哮喘患儿外周血单个核细胞瘦素及Foxp3的表达

目的 探讨哮喘患儿瘦素及CD4⁺CD25⁺调节性T细胞(Treg)特异性转录因子叉头状转录因子P3(Foxp3)在外周血单个核细胞(PBMC)中的表达及意义。方法 选取2013年8月～2015年5月在沭阳县人民医院门诊及住院的28例哮喘患儿发作期(发作组),26例哮喘患儿缓解期(缓解组)及25例健康体检儿童(对照组),采用ELISA法检测各组血浆及PBMC培养上清液中的瘦素浓度,实时荧光定量PCR法测定PBMC中Foxp3的相对表达量,进行统计学分析。结果 发作组、缓解组和对照组三组血浆浓度(19.98±5.40 ng/ml,13.73±2.28 ng/ml,12.17±3.95 ng/ml)及PBMC培养上清液瘦素浓度(55.94±11.09 pg/ml,31.97±7.71 pg/ml,27.85±7.67 pg/ml)差异均有统计学意义(F=27.07,75.96,P均<0.01); 组间两两比较,发作组均高于缓解组与对照组(P均<0.01),而缓解组与对照组差异无统计学意义(P>0.05)。发作组、缓解组和对照组三组PBMC Foxp3相对表达量(2.70±0.48,3.84±0.45,3.77±0.38)差异有统计学意义(F=57.35,P<0.01); 组间两两比较,发作组低于缓解组与对照组(P<0.01),而缓解组与对照组差异无统计学意义(P>0.05)。发作组患儿PBMC培养上清液瘦素浓度与PBMC Foxp3相对表达量呈负相关(R=-0.730,P<0.01),而血浆瘦素浓度与PBMC Foxp3相对表达量无明显相关性(R=-0.367,P=0.550)。结论 哮喘患儿PBMC分泌瘦素增加,且分泌的瘦素抑制了Foxp3的表达。     

肺炎患儿血清降钙素原与PBMC降钙素原水平的关系及其意义

目的为了阐明降钙素原 (PCT)产生的病理生理机制 ,作者对外周血单个核细胞 (PBMC)分泌PCT情况进行了初步的探讨。方法通过免疫荧光法检测 38例肺炎患儿血清PCT治疗前后的变化情况 ,并与 33例正常同龄儿童进行比较 ;体外分离PBMC ,植物血凝素 (PHA)刺激 72h ,检测患儿治疗前后培养基上清液中的PCT含量。结果治疗前肺炎患儿血清PCT的含量明显高于治疗后血清中的含量 (18.89± 6 .38μg/Lvs 0 .5 1± 0 .31μg/L ,P <0 .0 1)。PBMC培养上清液中的PCT含量明显低于治疗后的PCT含量 (5 .12± 1.89μg/Lvs 9.32± 1.97μg/L ,P <0 .0 5 ) ,但治疗后的PCT含量仍低于对照组水平。结论血清PCT的变化可作为评价肺炎儿童疗效的一个指标 ,感染后PBMC可能在体内已激活 ,致使其在体外对PHA的非特异性刺激反应低下。     

IL-13等因素对肾小球系膜细胞表达细胞周期调节负控蛋白p27的影响

目的 :探讨IL 13、ET 1、甲基强的松龙及肝素钠对肾小球系膜细胞表达细胞周期负控蛋白p2 7的变化。方法 :不同浓度IL 13 (10ng/mL、10 0ng/mL)、ET 1(10 7mol/L)、甲基强的松龙 0 5μg/mL、肝素钠 2 0 0mg/L和10 0 μg/L ,作用于培养的系膜细胞。流式细胞仪检测p2 7表达水平。结果 :IL 13 10ng/mL浓度组和 10 0ng/mL浓度组p2 7表达为 46 74± 3 2 5和 2 3 8± 2 56,与对照组比较差异有显著意义 (P <0 0 0 1,P <0 0 5) ,两不同浓度组之间差异有显著意义 (P <0 0 1)。ET 1刺激 14h和 18h后p2 7的表达分别为 14 76± 1 49和 12 18± 1 3 0 ,与对照组比较差异均有显著意义 (P <0 0 5,P <0 0 5)。甲基强的松龙 48h及 72h后p2 7表达为 9 9± 1 0 1和 9 12±0 93 ,与对照组比较明显降低 ,P <0 0 0 1。肝素钠 10 0mg/L浓度组和 2 0 0mg/L浓度组p2 7的表达分别为 2 6 94±1 2 3和 2 8 0 4± 0 99,较对照组明显升高 (P <0 0 5) ,不同浓度组间比较无明显差异。结论 :肾小球系膜细胞受不同因素作用后细胞周期调节负控蛋白p2 7表达水平不同。p2 7在调节系膜细胞增殖过程中起重要作用     

