质转变(EMT),减弱NSCLC细胞增殖、迁移和侵袭能力。     

长链非编码RNA LINC00473对人胃癌细胞增殖和迁移能力的影响

目的探讨LINC00473在人胃癌细胞系中的表达水平及其对胃癌细胞生物学行为的影响。方法采用实时荧光定量PCR检测胃癌细胞中LINC00473的表达水平;转染靶向LINC00473的siRNA片段或LINC00473过表达载体以构建敲减或过表达的胃癌细胞系;通过CCK-8细胞增殖实验、平板克隆形成实验、Transwell迁移实验、western blot实验检测细胞的增殖和迁移能力以及EMT相关蛋白标志物表达水平的变化。结果与GES-1细胞相比,LINC00473在胃癌细胞中的表达水平明显降低(P0.05)。与siNC转染对照组相比,敲减LINC00473表达后,靶细胞的增殖能力(F=163.10,P0.01)、克隆形成(t=3.29,P0.05)和迁移能力(t=4.68,P0.05)明显增加;E-cadherin表达减弱(t=4.08,P0.05),N-cadherin(t=5.06,P0.01)、Snail(t=7.69,P0.01)和Vimentin(t=3.82,P0.05)蛋白的表达水平升高。与Vector转染对照组相比,上调LINC00473表达后靶细胞的增殖能力(F=186.00,P0.01)、克隆形成(t=3.22,P0.05)和迁移能力(t=5.52,P0.01)明显下降;E-cadherin表达升高(t=2.90,P0.05),N-cadherin(t=7.44,P0.01)、Snail(t=2.78,P0.05)和Vimentin(t=4.64,P0.01)蛋白的表达水平降低。结论敲减LINC00473的表达可促进胃癌细胞的增殖、迁移的能力,可能通过调控EMT参与胃癌细胞的迁移。     

LncSox4在非小细胞肺癌中的表达及生物学作用

目的检测LncSox4在人非小细胞肺癌(NSCLC)中的表达水平变化,初步探讨其生物学作用及机制,为NSCLC诊断和治疗提供新的生物指标。方法采用qRT-PCR检测LncSox4在NSCLC患者肿瘤组织中的表达水平。通过克隆形成试验、生长曲线分析、Transwell迁移和侵袭试验检测敲除LncSox4对A549细胞生物学功能的影响;采用流式细胞术分析细胞周期情况;采用qRT-PCR和western blot检测上皮-间质转化(EMT)相关基因及蛋白质的表达水平。结果与癌旁对照相比,LncSox4在NSCLC癌组织中呈显著高表达(t=7.109,P0.01);LncSox4基因沉默后,A549细胞生长速度减缓,细胞克隆形成数量减少(P0.01),细胞迁移和侵袭能力降低(P0.01),诱导细胞发生G_1期阻滞(P0.01);LncSox4基因沉默抑制A549细胞中Cyclin D1、c-Myc、N-cadherin、Vimentin蛋白的表达,促进E-cadherin蛋白的表达;LncSox4基因沉默还显著降低EMT相关转录因子Snail、Slug和Twist的表达水平。结论 LncSox4在NSCLC中高表达,通过影响细胞增殖、迁移和侵袭促进NSCLC恶性进展,有望成为NSCLC诊疗新靶点。     

FOXC2通过上调MMP9促进非小细胞肺癌细胞的侵袭迁移

目的:探讨FOXC2对非小细胞肺癌(NSCLC)细胞侵袭迁移的影响。方法:采用实时荧光定量PCR(qRT-PCR)的方法检测人支气管上皮样细胞HBE和人NSCLC细胞A549、H1299中FOXC2的m RNA表达水平。利用pcDNA3.1-FOXC2建立FOXC2过表达的细胞模型,q RT-PCR和蛋白质印迹法(Western blot)验证转染效率。采用Transwell实验检测NSCLC细胞的侵袭迁移能力,qRT-PCR法检测基质金属蛋白酶9(MMP9)的表达水平。结果:人NSCLC细胞H1299、A549中FOXC2的表达水平显著高于人支气管上皮样细胞HBE(P0.05)。过表达FOXC2促进了A549细胞的侵袭迁移,上调了MMP9的表达(P0.05)。结论:NSCLC细胞中FOXC2表达水平明显高于正常支气管上皮样细胞,过表达FOXC2可能通过上调MMP9促进NSCLC细胞的侵袭迁移。     

