非创伤性预处理对心脏复苏的影响

目的　以心脏为靶器官观察短暂下肢缺血预处理对心肺复苏术 (CPR)的影响。方法　以窒息法复制大鼠死亡模型 ,随机分为对照组、短暂下肢缺血预处理组、复苏前后予去甲肾上腺素处理组及复苏前后予腺苷处理组。观察窒息至死亡时间、复苏成功率、自主循环恢复率、复苏成功后血清心肌酶及心肌超微结构。结果　短暂下肢缺血预处理组窒息至死亡时间明显长于对照组 (P <0 0 1) ;复苏成功率大于对照组 (P <0 0 5 ) ;自主循环恢复率大于对照组 (P <0 0 5 ) ;复苏成功后心肌酶明显低于对照组 (P <0 0 1) ,且心肌超微结构损伤小。结论　短暂下肢缺血预处理对CPR具正面影响 ,并由儿茶酚胺受体及腺苷受体部分介导。     

K_(ATP)通道参与介导吸入麻醉药诱导的兔在体心肌预适应

目的 :探讨 KATP通道在吸入麻醉药异氟醚、七氟醚和地氟醚所诱导的心肌预适应中的作用。方法 :64只新西兰白兔随机分成 8组 :缺血再灌注组 ( IR) ,异氟醚预处理组 ( IP) ,七氟醚预处理组 ( SP) ,地氟醚预处理组 ( DP) ,异氟醚预处理 优降糖组 ( IP G) ,七氟醚预处理 优降糖组 ( SP G) ,地氟醚预处理 优降糖组( DP G) ,优降糖组 ( G)。每组均接受左冠脉前降支 3小时阻断和 3小时再灌注。吸入药预处理组在缺血前分别吸入 1 .1 %异氟醚、2 %七氟醚、6%地氟醚 3 0分钟后 ,洗脱 1 5分钟 ,加用优降糖组在吸入麻醉药前或相当时间静脉注入优降糖 0 .3 3 mg/ kg。结果 :心肌梗死面积占缺血面积的比 :IR组为 0 .61± 0 .1 1 ,IP、SP、DP组分别减少至 0 .3 9± 0 .0 6、0 .3 1± 0 .0 7和 0 .3 2± 0 .0 8,与 IR组相比均有显著差异 ( P均 <0 .0 5) ;IP G、SP G、DP G组分别是 0 .64± 0 .1 2 ,0 .57± 0 .1 2和 0 .62± 0 .1 1 ,与 IR组相比均无显著差异 ( P均 >0 .0 5) ;G组并不增加梗死面积 ( 1 .1 7± 0 .3 2 ) g,梗死面积占缺血面积比为 0 .63± 0 .1 3 ,与 IR组相比无显著差异 ( P>0 .0 5)。结论 :异氟醚、七氟醚、地氟醚预处理产生的心肌保护作用与激活 KATP通道有关。     

清髓性和非清髓性预处理对移植物抗宿主病影响的实验研究

目的　建立大鼠异基因移植模型 ,探讨清髓性和非清髓性预处理方案对移植物抗宿主病 (GVHD)的发生率和严重程度的影响。方法　将受体SD大鼠随机分为A、B、C、D 4组 ,每组 10只大鼠 ,A、B组接受非清髓性预处理 :全身照射 (TBI) 2Gy +氟达拉宾 (FLU ) 1mg/kg ,C、D组接受清髓性预处理TBI 2GyBid× 3d +环磷酰胺 (CTX) 60mg/kg作为预处理。A、C组移植供体WISTAR大鼠骨髓细胞 ,B、D组为对照组。观察生存期 ,临床GVHD表现和病理等指标。结果　A组的生存期为 43 6± 2 8d ,B组为 50 0± 0 0d ,A、B组间比较差异有显著性 (P <0 0 1)。C组为 17 7± 1 4d ,D组为 19 7± 1 7d。C、D组间比较差异有显著性 (P =0 0 1) ,临床GVHD评分A组平均分数为 3 3± 1 0 ,C组平均分数为 5 4± 1 2 ,A、C组间差异有显著性 (P <0 0 0 1)。肝脏病理分级和结肠病理分级 ,A、C组间差异均有显著性 (P <0 0 1)。结论　非清髓性预处理大鼠生存期比清髓性组显著延长 ,且GVHD发生率和严重程度明显降低     

