氯氮平对不同病程女性精神分裂症患者血清白细胞介素6及可溶性白细胞介素6受体的影响

目的：探讨女性精神分裂症患者血清白细胞介素6(IL-6)、可溶性白细胞介素6受体(sIL-6R)治疗前后变化及其与抗精神病药物氯氮平血清水平的关系。方法：采用酶联免疫吸附法测定40例女性精神分裂症患者(病程≥5年组和病程&;lt;5年组，每组20例)治疗前及治疗后第1、2和4周血清IL-6和sIL-6R水平，同时用高效液相色谱法测定氯氮平水平，以20例女性健康者血清IL-6、sIL-6R水平作对照。治疗前与治疗后第4周评定阴性和阳性症状量表(PANSS)各一次。结果：①病程≤5年组患者治疗前血清IL-6和sIL-6R水平均显著高于正常对照组(P&;lt;0．01)；治疗后第1、2和4周血清IL-6和sIL-6R水平均显著低于对照组(P&;lt;0．01)。②病程&;gt;5年组患者治疗前及治疗后第1，2和4周血清IL-6、sIL-6R水平均显著低于正常对照组(P&;lt;0．01)。③除病程&;gt;5年组患者第1周血清IL-6水平与氯氮平水平呈负相关(r=0．57，P&;lt;0．01)外，余各时点血清sIL-6R水平与氯氮平水平均无显著相关性(r=-0．36～0．17，P&;gt;0．05)。④氯氮治疗4周后，PANSS减分率与IL-6，sIL-6R减分率无显著相关(r=-0．22～-0．01．P&;gt;0．05)。结论：女性精神分裂症患者血清IL-6、sIL-6R水平与健康女性差异显著，氯氮平对IL-6和sIL-6R有抑制作用，氯氮平的抗精神病作用可能与对IL-6，sIL-6R的调节作用有关。     

白细胞介素在扩张型心肌病患者血清中的表达及意义

目的观察扩张型心肌病（DCM）患者血清中的白细胞介素6（IL-6）,白细胞介素1α（IL-1α）,可溶性白细胞介素-2受体（SIL-2R）及白细胞介素10（IL-10）的水平,探讨其意义。方法扩张型心肌病患者组35例,健康对照组21例,用ELISA方法测定IL-6,IL-1α,SIL-2R,IL-10水平,并对其结果进行比较。结果DCM患者血清中IL-6,IL-1α,SIL-2R及IL-10水平明显高于健康对照组（P〈0.05）。结论DCM患者血清中IL-6,IL-1α,sIL-2R及IL-10水平的升高,说明DCM的发生、发展与免疫因素重要相关。     

原发性肝癌患者血清中TNF-a、IL-6、IL-8和sIL-2R的测定及其临床意义

目的探讨原发性肝癌（primary hepatic cancer，PHC）患者血清中肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、可溶性白细胞介素-2受体（sIL-2R）水平及其临床意义。方法采用ELISA法测定血清中TNF-α、IL-6、IL-8和sIL-2R的含量；观察患者治疗前后细胞因子变化及其预后的关系，并设正常对照组。结果PHC患者血清中TNF-α、IL-6、IL-8和sIL-2R含量明显高于对照组（P〈0．01）；临床Ⅲ期患者血清TNF-α和sIL-2R含量明显高于Ⅰ期（P〈0．01）；肿瘤根治术后血清中TNF-α、IL-6、IL-8和sIL-2R含量较术前明显降低（P〈0．05），但仍高于对照组（P〈0．01）。随着肝脏损伤程度的加重，血清中的TNF-α、IL-6、IL-8和sIL-2R含量随之增加。PHC患者在治疗前血清中sIL-2R和TNT-α水平明显地高于对照组（P〈0．01），经治疗后与对照组比较仍有显著性差异（P〈0．05）。结论提示检测PHC患者血清中TNF-α、IL-6、IL-8和sIL-2R含量，对了解PHC患者体内免疫状态、临床诊断和预后判断有重要意义。     