长链非编码RNA HMMR-AS1促进肺腺癌的恶性进展

目的探讨长链非编码RNA(long noncoding RNA, lncRNA)HMMR-AS1对肺腺癌(lung adenocarcinoma, LUAD)增殖转移的影响。方法采用实时荧光定量聚合酶链反应技术(RT-qPCR)检测LUAD细胞系中HMMR-AS1及其正义链HMMR的表达水平;通过小干扰RNA敲减HMMR-AS1的水平,并利用RT-qPCR检测转染效率及其对HMMR水平的影响;采用CCK-8法、克隆形成实验、细胞凋亡实验、划痕实验、Transwell侵袭实验等表型实验检测干扰HMMR-AS1的表达对A549和H1299细胞生物学功能的影响;western blot检测该两种细胞中HMMR-AS1水平降低对HMMR蛋白表达水平的影响。结果与正常肺上皮细胞BEAS-2A相比,LUAD细胞系A549和H1299中HMMR-AS1的表达水平分别上调了3.06倍和5.02倍(P0.05);转染小干扰RNA后A549和H1299细胞中HMMR-AS1的表达水平明显下降(P0.05),并且明显抑制HMMR的转录和蛋白质表达水平(P0.05);表型实验结果显示,与阴性对照组比较,敲减HMMR-AS1能够抑制LUAD细胞的生长、迁移和侵袭能力,并促进凋亡。结论 LncRNA HMMR-AS1能够促进LUAD细胞的生长、迁移和侵袭能力,影响肺腺癌的恶性进展。     

胃癌患者血清LINC00978表达及其临床意义

目的检测胃癌患者血清中LINC00978表达水平,评估其表达水平与临床病理参数的关系,并探讨其临床诊断价值。方法实时荧光定量RT-PCR检测LINC00978在胃癌细胞、体检健康者、胃良性疾病及胃癌患者血清中的表达水平,分析其与胃癌患者临床病理参数的相关性,并用ROC曲线分析其诊断效能。结果 LINC00978在人胃癌细胞系MGC-803中的表达水平(18.88±1.15)明显高于胃黏膜上皮细胞(1.00±0.03),差异有统计学意义(t=-21.926,P0.05)。LINC00978在胃癌患者血清中的平均含量[3.525(1.385,8.954)]较胃良性疾病患者[0.419(0.258,1.369)]和体检健康者[0.814(0.351,2.510)]均明显升高(Z值分别为-4.834和-4.686;P均0.01),且与淋巴结转移、浸润深度和TNM分期相关(r分别为0.448、0.369和0.383,P均0.01);胃癌患者术后血清中LINC00978的表达水平[0.17(0.15,0.39)]较术前[0.98(0.59,1.61)]明显降低(Z=-5.731,P0.01)。与体检健康者相比,LINC00978在胃良性疾病患者血清中表达差异无统计学意义(Z=-1.693,P0.05)。胃癌患者血清LINC00978的ROC曲线下面积(AUCROC)为0.807,95%可信区间(CI)为0.723~0.882,当cut-off值为1.806时,其诊断胃癌的敏感性为71.4%,特异性为75.9%。结论 LINC00978在胃癌患者血清中呈高表达,且与淋巴结转移、浸润深度和TNM分期相关,有望成为潜在的胃癌诊断的生物学标志物。     

长链非编码RNA LINC01094在胰腺癌组织中的表达及其对胰腺癌细胞增殖、侵袭和转移能力的影响

目的 探讨LINC01094在胰腺癌组织中的表达及其对胰腺癌细胞增殖、侵袭、迁移和血管形成能力的影响。方法 应用GSE数据集分析LINC01094的表达水平。采用qRT-PCR检测LINC01094在胰腺癌细胞中的相对表达量。构建LINC01094过表达及敲低的稳转株,qRT-PCR验证转染效率。克隆形成实验、Transwell实验、划痕实验检测LINC01094对MIA PaCa-2和PANC-1细胞增殖、侵袭和迁移能力的影响,血管形成实验检测LINC01094对血管形成的影响。结果 LINC01094在胰腺癌组织中表达增高,且与患者的不良预后相关。LINC01094上调后细胞增殖、侵袭、迁移以及血管形成能力增强,LINC01094下调后细胞增殖、侵袭、迁移以及血管形成能力减弱。结论 LINC01094在胰腺癌中高表达,发挥促细胞增殖、侵袭、迁移和血管形成的作用。     

