用改良Hodge试验筛查低产碳青霉烯酶肠杆菌科细菌

目的 筛查临床分离的对碳青霉烯类表型敏感但携带碳青霉烯酶耐药基因的肠杆菌科细菌,分析改良Hodge试验(MHT)的筛查效果。 方法 用MHT筛查低产碳青霉烯酶肠杆菌科细菌;M-H琼脂稀释法和纸片扩散法（K-B）检测对第三代头孢菌素和碳青霉烯类药物的敏感度;EDTA 双纸片协同试验检测金属碳青霉烯酶;PCR检测细菌相关耐药基因。 结果 203株表型第三代头孢菌素耐药的碳青霉烯类敏感肠杆菌科细菌中,24株MHT阳性,EDTA双纸片协同试验均阴性;M-H琼脂稀释法结果对头孢他啶（CAZ）2株敏感,2株中介,其余均耐药;对厄他培南（ETP）、亚胺培南（IPM）和美洛培南（MEM）均敏感;碳青霉烯酶、β内酰胺酶基因特异性PCR扩增,4株扩增出KPC基因,2株扩增出CTX-M基因,13株扩增出TEM基因。 结论 经MHT筛检出临床分离株中存在潜在的产KPC型碳青霉烯酶肠杆菌科细菌。阳性结果需用基因检测的方法进一步确认。     

低产碳青霉烯酶肠杆菌科细菌的筛选及耐药基因检测

目的:了解临床分离碳青霉烯类表型敏感的肠杆菌科细菌碳青霉烯酶耐药基因携带情况。方法:VITEK-2系统进行药物的最低抑菌浓度(MIC)检测;改良Hodge试验(MHT)筛查低产碳青霉烯酶肠杆菌科细菌;EDTA双纸片增效法检测金属β-内酰胺酶(MBL);PCR法检测相关耐药基因。结果:115株实验菌有12株MHT阳性;12株阳性菌中,3株EDTA双纸片增效试验阴性,9株阳性,这9株菌除阿米卡星、多粘菌素B敏感外,其他抗菌药物均呈耐药,含I类整合子,且检出IMP-4(blaIMP-4)和IMP-1(blaIMP-1)型的MBL基因,未检出KPC型碳青霉烯酶基因及其他MBL基因。结论:厄他培南对肠杆科细菌产碳青霉烯酶的筛选比亚胺培南、美洛培南敏感;经MHT筛选阳性的,潜在产碳青霉烯酶的肠杆科细菌,应进一步用基因检测法确认。     

应用改良Hodge试验检测肠杆菌科细菌产碳青霉烯酶的研究

目的应用改良Hodge试验(MHT)检测肠杆菌科细菌产碳青霉烯酶的应用价值。方法应用MHT检测对碳青霉烯类抗菌药物敏感性降低的24株肠杆菌科细菌产碳青霉烯酶的情况。同时利用聚合酶链反应(PCR)检测碳青霉烯酶的基因,包括KPC、NDM、IMP、SIM和VIM,PCR阳性的产物测序结果与Gen Bank数据库进行比对。综合分析MHT和PCR检测碳青霉烯酶的效率。结果对碳青霉烯酶抗菌药物敏感性降低的24株肠杆菌科细菌应用MHT检测碳青霉烯酶的阳性菌株共为13株,而PCR检测出碳青霉烯酶基因的只有5株。且PCR产物测序结果经比对后证实1株为KPC-2和4株为IMP-4。对比分析MHT和PCR的检测结果可知有4株肠杆菌科细菌的MHT和PCR同时检测出碳青霉烯酶;有9株肠杆菌科细菌的MHT为阳性,但PCR没检测出碳青霉烯酶的基因;有1株肠杆菌科细菌MHT为阴性,但PCR检测出碳青霉烯酶的基因。结论 MHT作为筛查碳青霉烯酶肠杆菌科细菌的准确性值得继续探讨。     

耐碳青霉烯类肠杆菌科细菌KPC和NDM-1β内酰胺酶耐药基因的研究

目的检测江苏盛泽医院耐碳青霉烯类肠杆菌科细菌的KPC和NDM-1耐药基因,分析耐碳青霉烯类的耐药机制。方法采用改良Hodge试验、亚胺培南-EDTA纸片协同试验和AmpC酶三维试验检测29株耐碳青霉烯类抗生素肠杆菌科细菌产酶情况;用PCR方法检测KPC及NDM-1两种碳青霉烯酶耐药基因。结果29株分离菌中,26株菌改良Hodge试验阳性,7株亚胺培南EDTA纸片协同试验阳性,7株AmpC酶三维试验阳性,16株携带KPC型碳青霉烯酶耐药基因,未扩增出NDM-1碳青霉烯酶耐药基因。结论该院耐碳青霉烯类抗生素肠杆菌科细菌的耐药机制主要是携带KPC型碳青霉烯酶基因。     