缺血预处理对沙土鼠前脑缺血再灌注后海马羟自由基生成的影响

目的 :研究缺血预处理对沙土鼠脑缺血再灌注后海马羟自由基含量的影响 ,以探讨其神经保护作用的可能机制。方法 :沙土鼠前脑缺血再灌注模型 :阻断双侧颈总动脉 5min ,然后松开即再灌注。将沙土鼠随机分为假手术组 (Sh组 )、缺血组(Is组 )、短暂缺血组 (Po组 )和缺血预处理组 (Ip组 ) ,每组 6只。在动物处死前 3 0min腹腔注射水杨酸钠 10 0mg/kg。在再灌注60min ,快速断头取脑 ,在冰面上分离海马 ,用高效液相电化学检测方法测定各组沙土鼠海马 2 ,3 -二羟基苯甲酸 (2 ,3 -DH BA)、2 ,5 -二羟基苯甲酸 (2 ,5 -DHBA)的含量 (mmol/L)。结果 :沙土鼠脑缺血再灌注 60min ,Sh、Is、Po和Ip组海马中 2 ,3 -DHBA、2 ,5 -DHBA含量分别为 0 2 3± 0 0 5、0 73± 0 12 ;0 46± 0 0 4、1 2 3± 0 11;0 2 7± 0 0 4、0 80± 0 12 ;0 2 9± 0 0 3、0 87± 0 0 7(mmol/L)。Is、Po和Ip组海马中 2 ,3 -DHBA、2 ,5 -DHBA含量分别约为Sh组 2 0 3 %、169% (P <0 0 1) ;118%、110 % (P >0 0 5 ) ;13 1%、119% (P >0 0 5 )。与Is组相比 ,Ip组海马中 2 ,3 -DHBA、2 ,5 -DHBA含量分别减少约 3 7% (P<0 0 1)和 2 9% (P <0 0 1) ;Po组海马中 2 ,3 -DHBA、2 ,5 -DHBA含量分别减少约 41% (P <0 0 1)和 3 5 % (P <     

心肌缺血预处理后亚低温对家兔急性心肌梗死面积的影响

目的　探讨心肌缺血预处理后亚低温治疗对家兔急性心肌梗死面积的影响。方法　 14只家兔随机分为为常温组和亚低温组 ,结扎前降支建立急性心肌梗死模型。亚低温组通过物理降温使结扎后 30min体温降到 35℃以下 ,常温组体温维持在 38℃以上。取心脏染色切片 ,计算梗死心肌、濒危心肌和左室心肌的重量。结果　 (1)亚低温组梗死心肌占濒危心肌的比例分别为 [(32 7± 6 5 ) %和 (4 4 9± 10 7) ,P=0 0 34];占左室心肌的重量比例分别为 [(5 8± 1 7) %和 (9 4± 2 0 ) % ,P =0 0 0 5 ]。 (2 )组织学检查显示亚低温组梗死心肌重量明显低于常温组 ,分别为 (0 38± 0 11)g和 (0 5 9± 0 14 )g ,P =0 0 13]。 (3)亚低温组梗死后 3h血清CK MB活性改变与常温组相近 [(3113 0± 135 1 8)U/L对 (2 733 4± 1792 3)U/L ,P=0 6 79]。 (4 )亚低温组心电图胸前导联抬高幅度之和与常温组无显著性差异 (5 1 4mV± 19 4mV对4 1 0mV± 2 7 6mV ,P =0 4 5 7)。结论　心肌缺血预处理后给予亚低温治疗可减少家兔急性心肌梗死的面积。     