子宫内膜异位症抗子宫内膜抗体与白细胞介素2及6的关系

目的探讨子宫内膜异位症患者抗子宫内膜抗体 (Emab)与白细胞介素 2 (IL - 2 ) ,白细胞介素 6 (IL - 6 )含量的关系。方法用放射免疫法测定 36例子宫内膜异位症患者及 2 1例健康生育妇女血清中 IL - 2和 IL - 6含量 ,以酶联免疫吸附试验测定 Emab。结果 Em ab阳性组 IL - 2 (8.12± 1.71) ng/L和 IL - 6 (7.0 4± 2 .0 4) ng/L含量较对照组 (5 .31± 1.38) ng/L及 (3.2 9± 1.2 3) ng/L明显增高 (P<0 .0 1) ;Em ab阴性组 IL - 2 (8.0 6± 1.38) ng/L明显高于对照组 (P<0 .0 1) ,IL - 6 (3.79± 1.2 7) ng/L与对照组比较差异无显著性 (P>0 .0 5 ) ;Em ab阳性与阴性组 IL - 6含量之间差异有显著性 (P<0 .0 1)。结论 IL - 6的含量改变可能与子宫内膜异位症病情变化有关     

哮喘患者Th1/Th2失衡及丙酸氟替卡松对其影响的研究

目的探讨哮喘病患者Th1/Th2的变化及丙酸氟替卡松(FP)对其的影响.方法采用ELISA法测定正常人和哮喘患者治疗前、后外周单个核细胞(PBMC)培养上清液中γ-干扰素和白细胞介素-4水平.结果γ-千扰素水平哮喘组治疗前、后分别为(79±30)ng/L、(83土35)ng/L,与正常对照组[(275±98)mg/L]比较差异均有显著性(P均＜0.05),治疗前、后γ-干扰素水平变化无显著性(P＞0.05);白细胞介素-4水平哮喘组治疗前、后分别为(121±86)ng/L、(37±28)ng/L,与正常对照组[(14士8)ng/L]比较差异均有显著性(P均＜0.05),哮喘组治疗后白细胞介素水平较治疗前显著降低(P＜0.05).结论哮喘患者Th1类细胞因子γ-干扰素表达减弱,Th2类细胞因子白细胞介素-4优势表达,存在Th1/Th2失衡;丙酸氟替卡松可抑制白细胞介素-4的表达,从而调节Th1/Th2平衡.     

老年高血压妇女炎症相关蛋白表达水平的研究

目的探讨老年高血压妇女控制血压后炎症相关蛋白的表达水平及与健康妇女间的差异。方法采用免疫浊度法、放射免疫分析法、酶联免疫吸附双抗体夹心法 (ELISA法 )测定 4 1例已接受降压治疗的老年妇女及 2 4例健康妇女循环中C反应蛋白 (CRP)、白细胞介素 6 (IL 6 )、可溶性细胞间粘附分子 1(sICAM 1)、E 选择素 (E se lectin)等炎症相关蛋白的表达水平。结果老年高血压组妇女CRP、IL 6、sICAM 1、E selectin水平分别为 (1.4 2± 0 .30 )mg/L ,(0 .2 9± 0 .0 5 )ng/ml,(2 5 1.79± 30 .34)ng/ml,(39.0 7± 6 .39)ng/ml较正常对照组上述指标的水平 [(1.13± 0 .19)mg/L ,(0 .2 4± 0 .0 3)ng/ml,(2 19.2 0± 2 2 .73)ng/ml,(2 9.82± 5 .30 )ng/ml]明显增高 ,差异均有统计学意义 (P <0 .0 5 )。结论老年高血压妇女积极控制血压后其炎症相关蛋白的表达水平仍存在明显异常 ,应寻求降压治疗之外的抗炎、抗粘附新途径     

白介素-10对肺泡巨噬细胞致炎效应的调节作用

目的 :探讨白介素 10 (IL 10 )对肺泡巨噬细胞致炎效应的影响。方法 :内毒素 (L PS)刺激体外培养的小鼠肺泡巨噬细胞 ,观察 IL 10对肺泡巨噬细胞释放细胞因子的影响。结果 :肺泡巨噬细胞受 10 mg/LL PS刺激后 6、12和 2 4小时 ,肿瘤坏死因子α(TNFα)、IL 1β和 IL 6释放达峰值 ,浓度分别为 (1790±985 ) ng/L、(986± 35 7) ng/L 和 (42 33± 6 5 7) ng/L,与 L PS刺激 0时比较 ,P均 <0 .0 5。IL 10在 L PS刺激后 8小时持续升高〔(2 38± 87) ng/L〕,2 4小时达到峰值 ,浓度为 (16 0 0± 5 2 1) ng/L(P<0 .0 5 )。 15 0 μg/L IL 10单克隆抗体抑制内源性 IL 10释放后 ,导致 TNFα、IL 1β、IL 6释放明显增加 ,分别达 (16 89± 36 4) ng/L、(12 0 0± 2 5 3) ng/L 和 (5 2 6 9± 112 7) ng/L。给予外源性重组 IL 10 (5 0 μg/L) ,则明显抑制 L PS诱导的TNFα、IL 1β、IL 6释放 ,浓度分别降低 5 2 %、84%和 39%。结论 :IL 10对炎症性细胞因子释放具有明显抑制作用 ,补充外源性 IL 10有助于控制肺泡巨噬细胞的异常炎症反应。     