高位硬膜外阻滞对扩张型心肌病患者白细胞介素6及可溶性白细胞介素2受体的影响

背景：扩张型心肌病患者血清中细胞因子明显升高。心肌组织中也有细胞因子mRNA的表达，通过高位硬膜外阻滞治疗可以阻断细胞因子参与的恶性循环，改善心功能。目的：观察扩张型心肌病患者经过高位硬膜外阻滞术治疗后白细胞介素6及可溶性白细胞介素2受体的变化。设计：病例-对照分析。单位：首都医科大学宣武医院的检验科，哈尔滨医科大学第一临床医院的检验科和心内科。对象：哈尔滨医科大学第一临床医学院心内科2001—10／2002-05的扩张型心肌病患者35例，随机分为高位硬膜外阻滞组和常规治疗组，高位硬膜外阻滞组22例，男15例，女7例；心功能Ⅱ级4例，Ⅲ级9例，Ⅳ级9例。常规治疗组13例，男11例，女2例；心功能Ⅱ级1例，Ⅲ级5例，Ⅳ级7例。同期选择本院的健康体检者21例，男13例，女8例。干预：扩张型心肌病患者分别采用高位硬膜外阻滞治疗及常规治疗，常规治疗组只采用常规治疗方法。所有患者于治疗前及治疗4周后清晨抽取空腹肘静脉血3mL，酶联免疫吸附法测定血清中白细胞介素6和可溶性白细胞介素2受体水平。主要观察指标：各组患者血清中白细胞介素6和可溶性白细胞介素2受体水平。结果：56例观察对象的血样均合格，全部进入结果分析。①扩张型心肌病患者血清白细胞介素6水平（13．9ng／L）明显高于健康对照组（11．22ng／L），（z=-3.072，P〈0．05）。②高位硬膜外阻滞治疗组治疗后白细胞介素6水平（11．42ng／L）较治疗前（20．42ng／L）明显下降0=2．5829，P〈0．05）。常规治疗组治疗前后白细胞介素6水平相似（12．16ng／L,12．80ng／L,z=-1．89，P〉0．05）。高位硬膜外阻滞组治疗前后白细胞介素6水平差值（-2．04ns／L）明显高于常规治疗组（0．28ng/L），0=3．1829，P〈0．01）。③扩张型心肌病组可溶性白细胞介素2受体水平[（1306．17&;#177;1．46）ns／L]高于健康对照组[（1078．95&;#177;1．23）ns／L]，（t=2．51,P〈0．05）。④高位硬膜外阻滞治疗组治疗后可溶性白细胞介素2受体水平[（1086．68&;#177;1．34）ng／L]低于治疗前[（1328．01&;#177;1．51）ng／L，（t=2．145，P〈0．05）]。常规治疗组治疗前后可溶性白细胞介素2受体水平相似[（1473．33&;#177;1．66）ng／L（1331．07&;#177;1．52）ng／10=-1．06，P〉0．05]。结论：高位硬膜外阻滞治疗后细胞因子白细胞介素6及可溶性白细胞介素2受体水平都明显下降，而常规治疗组未见此效果，表明高位硬膜外阻滞治疗对细胞因子有良好的调节作用，优于常规治疗。高位硬膜外阻滞对细胞因子的调节作用与其阻滞效应中的全面抑制心脏交感神经，抑制交感神经对体液免疫系统的激活及阻断其恶性循环有关。     