改良Hodge试验检测肠杆菌科IMP型碳青霉烯酶的性能评价

目的探讨改良Hodge试验（modified Hodge test,MHT）在检测肠杆菌科细菌IMP型碳青霉烯酶中的应用价值。方法以VITEK2Compact全自动细菌鉴定及药敏系统进行细菌鉴定和药敏试验,筛选2010-2012年非重复临床分离的碳青霉烯类药物敏感性降低的肠杆菌科细菌,以MHT进行产碳青霉烯酶表型确证试验,PCR检测碳青霉烯酶blaKPC、blaIMP;6如VIM、blaoXA-48及blandm-1基因型,阳性结果进行测序并Blast比对确定基因型。以基因测序结果为金标准,分析统计MHT检测肠杆菌科碳青霉烯酶的各项性能指标。结果本实验共收集62株碳青霉烯类药物敏感性降低的肠杆菌科细菌,包括肺炎克雷伯菌42株,阴沟肠杆菌12株,大肠埃希菌5株,产酸克雷伯菌3株;MHT检测阳性51株,占总株数的82．26％,肺炎克雷伯菌、阴沟肠杆菌、大肠埃希菌、产酸克雷伯菌分别占各自菌种的比例为83．33％,75．0％,80．0％,100．0％;经PCR扩增并测序证实27株为产IMP-4型菌株,20株为产IMP-8型菌株,其他15株为碳青霉烯酶阴性菌株;MHT检测肠杆菌科细菌产IMP型碳青霉烯酶的灵敏度为97．87％％,特异性为66．67％,阳性预测值为90．2％,阴性预测值为90．91％,检验效能为90．32％。结论MHT检测肠杆菌科细菌产IMP型碳青霉烯酶具有良好的灵敏度,但特异性偏低,建议进一步使用分子生物学技术检测碳青霉烯酶肠杆菌科细菌基因型。     

不同底物在CIM试验检测革兰阴性杆菌碳青霉烯酶中的应用评价

目的评价不同碳青霉烯类抗生素作为指示底物对碳青霉烯类抗生素不活跃检测方法(CIM)结果的影响。方法分别用美罗培南、亚胺培南和厄他培南作为指示药物,对90株肠杆菌科细菌和105株非发酵菌进行CIM试验来检测碳青霉烯酶,并用PCR方法检测碳青霉烯酶基因。结果肠杆菌科细菌中碳青霉烯酶基因阳性菌株用美罗培南检出率为91.0%(71/78),亚胺培南检出率为92.3%(72/78),厄他培南检出率为85.9%(67/78),3种药物检出率差异无统计学意义(χ2=1.95,P=0.377);肠杆菌科细菌中碳青霉烯酶基因阴性菌株CIM试验用美罗培南、亚胺培南和厄他培南检测均阴性。非发酵菌碳青霉烯酶基因阳性菌株用美罗培南检出率为94.0%(63/67),亚胺培南检出率为74.6%(50/67),厄他培南检出率为70.1%(47/67),美罗培南检出率均高于厄他培南和亚胺培南的检出率,差异有统计学意义(P0.05)。32株碳青霉烯酶基因阴性鲍曼不动杆菌菌株中有2株美罗培南CIM试验阳性,而亚胺培南和厄他培南检测均阴性。结论应用美罗培南作为反应底物进行CIM试验与基因检测的一致性最高。此方法操作简单,成本低廉,结果易判断,适合在临床实验室开展。     

改良Hodge试验检测肠杆菌科细菌碳青霉烯酶的性能评估

目的 评估改良Hodge试验在碳青霉烯类药物敏感性降低的肠杆菌科细菌中检测碳青霉烯酶的效能.方法 收集2004-2008年我国16家教学医院的49株碳青霉烯类药物敏感性降低(亚胺培南、美罗培由或厄他培南的MIC≥2μg/ml)的肠杆菌科细菌;采用对倍琼脂稀释法测定其对亚胺培南、美罗培南和厄他培南的MIC;通过改良Hodge试验检测碳青霉烯酶;利用加苯硼酸或苯唑西林的改良Hodge试验区分碳青霉烯酶或AmpCs/ESBLs导致的阳性结果 ;采用PCR检测包括NDM-1型碳青霉烯酶基因在内的多种β内酰胺酶基因,并对PCR阳性产物测序鉴定.结果 49株菌中,36株菌对亚胺培南不敏感(MIC>4μg/ml),31株菌对美罗培由不敏感(MIC>4μg/ml),47株菌对厄他培南不敏感(MIC>2μg/ml).49株临床分离菌中23株菌改良Hodge试验刚性,包括9株弱阳性和14株强阳性.经过对菌株进行β内酰胺酶基因PCR和测序,发现9株Hodge弱阳性菌株中2株携带blaKPC-2,7株不携带碳青霉烯酶基因,但携带blaampC/blaESBL;14株强阳性菌株中4株携带blaKPC-2,8株携带blaIMP-4,2株携带blaIMP-8;26株改良Hodge试验阴性菌株均未携带碳青霉烯酶基因.所有49株菌均未检测到blaNDM-1.以碳青霉烯酶基因检测为标准,则改良Hodge试验对检测碳青霉烯类药物敏感性降低的肠杆菌科菌中碳青霉烯酶的敏感度为100%,特异度为79%,阳性预测值为70%,阴性预测值为100%,准确性为86%.结论 改良Hodge试验具有很好的敏感性,但存在一些假阳性结果 .利用苯硼酸和苯唑西林可有效区分改良Hodge试验的假阳性和真阳性.     

