白介素13基因+1923C/T 及+2044G/A 多态性与支气管哮喘的相关性研究

目的：探讨白细胞介素13(IL-13)基因第3内含子+1923C/T 及第4外显子+2044G/A 多态性与哮喘的关系。方法采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)方法,检测100例哮喘患者和100例健康人群 IL-13基因+1923C/T 及+2044G/A 位点单核苷酸多态性,分析其基因型和等位基因分布频率。结果 IL-13+1923C/T 位点基因型 CC、CT 和 TT 在哮喘组分布频率为21.0%、41.0%和38.0%,对照组为41.0%、44.0%和15.0%。IL-13+2044G/A 位点基因型 GG、GA 和 AA 在哮喘组分布频率为51.0%、39.0%和10.0%,对照组为70.0%、25.0%和5.0%。IL-13+1923C/T 和+2044G/A 位点各基因型分布在两组间差异有统计学意义(χ2=16.54,P <0.01;χ2=7.71,P <0.05)。结论 IL-13基因+1923C/T 和+2044G/A 多态性与哮喘易感性相关,携带+1923T 或+2044A 等位基因的个体患哮喘的风险更大。     

白细胞介素-16基因多态性与肝癌遗传易感性的研究

目的:探讨白细胞介素-16(IL-16)基因rs11556218T/G、rs4072111C/T、rs4778889T/C3个位点的多态性与肝癌(HCC)易感性的关系。方法:采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)方法检测141例HCC患者(HCC组)与142例健康个体(对照组)的IL-16基因的3个位点的基因型分布及差异。结果:rs11556218T/G和rs4072111C/T两个位点的基因型分布在HCC组和对照组人群中差异无统计学意义(P>0.05)。rs4778889T/C位点的TC基因型在HCC组中的频率显著低于对照组(P<0.05),与TT基因型相比,TC基因型患HCC风险显著降低至0.50倍。GTC单倍型在HCC组和对照组中的分布频率有差异(P<0.05)。结论:IL-16rs4778889T/C位点的基因多态性与肝癌的遗传易感性有关。     

IL-I3、IL-4及FCERIB基因多态性对吸入糖皮质激素治疗儿童哮喘疗效的影响*

摘要:目的分析 IL-I3、IL-4及FCERIB基因多态性与吸入糖皮质激素(ICS)治疗儿童哮喘疗效的关系。方法将2020年1月至2022年1月于绍兴市第二医院就诊的急性发作期哮喘患儿56例作为急性发作期组,慢性持续期哮喘患儿52例作为慢性持续期组,临床缓解期哮喘患儿53例作为临床缓解期组,另选取同期体检健康者60例作为健康人对照组。采用化学发光法检测并分析不同分期患儿治疗前后血清IgE水平。采用实时荧光定量PCR法分析哮喘患儿以及健康人对照组口腔黏膜脱落细胞中IL-I3 基因rs20541位点、IL-4基因rs2243250 位点、FCERIB基因rs569108 位点多态性与患儿肺功能[1秒用力呼气容积(FEV1)、1秒用力呼气容积与最大肺活量比值( FEV1/VCmax)、用力呼出50%肺活量时的平均呼气流速(MEF50)]、呼出气一氧化氮(Fe-NO)以及儿童哮喘控制测试量表(C-ACT)评分变化的关系;根据治疗结果将患儿分为控制组49例、部分控制组37例和未控制组19例,比较不同分组间各基因型分布情况。结果治 疗前临床缓解期、慢性持续期、急性发作期哮喘患儿血清IgE水平依次升高( 335.42+37.34 IU/ mL vs 446.71+40.95 IU/mL vs 681.52+96.57 IU/mL,F=412.128,P<0.05);与治疗前相比,3组患儿治疗后血清IgE水平均降低( 335.42+37.34 IU/mL vs 158.71+ 28.38 IU/mL, 446.71+40.95 IU/mL vs 166. 92+29.56 IU/mL,681.52+96.57 IU/mL vs 435.17+62.15 IU/mL,t分别为28.195,39.949, 15.617,P均<0.05);健康人对照组、临床缓解期、慢性持续期+急性发作期患儿L-I3 JIL-4 、FCERIB基因表达型差异有统计学意义(X2分别为9.742,20.340,9.555,P均<0.05);患儿IL-I3 IL-4、FCERIB基因各基因型FEV1、VCmax、MEF50、Fe-NO、C-ACT治疗前后差异具有统计学意义(P均<0.05);IL-13基因ns20541位点控制组AA型(4.1% vs21.1%) A等位基因比例(9.2% vs42.1%) ,IL-4基因rs2243250位点控制组T等位基因比例( 17.3% vs 10.5%)，FCERIB基因rs569108位点控制组GG型(4.1% vs 31.6%) .G等位基因比例(11.2% vs 36.8%)低于未控制组,差异均有统计学意义(X2分别为4.902, 19.781 ,7.451,5.127,11.977,P均<0.05)。结论FCERIB 基因rs569108位点、IL-4基因rs2243250位点、JL-I3基因1rs20541 位点多态性与哮喘患儿ICS疗效相关,上述基因位点突变有助于预测哮喘患儿的ICS治疗效果。     

