引导性骨再生中内源性BMP的作用

为探讨引导性骨再生中，内源性ＢＭＰ对骨再生过程的作用而进行以下研究。手术的方法造成兔桡骨中段１０ｍｍ缺损。实验侧用硅胶膜管连结骨缺损，作为引导性骨再生模型。另一侧作为对照。１５只新西兰兔分为三组，分别于术后３，７及１４日处死，标本行组织学及ＢＭＰ免疫组化检查。切片上，距骨端１，２，５ｍｍ处设置ａ，ｂ，ｃ线。利用真彩色计算机图像分析系统在三条线上选点测量ＢＭＰ值。实验侧骨缺损区内有一个完整的血肿结构，其ＢＭＰ染色阳性，膜管外组织ＢＭＰ染色几乎完全阴性。对照侧ＢＭＰ弥散于骨缺损周围的肌肉组织中。１周时，实验侧及对照侧均可见新骨形成。２周时，对照侧已停止，实验侧仍可见持续骨再生。ＢＭＰ定量分析中，实验侧三条带的ＢＭＰ值大部分高于对照侧。实验侧和对照侧ｂ，ｃ带之间存在梯度差，但实验侧的差值小于对照侧。这不仅证明了Ｈｕｌｔｈ关于骨折间隙存在ＢＭＰ浓度梯度的假说，也显示膜在引导性骨再生中可将内源性ＢＭＰ局限于骨缺损区内，提高内源性ＢＭＰ浓度并改善其分布的作用。这有利于骨再生，可能是引导性骨再生机理之一。对照侧ＢＭＰ值１周时最高，而实验侧在２周时仍呈持续升高。这说明，内源性ＢＭＰ有两个来源：骨端吸收释放及骨形成细胞合成。     

几丁质膜引导兔桡骨缺损骨再生的实验研究

采用引导骨组织再生原理进行长管状骨缺损修复实验。取兔１０只，造成双侧桡骨８ｍｍ节段性骨缺损，一侧采用几丁质膜覆盖成管室状，另一侧作为空白对照。术后６周，对愈后情况进行Ｘ线及组织学检查，对照侧均呈骨不连，骨端圆纯、髓腔闭合，治疗侧在膜表面形成薄形骨痂使骨缺损取得愈合。结果表明，几丁质膜具有引导骨组织再生、防止骨不连作用。而膜管内骨痂稀少可能与膜管阻碍了一些成骨因子进入膜管内有关，在膜管中植入ＢＭＰ，     

内源性骨形态发生蛋白在骨修复中的作用

目的：研究内源性骨形态发生蛋白（ＢＭＰ）对骨修复的作用。方法：３６只家兔,环形切除双侧胫骨中段骨膜后剥脱部分胫侧骨皮质,右侧钻孔达骨髓腔,左侧不钻孔作为对照。术后３ｄ,１、２、４、６、８周分批处死取材,用石蜡切片做ＢＭＰ免疫组化染色。结果：ＢＭＰ免疫组化染色显示,对照染色阴性,始终无骨痂形成。实验侧术后３ｄ多形间充质细胞染色呈阳性,术后１周内源性ＢＭＰ浓度达高峰,成骨能力增强。术后６周阳性细胞消失,但随着骨重建过程增强,骨基质染色变深。结论：骨损伤后内源性ＢＭＰ呈阶段性分泌,且对骨损伤的修复起重要作用     

骨形态发生蛋白复合纤维蛋白载体修复骨缺损的实验研究

目的：探讨以纤维蛋白作为骨形态发生蛋白的载本修复节段性骨缺损。材料和方法：于３６只新西兰白兔两侧桡骨干处造成１．５ｃｍ缺损，采用四种方法进行处理：Ａ组，植入２５ｍｇ ＢＭＰ与人纤维蛋白制成的复合物；Ｂ组，植入单纯２５ｍｇＢＭＰ：Ｃ组，植入单纯纤维蛋白；Ｄ组，留作空白对照，术后不同时间进行放射学，组织学和放射性核素显像检查。结果：Ａ组骨缺损区在成骨活跃程度，骨再生量和再生髓腔结构等方面均显著优于Ｂ组     