以cDNA为内参标RT-PCR定量检测心肌细胞内p53和Bcl-2基因mRNA表达量的方法研究

目的 :探讨 p5 3和 Bcl 2基因在急性心肌梗死时心肌细胞中 m RNA表达量的检测方法。方法 :用以c DNA为内参标的逆转录聚合酶链反应 (RT PCR)方法检测 p5 3和 Bcl 2基因的 m RNA表达量。结果 :p5 3基因 m RNA表达量〔m RNA/总 RNA(ng/ g)〕依次为 :冠脉结扎后 4小时组 (5 76 4 8.78± 19776 .96 ) ng/ g>结扎后 6小时组 (339.0 6± 10 4 .11) ng/ g>结扎后 3小时组 (16 5 .4 4± 33.36 ) ng/ g>结扎后 2小时组 (88.2 5±16 .6 5 ) ng/ g>未结扎 (0 )组 (3.16± 0 .6 9) ng/ g和结扎后 1小时组 (16 .37± 2 .73) ng/ g、8小时组 (2 3.13±7.0 3) ng/ g、 12小时组 (6 .75± 2 .86 ) ng/ g,P均 <0 .0 5 ;Bcl 2基因 m RNA表达量〔m RNA/ g总 RNA(ng/ g)〕:冠脉结扎后 3小时组 (4.5 3± 1.5 9) ng/ g、 4小时组 (0 .0 2± 0 .0 1) ng/ g和 6小时组 (3.4 6±0 .39) ng/ g<结扎后 2小时组 (5 2 .4 8± 14 .18) ng/ g、8小时组 (5 9.2 4± 2 .91) ng/ g<结扎后 1小时组 (77.2 0±12 .4 8) ng/ g和未结扎 (0小时 )组 (81.77± 9.6 2 ) ng/ g<结扎后 12小时组 (99.6 0± 4 .71) ng/ g,P均 <0 .0 5。该种方法能对不同的样本检出不同量的 m RNA含量 ,其特异性强 ,且能检出 0 .0 2 ng/ g的 m RNA含量 ,敏感性高。结论     

雷公藤对激素抵抗性哮喘患者Th1/Th2的影响

目的:观察雷公藤对激素抵抗性哮喘(SR)患者外周血Th1/Th2功能的影响.方法:采集35例SR哮喘发作期患者和25例健康成人外周血单个核细胞(PBMC),分别经植物血凝素(PHA)、PHA+Triptolide 1(6 ng/mL)、PHA+Triptolide 2(0.6 ng/mL)诱导后,测定培养上清液中白介素-4(IL-4)和γ-干扰素(γ-IFN)含量.结果:SR 哮喘患者PBMC经PHA诱导后产生的γ-IFN、IL-4量与健康成人相比,差异存在显著性意义(P<0.01).PHA+Triptolide 1诱导组患者PBMC产生的γ-IFN、IL-4量及γ-IFN/IL-4比值均明显高于单纯PHA诱导组及PHA+Triptolide 2诱导组(P<0.01),PHA+Triptolide 2诱导组患者PBMC产生的γ-IFN量及γ-IFN/IL-4比值均明显高于单纯PHA诱导组(P<0.01),而IL-4水平则降低(P<0.05).结论:雷公藤可明显促进SR哮喘患者PBMC 产生γ-IFN和IL-4,剂量大更显著,在促进Th细胞成熟的同时上调Th1细胞功能,改善SR患者Th1/Th2功能失衡状态.     

血浆置换对重型病毒性肝炎患者血清细胞因子的影响

目的 :观察重型病毒性肝炎患者血清细胞因子的变化 ,探讨血浆置换疗法对患者的影响。方法 :随机选择 4 0例经血浆置换治疗的重型病毒性肝炎患者 ,测定治疗前后血清肿瘤坏死因子 α(TNFα)和白介素 4(IL 4 )的水平 ,观察其与预后、肝功能、并发症间的关系。结果 :4 0例患者经治疗后 TNFα由 (79.32±2 2 .39) ng/L 下降到 (2 0 .0 1± 2 2 .2 5 ) ng/L(P<0 .0 0 1) ,IL 4由 (0 .6 1± 0 .0 7) ng/L 降至 (0 .5 7± 0 .0 6 ) ng/L(P<0 .0 1) ,好转出院的患者较恶化出院的患者下降尤其明显 (P均 <0 .0 5 ) ;肝功能的恢复同样是好转出院的患者较恶化出院的恢复得更好 (P <0 .0 5或 P <0 .0 1) ;对嗜睡、定向能力均有明显改善 (P<0 .0 1和 P <0 .0 5 ) ,对治疗各种并发症更好 (P<0 .0 1)。结论 :血浆置换能清除 TNFα和 IL 4 ,是防治各种并发症的有效措施。预后不佳者与炎症的持续存在导致血清中 TNFα和 IL 4水平较高有关。     

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.