高位硬膜外阻滞对扩张型心肌病患者白细胞介素6及可溶性白细胞介素2受体的影响

背景扩张型心肌病患者血清中细胞因子明显升高,心肌组织中也有细胞因子mRNA的表达,通过高位硬膜外阻滞治疗可以阻断细胞因子参与的恶性循环,改善心功能. 目的观察扩张型心肌病患者经过高位硬膜外阻滞术治疗后白细胞介素6及可溶性白细胞介素2受体的变化. 设计病例-对照分析. 单位首都医科大学宣武医院的检验科,哈尔滨医科大学第一临床医院的检验科和心内科. 对象哈尔滨医科大学第一临床医学院心内科2001-10/2002-05的扩张型心肌病患者35例,随机分为高位硬膜外阻滞组和常规治疗组,高位硬膜外阻滞组22例,男15例,女7例;心功能Ⅱ级4例,Ⅲ级9例,Ⅳ级9例.常规治疗组13例,男11例,女2例;心功能Ⅱ级1例,Ⅲ级5例,Ⅳ级7例.同期选择本院的健康体检者21例,男13例,女8例. 干预扩张型心肌病患者分别采用高位硬膜外阻滞治疗及常规治疗,常规治疗组只采用常规治疗方法.所有患者于治疗前及治疗4周后清晨抽取空腹肘静脉血3 mL,酶联免疫吸附法测定血清中白细胞介素6和可溶性白细胞介素2受体水平. 主要观察指标各组患者血清中白细胞介素6和可溶性白细胞介素2受体水平. 结果56例观察对象的血样均合格,全部进入结果分析.①扩张型心肌病患者血清白细胞介素6水平(13.9 ng/L)明显高于健康对照组(11.22 ng/L),(z=-3.072,P＜0.05).②高位硬膜外阻滞治疗组治疗后白细胞介素6水平(11.42 ng/L)较治疗前(20.42 ng/L)明显下降(z=2.582 9,P＜0.05).常规治疗组治疗前后白细胞介素6水平相似(12.16 ng/L12.80 ng/L,z=-1.89,P＞0.05).高位硬膜外阻滞组治疗前后白细胞介素6水平差值(-2.04 ng/L)明显高于常规治疗组(0.28 ng/L),(z=3.182 9,P＜0.01).③扩张型心肌病组可溶性白细胞介素2受体水平[(1 306.17±1.46)ng/L]高于健康对照组[(1 078.95±1.23)ng/L],(t=2.51,P＜0.05).④高位硬膜外阻滞治疗组治疗后可溶性白细胞介素2受体水平[(1 086.68±1.34)ng/L]低于治疗前[(1 328.01±1.51)ng/L,(t=2.145,P＜0.05)].常规治疗组治疗前后可溶性白细胞介素2受体水平相似[(1473.33±1.66)ng/L(1 331.07±1.52)ng/L,t=-1.06,P＞0.05].结论高位硬膜外阻滞治疗后细胞因子白细胞介素6及可溶性白细胞介素2受体水平都明显下降,而常规治疗组未见此效果,表明高位硬膜外阻滞治疗对细胞因子有良好的调节作用,优于常规治疗.高位硬膜外阻滞对细胞因子的调节作用与其阻滞效应中的全面抑制心脏交感神经,抑制交感神经对体液免疫系统的激活及阻断其恶性循环有关.     

氟伐他汀对扩张型心肌病患者血炎症介质及心功能的影响

目的研究氟伐他汀对扩张型心肌病患者血清细胞因子水平及心功能的影响。方法心功能Ⅱ、Ⅲ级的扩张型心肌病患者随机分为2组．氟伐他汀组（n=32例）每日口服氟伐他汀40mg，对照组（30例）不用降脂药物：于研究开始及6个月结束时监测血清肿瘤坏死因子d（TNF—d1、白细胞介素-6（IL-6）、血清超敏C反应蛋白（hs—CRP）水平．监测肝酶及肌酶变化及左心室射血分数（LVEF）。结果氟伐他汀组及对照组治疗后的LVEF均较治疗前明显改善．差异有统计学意义（t分别=5．75、6．78，P均〈0．05）；两组的血TNF—a、IL-6及hs—CRP水平在治疗前后比较，差异均无统计学意义（t分别=1．37、O．46、1．73、0.37、0．63、0．46，P均〉0．05）；但对于心功能Ⅲ级患者氟伐他汀组能显著降低血TNF—a、IL-6水平（t分别=2，55、2．77，P均〈0．05），与对照组治疗后比较，差异也有统计学意义（t分别=2．13、2．05，P均〈0．05）。治疗后的氟伐他汀组LVEF较对照组明显提高（t=2．80，P〈0．05）。结论对心功能Ⅲ级的扩张型心肌病患者使用氟伐他汀治疗有一定的治疗价值，但对扩张型心肌病患者中常规缺乏依据。     