多孔磷酸三钙与自体红骨髓复合移植修复骨缺损的临床应用

为观察多孔磷酸三钙（ｔｒｉｃａｌｃｉｕｍｐｈｏｓｐｈａｔｅ，ＴＣＰ）与自体红骨髓（ｂｏｎｅ－ｍａｒｒｏｗ，ＢＭ）复合移植修复骨缺损的临床应用效果，应用ＴＣＰ－ＢＭ复合移植，修复骨缺损２１例，其中肿瘤性骨缺损１７例，陈旧性骨折骨缺损４例。术后定期拍摄Ｘ线片复查。术后６周，植入人工骨与周围骨组织界面间已有明显新骨形成；术后３个月，植入材料与周围骨组织愈合成一体。随访１～３年，结果显示植入材料的成骨作用明显，效果满意。ＴＣＰ－ＢＭ具有骨传导和骨诱导双重成骨作用，能促进新骨形成和加快骨缺损修复，是治疗骨缺损较理想的方法之一     

异种PDGF与复方BMP联合使用促进骨缺损的修复

将牛血小板衍生生长因子（ｂ ＰＤＧＦ）与猪骨形态形成蛋白（ｐ ＢＭＰ）用于家兔桡骨中段２ｃｍ大段骨缺损的修复。经Ｘ线照片，大体观察，组织学及生物力学检测。术后１４～１８周联合使用ＰＤＧＦ与复方ＢＭＰ组的骨连接率为１００％。实验结果表明：联合应用ＰＤＧＦ和复方ＢＭＰ组的骨连接率及生物力学强度均显著优于单用ＰＤＧＦ或复方ＢＭＰ组。证明ＰＤＧＦ和ＢＭＰ在加快骨缺损的修复方面有协同作用。     

纤维蛋白用作BMP载体的研究

目的：将纤维蛋白用作ＢＭＰ（骨形态发生蛋白）的载体材料。方法：用５ｍｇ ＢＭＰ分别与３种不同浓度的纤维蛋白制成复合物，植入小鼠肌囊后不同时间进行组织学观察、测定碱性磷酸酶活性和钙含量等。结果：纤维蛋白浓度为１２０ｍｇ／ｍｌ的复合物具有良好的骨诱导活性，成骨量是单纯５ｍｇ ＢＭＰ的两倍。结论：纤维蛋白是理想的ＢＭＰ载体材料，复合物可望应用于临床骨缺损的修复。     

骨形态发生蛋白4（BMP4）基因表达在骨折愈合过程中的定位研究

创伤后，骨组织的再生修复十分完全，其修复常无瘢痕残留。骨组织之所以有如此完美的愈合能力，是因为骨骼组织内存在有成骨因子，即骨生长因子。骨形态发生蛋白（ｂｏｎｅｍｏｒｐｈｏｇｅｎｅｔｉｃｐｒｏｔｅｉｎ，ＢＭＰ）因其直接诱导软组织成骨而受重视。本文应用ＢＭＰ４ｃＤＮＡ探针检测骨折愈合过程中外骨痂内ＢＭＰ４基因表达的定位与分布，探讨ＢＭＰ４基因表达在闭合性骨折愈合外骨痂形成中的作用。用６４只健康ＳＤ大鼠制备闭合性胫骨骨折动物模型。分别于骨折后１２小时、１、３、５、７、９、１４及２８天取材。取材后行恒冷切片，用地高辛素标记的ＢＭＰ４ｃＤＮＡ探针进行原位核酸分子杂交。大鼠骨折后１２小时～３天，骨折周围血肿内细胞及肌肉中新出现的间充质细胞内ＢＭＰ４ｍＲＮＡ表达检测为阳性信号。表明创伤激活ＢＭＰ４ｍＲＮＡ的表达，并呈区域性参与骨折的修复，也说明骨折血肿及周围软组织在骨折愈合过程中具有非常重要的地位。     

组织工程骨修复兔颅骨缺损中骨形态发生蛋白的表达

目的 探讨组织工程骨修复骨缺损,内源性骨形态发生蛋白（BMP）在组织工程骨再生过程中的分布及作用,方法 将自体成骨样细胞即刻种植在胶原包埋的聚羟基乙酸（PGA）基质材料上, 然后将该复合体或单纯基质材料移植到兔颅骨的一侧全层骨缺损区,作为实验侧Ⅰ或实验侧Ⅱ。对凤对照,不作任何植入。18只新西兰兔分别于术后3、8及14天处死,标本行组织学及BMP免疫组织化学检查,切片上,确定骨缺损区中央,距骨断端2mm、5mm为A、B、C三区,利用真彩色计算机图像分析系统在各区间测量BMP值。结果 术后3天,实验侧Ⅰ基质间存在BMP阳性细胞,8天时,实验侧Ⅰ新骨形成明显优于实验侧Ⅱ及对照侧。14天时,实验侧Ⅰ可见骨小梁形成,对照侧为纤维组织修复。BMP定量分析中,实验侧（Ⅰ、Ⅱ）三区的BMP值高于对照侧,但实验侧的浓度梯度差值小于对照侧。结论 即刻种植于PGA基质材料上的成骨样细胞在体内可合成和分泌BMP,利用组织工程技术将内源性BMP局限于骨缺损区,提高内源性BMP浓度并改善其分布,可能是组织工程骨诱导骨再生机制之一。     