骨保护素基因rs2073617T/C、rs2073618G/C多态性在东南沿海地区汉族人群中分布及与急性冠状动脉综合征相关性研究

目的 探讨骨保护素(OPG)基因启动子rs2073617T/C和第一外显子rs2073618G/C位点基因多态性在福建地区汉族人群中的分布及与急性冠状动脉综合征(ACS)的相关性.方法 纳入720例福建地区无血缘关系的汉族人为研究对象,分成ACS 360例(ACS组)和对照组360例(对照组),采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术,对OPG基因rs2073617T/C和rs2073618G/C多态性位点进行基因型分型,同时采用DNA测序对酶切产物进行鉴定.结果 (1)在福建地区汉族人群中,OPG基因rs2073617T/C多态性位点存在TC、TT、CC三种基因型;rs2073618G/C多态性位点也存在GG、GC、CC三种基因型.(2)对ACS组与正常对照组OPG基因rs2073617T/C、rs2073618G/C基因型及等位基因频率分布进行比较均无统计学差异(P均>0.05).(3)ACS组患者单支病变、双支病变及三支以上病变组之间比较OPG基因rs2073617T/C、rs2073618G/C各基因型差异无统计学意义(P均>0.05).结论 福建地区汉族人群OPG rs2073617T/C、rs2073618G/C位点基因多态性与ACS发生无明确相关性.     

福建龙岩地区淋巴瘤相关噬血细胞综合征患者的基因多态性研究

目的：分析福建龙岩地区淋巴瘤相关噬血细胞综合征患者的基因多态性。方法：选择2017年5月-2020年11月福建医科大学附属龙岩第一医院收治的福建龙岩地区淋巴瘤相关噬血细胞综合征患者125例，采集患者外周静脉血，通过PCR-荧光探针法检测穿孔素1(PRF1)、白介素-10(IL-10)基因各位点基因型，分析PRF1、IL-10基因各位点基因多态性与淋巴瘤相关噬血细胞综合征的相关性。结果：淋巴瘤相关噬血细胞综合征患者PRF1基因位点rs885821(C>T)、rs885822(C>T)、rs1889490(G>A)的基因突变频率分别为10.4%、78.8%、64.4%;IL-10基因位点rs1800872(A>C)、rs1800871(C>T)、rs1800896(G>A)的基因突变频率分别为56.0%、45.2%、77.6%。结论：福建龙岩地区淋巴瘤相关噬血细胞综合征患者PRF1、IL-10基因位点呈多态性，PRF1、IL-10等位基因C、G是其危险性因素，等位基因T、A是其保护性因素。     

炎症相关因子基因多态性与弥漫大B细胞淋巴瘤的易感性研究

目的:探讨甘肃汉族人群中炎症相关因子基因多态性与弥漫大B淋巴瘤(diffuse large B-cell lymphoma,DLBCL)发病率的相关性。方法:运用高分辨率溶解曲线(high-resolution melting,HRM)方法检测炎症因子基因多态性。结果:IL-1RA的rs4251961位点CC纯合子基因型携带者与患DLBCL风险有关(以TT为参照,CC基因型的OR为0.83,95%CI=0.697-0.997,P0.05),但与T等位基因相比,C等位基因与DLBCL风险升高显著相关(OR=8.83,95%CI=1.909-40.813,P0.01)。结论:IL-1RA的rs4251961位点的次等位基因C与DLBCL的易患性显著相关。     

IL-17基因多态性与支气管哮喘患儿血清TIgE、ECP的关系分析

目的分析白细胞介素(IL)-17基因多态性与支气管哮喘患儿血清总IgE(TIgE)、嗜酸性粒细胞阳离子蛋白(ECP)的关系。方法将该院2018年1—12月收治的60例哮喘患儿设为哮喘组,同期于该院行健康体检的60例健康儿童设为对照组,采用PCR-限制性片段长度多态性分析法检测2组IL-17基因多态性,采用免疫比浊法、酶联免疫吸附试验法分别检测其血清TIgE、ECP水平,比较2组IL-17基因多态性、TIgE和ECP水平及不同基因型、不同等位基因型患儿血清TIgE、ECP水平。结果哮喘组中IL-17A-152G/A位点中AA型基因频数频率、A等位基因频数频率,IL-17F 7488T/C位点中TT型基因频数频率、T等位基因频数频率,血清TIgE、ECP水平均显著高于对照组(P<0.05)。哮喘组IL-17A-152G/A位点AA型基因血清TIgE显著高于AG、GG型(P<0.05)。IL-17A-152G/A位点A等位基因携带患儿血清TIgE显著高于非A等位基因携带患儿(P<0.05)。哮喘组IL-17F 7488T/C位点不同基因型、等位基因携带者间血清TIgE、ECP与对照组比较,差异无统计学意义(P>0.05)。结论IL-17A-152G/A基因多态性与哮喘易感性有关,变异等位基因A携带患儿哮喘风险更高,尤其是突变纯合子AA基因型,野生型TT纯合子与哮喘也有一定关联性;且IL-17基因多态性虽与血清ECP均无明显关联,但血清ECP在哮喘患儿中仍明显高表达。     