耐碳青霉烯类肠杆菌科细菌表型检测及其耐药性研究

目的了解耐碳青霉烯类肠杆菌科细菌(CRE)感染状况及其产酶类型。方法采用最低抑菌浓度(MIC)法分析肠杆菌科细菌的耐药情况。采用厄他培南纸片扩散法初筛产碳青霉烯酶菌株,对初筛阳性菌株分别采用改良Hodge试验、加硼酸或苯唑西林的改良Hodge试验、EDTA亚胺培南复合纸片法进行表型确证。结果肠杆菌科细菌对亚胺培南和美罗培南的耐药率分别为2.7%、2.3%。厄他培南纸片扩散法初筛阳性菌株11株,其中改良Hodge确证试验阳性(或弱阳性)菌株3株,包括产金属酶菌株1株,产超广谱β-内酰胺酶(ESBLs)或AmpC酶菌株2株。2株改良Hodge确证试验弱阳性菌中未检出碳青霉烯酶基因,但检出AmpC、TEM、CTX-M基因,改良Hodge试验阳性菌中检出blaIMP基因。结论改良Hodge试验、加硼酸或苯唑西林改良Hodge试验及EDTA亚胺培南复合纸片法相结合进行碳青霉烯酶检测,在暂无条件开展基因分型的医院具有很好的应用前景。     

耐碳青霉烯类抗生素产气肠杆菌的KPC-2酶检测与分析

目的 了解分离自临床标本的耐碳青霉烯类抗生素产气肠杆菌的耐药机制.方法 对临床分离到非重复的16株厄他培南耐药,及亚胺培南耐药或敏感性减低的产气肠杆菌采用改良Hodge试验和聚合酶链反应(PCR)检测KPC酶及其KPC酶基因,并采用转移接合试验对KPC酶基因阳性的菌株进行转移接合.结果 对16株产气肠杆菌的改良Hodg...     

不同检验方案对碳青霉烯类非敏感类肠杆菌科细菌检测的临床应用

目的分析改良Hodge试验(MHT)、Carba NP direct试验(CNPt-d)、Carba NP试验(CNPt)对碳青霉烯类非敏感类肠杆菌科细菌(CRE)检测的临床应用价值。方法收集我院2018年5月-2019年5月临床分离的碳青霉烯类非敏感类肠杆菌科细菌138株,采用聚合酶链式反应(PCR)、MHT、CNPt-d、CNPt对碳青霉烯酶耐药基因进行检测,以PCR检测为金标准,分析MHT、CNPt-d、CNPt对碳青霉烯类非敏感类肠杆菌科细菌的检测价值。结果 PCR检测结果显示138株碳青霉烯类非敏感类肠杆菌科细菌共检测出含碳青霉烯酶基因的CRE120株,其中NDM-1型大肠埃希菌10株,KPC-2型肠科杆菌106株,VIM-2型肺炎克雷伯菌4株;120株碳青霉烯酶基因阳性的CRE中,有110株MHT检测结果为阳性,阳性率为91.67%;120株碳青霉烯酶基因阳性的CRE中,有115株CNPt检测结果为阳性,阳性率为95.83%;120株碳青霉烯酶基因阳性的CRE中,有120株CNPt-d检测结果为阳性,阳性率为100.00%;MHT、CNPt-d、CNPt中,CNPt-d对碳青霉烯类非敏感类肠杆菌科细菌的检测价值最高。结论 MHT、CNPt-d、CNPt均能迅速检测出碳青霉烯类非敏感类肠杆菌科细菌,但CNPt-d灵敏性更强,准确性更高,且无需昂贵的蛋白抽提液,试剂成本价廉,可作为碳青霉烯类非敏感类肠杆菌科细菌的有效筛查方法。     

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.     

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.     

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.     

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.