引导性骨再生中成骨细胞来源的实验观察

目的 研究 长管骨引导性骨再生成骨细胞来源,进一步完善引导性骨再生理论。方法 将４２只成年雄性新西兰兔在双侧桡骨中段制作标准骨缺损不愈合模型,用硅胶膜呈管状包囊一侧骨缺损,另一侧作为对照侧。１只兔术后１￣１２周分别于每周进行Ｘ线检查;３０只兔,随机分为６组,分别于术后３天、１、２、３、４、５周外死取材,分别进行常规ＨＥ染色,ＳＰ方法ＢＭＰ、ＢＧ抗体的免疫组化染以。结果 隔膜在骨缺损局部生成隔离密闭     

The following abstracts were submitted for the 2nd Congress of the International Society for Rotary Blood Pumps, held September 23–25, 1994, Vienna, Austria, but papers were not submitted.

1 AXIAL FLOW BLOOD PUMP FOR CHRONIC IMPLANT USE. K. Butler. T. Maher, H. Borovetz,* P. Litwak,* and R. Kormos,* Nimbus, Inc., U.S.A., and *University of Pittsburgh, U.S.A. 2 A NEW APPLICATION OF A ROTARY PUMP IN A SIMULTANEOUS ADSORPTION/FILTRATION PROCESS. D. Falkenhagen, C. Weber, Ch. Rajnoch, H. Schima,* F. Loth. ?Interdisciplinary Institute of Bioengi-neering, Danube University, Krems, Austria, *Centre of Biomedical Research, University of Vienna, Austria, and ?Fraunhoferinstitute of Polymerresearch, Teltow, Germany. 3 TESTING AND MEASUREMENT OF THE PERISTALTIC PUMP FOR THE EXTRACORPOREAL CIRCULATION. Z. Kratochvil and P. Fleischner, Department of Hydraulic Machines and Equipment, Technical University of Brno, Faculty of Mechanical Engineering, Czech Republic 4 SIMULATION OF THE CARDIOVASCULAR SYSTEM AND SOME POSSIBILITIES OF THE BLOOD PUMP SYSTEM OPTIMIZATION. J. Nevrlv . Technical University of Brno, Czech Republic. 5 VIBRATORY ORBITING BLOOD PUMP. A.J. Sipin . Anatole J. Sipin Co., Inc. 6 MECHANICAL HEMOLYSIS DERIVED IN SEVERAL TYPES OF STENOTIC TUBES BY USING A CENTRIFUGAL PUMP. M. Umezu, Department of Mechanical Engineering, Waseda University, Tokyo, Japan. 7 BASIC PERFORMANCE OF A MINIATURE INTRA-VENTRICULAR AXIAL PUMP. M. Umezu . Y. Otake, K. Sakata, T. Fujimoto, K. Yamazaki,* H. Koyanagi,* H. Iiyama.? T. Mori,? K. Higuchi.? Department of Mechanical Engineering, Waseda University, Tokyo, Japan, *Heart Institute of Japan, Tokyo, Japan, and ?Sun Medical Technology Research Corp., Nagano, Japan. 8 A FLUID DYNAMIC ANALYSIS OF THE BAYLOR/ NASA AXIAL FLOW BLOOD PUMP FOR DESIGN IMPROVEMENT. J.-T. Wernicke . D. Meier, K. Mizugu-chi, G. Damm, G. Aber,* B. Benkowski, Y. Nose, G. P. Noon, and M. E. DeBakey, Department of Surgery, Baylor College of Medicine, Houston, TX, U.S.A. and *NASA/Johnson Space Center, Houston, TX, U.S.A. 9 USE OF HEPARIN-COATED DEVICES: IS HEPA-RINIZATION STILL NECESSARY?: A CASE REPORT. G. Wieselthaler . H. Schima, R. Seitelberger, D. Heilinger,* E. Donner, M. Hiesmayer,* and E. Wolner, Department of Cardiothoracic Surgery, LBI for Cardio-surgical Research, and *Department of Cardiothoracic Anesthesiology, University of Vienna. 10 PULSATILE VERSUS NONPULSATILE PERFU-SION USING A CENTRIFUGAL PUMP FOR CAR-DIOPULMONARY BYPASS DURING CABG EFFECTS ON HEMODYNAMICS, OXYGENATION, AND INFLAMMATORY RESPONSE. J. Driessen . H. Dhaese, L. Rondelez, G. Fransen, and L. Gevaert, St. Jans Hospital, Brugge, Belgium.     