系统性红斑狼疮患者血清γ干扰素诱导的蛋白10表达水平与疾病活动的关系

目的　探讨血清γ干扰素诱导的蛋白 10 (IP 10 )水平 ,与红斑狼疮 (SLE)疾病活动的关系及其在SLE肾损伤中的可能作用。方法　收集了 112例SLE患者及 4 0名正常健康人和 30例类风湿性关节炎 (RA)患者血清。应用ELISA测定血清IP 10水平。结果　SLE活动组血清IP 10水平 (5 0 8 7± 2 5 2 4 ) μg/L较非活动组 (32 2 2± 95 9) μg/L和对照组 (12 4 9± 4 1 3) μg/L明显升高 (P<0 0 0 1)。活动性狼疮肾炎 (LN)组IP 10水平 (5 5 0 9± 2 0 6 1) μg/L与活动性无肾损伤组 (35 4 8±10 5 3) μg/L及对照组比较其差异均具有统计学意义 (P <0 0 0 1)。特别是Ⅲ型和Ⅳ型LN患者血清IP 10水平 (6 2 9 85± 16 4 ) μg/L升高最为显著 ,与Ⅱ型和Ⅴ型LN(30 2 9± 2 0 7 1) μg/L相比其差异具有统计学意义 (P <0 0 1)。另外 ,血清IP 10水平随着SLE疾病活动水平明显升高 ,与总的SLEDAI评分密切相关 (r=0 6 312 ,P <0 0 0 1) ,与SLEDAI肾评分亦密切相关 (r =0 6 880 ,P <0 0 0 1)。结论　以上结果表明IP 10可能在SLE肾损伤中起着十分重要的作用 ,血清IP 10水平与SLE疾病活动密切相关 ,可作为SLE疾病活动、尤其是监测狼疮肾损伤的重要指标。     

Ly49A转基因小鼠脾细胞对半相合异基因骨髓移植后GVHD和GVL的作用

目的　观察Ly4 9A基因转染的C5 7BL 6小鼠脾细胞对半相合异基因骨髓移植 (allo BMT)后移植物抗宿主病 (GVHD)和移植物抗白血病效应 (GVL)的影响。方法　经由逆转录病毒介导将Ly4 9A基因转染至C5 7BL 6小鼠的脾细胞 ;流式细胞仪检测Ly4 9A受体在转染后脾细胞上的表达率 ;以亲代C5 7BL 6H 2 b 小鼠为供者 ,以接种EL96 11红白血病细胞的 (BALB c×C5 7BL 6 )F1H 2 d b(CB6F1)小鼠为受者 ,预处理条件为全身照射 (TBI,6 0 Co照射 10 .5Gy) ,进行脾细胞混合骨髓细胞移植 ,建立半相合异基因急性GVHD模型并在该模型基础上观察Ly4 9A基因转染的脾细胞对GVHD和GVL的作用。结果　Ly4 9A基因转染的C5 7BL 6小鼠的脾细胞 2 4h后蛋白表达率为 (42 .2 0± 4 .87) % ,空载体转染组为(18.6 7± 2 4 8) % ,未转染对照组为 (18.73± 3.82 ) % ,在半相合异基因移植中 (C5 7BL 6 H 2b →CB6F1H 2d b) ,未进行移植的单纯照射组生存期为 (7.80± 3.36 )d ;环磷酰胺治疗组生存期为 (2 1.70±2 87)d ;脾细胞混合骨髓细胞移植组生存期为 (2 9.4 0± 6 .4 3)d ;空载体转染的脾细胞混合骨髓细胞移植组生存期为 (2 9.10± 7.39)d ;Ly4 9A转染的脾细胞混合骨髓细胞移植组生存期为 (45 .0 0± 12 .38)d ,较上述各组生存期明显延长 (P     