系统性红斑狼疮与IL-19基因单核苷酸多态性及血清水平相关性研究

目的探讨系统性红斑狼疮(SLE)IL-19基因单核多态性及血清水平相关性。方法选取2013年2月~2014年9月我院收治78例SLE患者作为SLE组,选取同期我院体检中心体检健康人80名作为对照组。比较两组IL-19基因rs2243188位点基因频率和等位基因,血清IL-19浓度,并将SLE分为肾炎组和非肾炎组、活动期和稳定期,分别比较血清IL-19浓度。结果 SLE组IL-19基因rs2243188位点C等位基因频率分布与对照组比较差异有统计学意义(P0.05);SLE组显性模型(CC+CA)基因频率分布与对照比较差异有统计学意义(P0.05)。SLE组和对照组、肾炎组和非肾炎组、活动期和非活动期各组间血清IL-19浓度比较差异无统计学意义(P0.05)。结论系统性红斑狼疮发病与IL-19基因rs2243188位点多态性有关,IL-19基因rs2243188位点C基因可能会降低SLE发病率。系统性红斑狼疮患者体内IL-19浓度无特意检测性。     

肝癌相关基因单核苷酸多态性基因芯片制备与检测分析

目的　研制肝癌多种相关基因芯片 ,进行肝癌组织中基因编码区单核苷酸多态性(cSNP)检测分析研究。方法　选取定位于肝癌高频缺失区的基因 ,经NCBIdbSNP数据库查询 ,获得基因cSNP序列 ,且根据多态位点设计寡核苷酸探针 ,制备成含 2 5个肝癌相关基因的 4 8个cSNP芯片。并对 10例肝癌患者cSNP进行检测分析 ,而对 7例患者的部分检测结果用聚合酶链反应 单链构象多态性法 (PCR SSCP)和测序进行验证。结果　芯片检测的灵敏度为 6× 10 3 ng/ μl,检测重复率高于 95 83% ,随探针浓度降低 ,杂交信号逐渐减弱。 10份肝癌患者组织中 ,检测到半胱氨酸酶caspase9(rs2 30 894 1)C→T多态性和停泊蛋白DOK2 (rs2 2 4 2 2 4 1)T→G各 7份 ,表皮生长因子类似物EGFL3(rs94 7345 )A→G多态性、caspase9(rs2 30 8938)C→G多态性和磷酸甘油酸盐脱氢酶PHGDH(rs180 195 5 )T→A多态性各 6份 ,启动子结合因子E2F2 (rs32 18170 )G→A多态性 5份 ,DNA切除修复糖基化酶MUTYH(rs114 0 5 0 7)T→C和胞内蛋白BNIP3L(rs10 5 5 80 6 )G→T多态性 4份 ,肿瘤坏死因子家族成员TNFRSF1B (rs10 6 16 2 2 )T→G多态性 1份。经PCR SSCP检测 ,7例肝癌患者有多态性单链迁移率改变。选取有caspase9(rs2 30 894 1G)与 (rs2 30 894 1A)的样本分别连     

RAD50,IL-33和IL1RL1基因与汉族人群过敏性哮喘发病的相关性

目的探讨CDHR3,GSDMB,IL-33,RAD50和IL1RL1等基因多态性位点与汉族人群过敏性哮喘及其严重程度的相关性。方法研究共纳入516例儿童过敏性哮喘患者和552例健康对照人群。对上述5个基因等多态性位点进行基因分型,包括CDHR3的rs6967330,GSDMB的rs2305480,IL-33的rs928413,RAD50的rs6871536和IL1RL1的rs1558641。比较患者组和对照组基因型和等位基因频率。分析基因型与临床表型包括FEV1%和总IgE的关系。结果与对照组相比,患者组有显著较高频率的rs928413等位基因G和rs6871536等位基因C(P0.001)。患者组较正常对照组有显著降低的rs1558641等位基因G(P=0.007)。相比与其他基因型,患者rs928413基因型GG和rs1558641基因型GG与低FEV1%和高水平的血清总IgE有显著相关性。结论 IL-33,IL1R1和RAD50基因与中国人群的哮喘风险相关。     

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.