长链非编码RNA LINC00222对肺腺癌细胞增殖、迁移、侵袭和凋亡的影响及作用机制的研究

目的　检测肺腺癌组织及细胞系中LncRNA LINC00222表达,探究其对肺腺癌细胞增殖、迁移、侵袭和凋亡的影响和相关作用机制。方法　采用实时荧光定量PCR（qRT-PCR）法和Western blot 实验检测肺腺癌组织及细胞中LINC00222表达;构建LINC00222过表达载体,验证其转染效率;采用CCK-8法、Hoechst 33342/PI 染色法、划痕实验及Transwell实验分别检测过表达LINC00222对肺腺癌细胞增殖、凋亡、迁移和侵袭的影响;采用Western blot 法检测肺腺癌细胞中P-GSK-3β,GSK-3β蛋白及β-catenin核蛋白表达;采用荧光霉素基因实验及RIP实验验证探究LINC00222影响肺腺癌生物学行为的相关作用机制。结果　肺腺癌组织中LINC00222 mRNA和蛋白表达明显低于癌旁正常组织,差异有统计学意义（t=7.388,15.100,均P<0.001）;肺腺癌细胞系中LINC00222表达明显低于人正常肺胚细胞（F=21.926,P<0.001）。过表达LINC00222后,肺腺癌细胞增殖、迁移、侵袭能力明显抑制,细胞凋亡数目明显增多（P<0.01）。过表达 LINC00222后,GSK-3β磷酸化明显降低, GSK-3β催化活性明显增强,β-catenin 核转位受到抑制（P<0.01）。LINC00222靶向调控结合GSK-3β和GSK-3β蛋白共沉淀中LINC00222表达显著高于IgG蛋白共沉淀（P<0.05）。结论　肺腺癌中LncRNA LINC00222低表达,其过表达可抑制肺腺癌细胞的增殖、迁移及侵袭,促进细胞凋亡,可能与其调控GSK-3β催化活性,抑制β-catenin 核转位有关。     

LncRNA NPSR1-AS1在胃癌中的表达及作用机制

目的探讨LncRNA NPSR1-AS1在胃癌(gastric cancer, GC)中的表达及临床意义,分析其对胃癌细胞生物学行为的影响和作用机制。方法收集86例胃癌患者癌组织及癌旁组织,另收集21例胃癌患者及体检健康者血浆标本,采用实时荧光定量PCR(RT-qPCR)检测各组LncRNA NPSR1-AS1的表达水平,并与患者临床病理资料进行相关性分析。siRNA敲减NPSR1-AS1后,采用细胞增殖试验、Transwell试验、流式细胞术检测癌细胞增殖、迁移、侵袭、凋亡能力,并用RT-qPCR检测肿瘤相关基因表达量的变化。结果 LncRNA NPSR1-AS1在胃癌组织中的表达水平显著升高,且与肿瘤大小(t=11.02,P0.01)、淋巴结转移(t=2.30,P0.05)、TNM分期(t=3.55,P0.01)、肿瘤血管或神经侵袭(t=3.10,P0.05)显著相关;血浆LncRNA NPSR1-AS1筛查胃癌的ROC曲线下面积(AUC~(ROC))为0.696。LncRNA NPSR1-AS1敲减后可使GSK-3β(t=16.15,P0.01)和E-cadherin(t=10.17,P0.01)表达上调,β-catenin(t=4.869,P0.05)、N-cadherin(t=3.77,P0.05)、Snail(t=9.372,P0.01)和MMP2(t=15.57,P0.01)表达下调。结论 LncRNA NPSR1-AS1敲减可抑制胃癌细胞增殖、迁移及侵袭并诱导其凋亡,其作用机制与上皮-间质转化(EMT)有关。     

载脂蛋白M在非小细胞肺癌A549细胞增殖、迁移和侵袭中的作用

目的探讨载脂蛋白M(apo M)对非小细胞肺癌(NSCLC)A549细胞系增殖、迁移、侵袭的影响及与基质金属蛋白酶(MMP)-10的关系。方法以转染apo M慢病毒的A549细胞作为实验组(apo M-OE组),转染空慢病毒的A549细胞作为阴性对照组。分别采用CCK-8法、划痕实验和Transwell侵袭实验检测各组细胞的增殖、迁移和侵袭能力。采用实时荧光定量聚合酶链反应(qRT-PCR)和免疫印迹法检测各组细胞apo M及MMP-10的表达水平。结果与阴性对照组相比,apo M-OE组apo M表达明显上调(P0.01),表达量约为阴性对照组的28倍。apo M-OE组细胞增殖倍数及侵袭率明显高于阴性对照组(P0.001)。与阴性对照组比较,apo M-OE组空白视野显著减少,闭合速率显著加快,即细胞迁移率更大(P0.001)。apo M-OE组中MMP-10 mRNA及apo M、MMP-10蛋白表达量显著高于阴性对照组(P0.05)。结论过表达apo M可增强A549细胞的增殖、迁移和侵袭能力,同时使细胞高表达MMP-10。     

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.