3-硝基丙酸多次预处理治疗帕金森病的研究

目的研究3-硝基丙酸(3-NP)多次预处理治疗帕金森病及其可能的机制。方法选择 C57BL小鼠,应用3-NP(20 mg/kg体重)腹腔注射进行预处理后,经腹腔注射MPTP(30 mg/kg体重)制造帕金森病模型,对小鼠进行动作行为评分;测定中脑黑质丙二醛(MDA)及还原型谷胱甘肽(GSH)含量。结果经腹腔注射MPTP后,小鼠爬杆实验、悬挂实验评分由对照组(2．7±0．1)分和(2．7±0．2)分下降至(1．0±0．4) 分和(0．9±0．2)分(P<0．01);经过3-NP单或多次预处理后,其评分明显上升(1．5±0．3,1．5±0．1;2．1± 0．5,2．3±0．3),差异均有统计学意义(P<0．05,P<0．01);多次预处理组与单次预处理组间差异也有统计学意义(P<0．05)。腹腔注射MPTP后MDA含量(5．39±0．68)μmol/g较对照组(2．33±0．12)μmol/g明显升高,差异有统计学意义(P<0．01);3-NP单次预处理后,MDA含量明显下降至(4．12±0．56)μmol/g,与MPTP 组比较,差异有统计学意义(P<0．05);3-NP多次预处理后,MDA含量下降更为明显(3．11±0．49)μmol/g,与 MPTP组比较,差异有统计学意义(P<0．01);多次预处理组与单次预处理组比较,差异也有统计学意义(P< 0．05);MPTP组GSH含量(2．46±0．47)mg/g较对照组(5．23±0．64)mg/g明显下降,差异有统计学意义(P <0．01),单次预处理后,GSH含量升高不明显(2．69±0．41)mg/g(P>0．05),多次预处理后GSH含量明显升高(3．95±0．33)mg/g,差异有统计学意义(P<0．05)。结论 3-NP多次预处理可通过减少MDA生成,激发 GSH合成,达到治疗帕金森病,保护多巴胺神经元的作用。     

大剂量肾上腺素与异丙基肾上腺素联用于心肺复苏的疗效观察

目的　观察大剂量肾上腺素与异丙基肾上腺素联用救治冠心病猝死心肺复苏的临床疗效。方法　 32例冠心病猝死病人常规实施心肺复苏 (CPR)程序 ,肾上腺素 1～ 3mg静脉注射加电击复律无效 ,分为大剂量肾上腺素组 (H -Epi)与大剂量肾上腺素 +异丙基肾上腺素组 (H -Epi+Iso) ,观察用药到恢复自主循环 (Rosc)时间及用药剂量 ;Rosc机率及持续时间。结果　H -Epi组与H -Epi+Iso组肾上腺素用药量无差异情况下 ,Rosc时间分别为 (2 8± 0 9)min与 (1 6± 0 5 )min(P <0 0 5 ) ,Rosc机率分别为 2 6 7%与 5 8 8% (P <0 0 1) ,Rosc持续时间分别为 (6± 5 2 )minvs(18 8± 12 9)min(P <0 0 0 1)。结论　异丙基肾上腺素作为肾上腺素的辅助用药可促进心脏骤停病人自主循环的恢复     

网织红细胞四项检测指标的正常参考值调查

CoulterMAXM型全自动血液分析仪 ,兼有采用VCS原理检测网织红细胞的功能。本文报道 ,5 2例健康成人 (男女各占一半 ,男 2 2～ 39岁 ;女 2 0～ 40岁 )的网织红四项指标的参考值调查结果 :(1)RET % ,男 1 82± 0 5 6 (x±s) ;女 1 75± 0 5 9,二组无显著性差异 ,合计 5 2例的RET %为 1 78± 0 5 7(0 6 4～ 2 92 % ) ;(2 )RET # (× 10 9/L) :男 90 3± 2 9 4(31 5～ 149 1) ;女74 1± 2 4 7(2 4 7～ 12 3 5 ) ,二组有显著性差异 (t=2 15 4,P <0 .0 5 ) ;(3)MRV(fl) :男 10 6 9± 8 5 ;女 10 8 3± 7 3,二组无显著性差异 ,合计 5 2例的MRV为 10 7 6± 7 8(92 0～ 12 3 2 ) ;(4 )MI(% ) ;男 2 7 1± 4 9,女 2 5 7± 4 6 ,二组无显著性差异 ,合计 5 2例的MI为 2 6 4± 4 7(16 9～ 35 9)。     

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.