肺癌患者血清白细胞介素6、可溶性白细胞介素6受体的测定及其临床意义

目的:探讨血清白细胞介素6(IL-6)及可溶性白细胞介素6受体(sIL-6R)的表达水平与肺癌诊断、疗效判断及预后的关系。方法:采用双抗体夹心酶联免疫吸附法(ELISA)检测20例健康成人,100例肺癌患者化疗前后血清IL-6和sIL-6R水平,并进行化疗前后对比。结果:肺癌患者化疗前血清IL-6、sIL-6R均高于对照组,化疗后明显降低,差异有显著性(P<0.01),临床分期越高血清IL-6、sIL-6R水平越高,而与肺癌病理类型无关。结论:动态观察血清IL-6、sIL-6R的变化在一定程度上可反映肺癌发生、发展及治疗效果。     

病毒性心肌炎、扩张型心肌病患者TNF、sIL—2R、IL—6、IL—8、T细胞亚群的改变

目的：免疫反应在病毒性心肌炎（VMC）、扩张型心肌病（DCM）发病中所起的作用。方法：对30例VMC患者、40例DCM患者分别采用放免法测定血清肿瘤坏死因子（TNF）水平;ELISA法测定血清可溶性白细胞介素2受体(sIL-2R)、白细胞介素6（IL－6）、白细胞介素I（IL－8）水平;ABC染色法测定外周血T淋巴细胞亚群,并与30例正常从（NC）对照。结果：VMC组、DCM组血清TNF、sIL-2R、IL－6、IL－8水平均显著高于NC组（P＜0．01－0．001）,T细胞亚群中CD4、CD8显著低于NC组（P＜0．05－0．01）,CD4／CD8显著高于NC组（P＜0．001）。结论：一系列细胞因子介导的免疫、炎症反应,免疫调节网络功能的失衡在VMC、DCM的发生、发展中起重要作用。     

卡介菌多糖核酸对白癜风患者血清sIL-2R、IL-10、TNF-γ的影响

【目的】观察sIL-2R、IL-10、TNF-α在白癜风患者血清中的变化以及卡介菌多糖核酸（BCG-PSN）对白癜风患者血sIL-2R、IL-10、TNF-α的影响.【方法】用ELISA 法检测20例正常对照和56例白癜风患者在BCG-PSN治疗前后血清sIL-2R、IL-10、TNF-α水平.【结果】白癜风患者BCG-PSN治疗前血清sIL-2R、 IL-10水平明显高于正常对照组（P〈0.01）;治疗后与治疗前比较sIL-2R 、IL-10显著下降（P〈0.01）,与正常对照组相比差异无显著性（P〉0.05）;白癜风患者BCG-PSN治疗前血清TNF-α水平明显高于正常对照组（P〈0.01）;治疗后与治疗前比较TNF-α无显著下降（P〉0.05）,与正常对照组相比差异仍有显著性（P〈0.01）.【结论】白癜风患者存在免疫功能紊乱, sIL-2R、IL-10、TNF-α在白癜风自身免疫机制中可能起一定作用,血清sIL-2R 、IL-10水平与白癜风的病情活动性有一定关系;BCG-PSN具有显著降低白癜风患者血清中sIL-2R、IL-10 水平的作用,提高了患者的细胞免疫功能,从而发挥治疗作用. [ 关键词：白癜风/药物疗法;分支杆菌,牛,甘露聚糖类/治疗应用;受体,白细胞介素2/血液;白细胞介素10/血液;肿瘤坏死因子/血液     

慢性肾功能不全患者血清白细胞介素6和可溶性白细胞介素6受体检测及临床意义

目的：探讨慢性肾功能不全患者血清白细胞介素6（IL-6）和可溶性白细胞介素6受体肝（sIL-6R）检测的临床意义。方法：采用ELISA法检测慢性肾功能不全各期及血液透析患者血清IL-6和sIL-6R变化及两者相关性。结果：肾功能不全代偿期IL-6和sIL-6R水平与正常对照组比较无明显改变（P＞0.05），氮质血症期开始逐渐上升（P＜0.05），尿毒症期和血液透析患者IL-6和sIL-6R水平与正常对照比较，其差异有极显著意义（P＜001），且两者之间有良好相关性（r=0.56，P＜0.01），患者血清IL－6和sIL-6R与血清尿素氮相关明显（r=0．49，P＜0.05）。28例血液透析患者透析后IL－6水平较透析前无明显改变（P＞0.05），但sIL－6R水平透析后显著降低（P＜0.05）。结论：IL－6和sIL－6R水平可作为判断病情和预后的指标。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.