激光直接心肌隧道术治疗缺血性心脏病实验研究

研究钬激光和高功率二氧化碳激光在急性缺血心肌上产生穿透室壁全层隧道对心肌缺血的保护作用。以２０ｋｇ体重Ｙｏｒｋｓｈｉｒｅ猪分为钬激光组（７只），ＣＯ２激光组（１０只）及对照组（８只）进行实验。结果表明：钬激光无法产生满意的激光隧道，但有诱发新生血管形成的可能；高功率二氧化碳激光能够产生理想的激光隧道，对急性缺血心肌提供血液灌注，并可避免室颤的发生。但远期通畅仍有待解决。     

Acknowledgement

The Editor of Cerebral Cortex would like to thank the followingreviewers who have helped us in 2004. Abbott, Laurence Abraham, Wickliffe C. Aghajanian, George Aine, Cheryl Aizenstein, Howard Allen, John Allman, John Alloway, Kevin Alonso, Jose Manuel Amit, Daniel Andersen, Richard Anderson, Charles H. Andrews, Sally Ang, Eugenius Anton, Eva Aoki, Chiye Apkarian, Apkar Arieli, Amos Ashburner, John Ashe, James Astafiev, Serguei V. Averbeck, Bruno B. Ayoub, Albert Baciu, Monica Baker, Curtis Balaban, Evan Banich, Marie Bao, Shaowen Barash, Shabtai Barbas, Helen Barnes, Carol Barone, Pascal Barrionuevo, German Barth, Daniel Barto, Andrew G. Basar, Erol Basso, Michele A. Baxter, Mark Behar, Toby Belger, Aysenil Belin, Pascal Benson, Deanna L. Benveniste, Helene Berman, Karen Bernstein, Lynne Binder, Jeffrey Binkofski, Ferdinand Birbaumer, Niels Black, Sandra Blakemore, Sarah-Jane Blankenburg, Felix Bliss, Timothy Blood, Anne Blumenfeld, Hal Blumstein, Sheila Blusztajn,     

Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment

For treatment of teenagers with progressive adolescent idiopathic scoliosis in an early stage, two options are generally considered: treatment with a brace or observation followed by surgery if necessary. Many doctors and patients prefer conservative treatment (i.e. brace treatment) to surgical treatment, because surgery of the spine is generally considered a drastic intervention. Because potential differences in health-related quality of life (HRQoL) after treatment between braced and surgically treated patients are not well explored, this study aimed to determine whether short-term differences exist in HRQoL between adolescents treated with a brace or treated surgically. A cross-sectional analysis of HRQoL was made of 109 patients with adolescent idiopathic scoliosis who, after completing treatment, filled out the Dutch SRS-22 Patient Questionnaire. All patients had been treated either with a brace or surgery, or with a brace followed by surgery. Patients treated surgically had significantly higher mean scores in the satisfaction with management domain than those treated with a brace. No other consistent differences in HRQoL were found between patients treated with a brace and patients treated surgically. Gender, curve type and curve size had no relevant effect on HRQoL. We conclude that short-term differences in HRQoL after treatment in adolescent patients with idiopathic scoliosis are negligible and cannot support preference of one treatment above the other. The NESCIO group: H.D. Been, MD, PhD, L.N.J.E.M. Coene, MD, PhD, H. Creemers, MD, A.J. de Gruijter, MD, PhD, A.A.J.M. Hazebroek-Kampschreur, MD, PhD, P. Klop, MD, H.J.A. Kruls, MD, PhD, P.J.M. van Loon, MD, L.C.F. Luttmer, MD, F. de Nies, MD, J.E.H. Pruijs, MD, PhD, L.W. van Rhijn, MD, PhD, M.P. Teeuwen, MD, P.A. Wiegersma, MD, PhD.     

Perioperative mortality and morbidity in the year 2000 in 502 Japanese certified anesthesia-training hospitals: with a special reference to ASA-physical status--report of the Japan Society of Anesthesiologists Committee on Operating Room Safety

Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, 2000 were studied retrospectively. Committee on Operating Room Safety in Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 certified training hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to ASA physical status (ASA-PS). The total number of anesthesia available for this analysis was 897,733. The percentages of patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E are 38.0, 40.3, 8.5, 0.4, 4.3, 5.3, 2.5, and 0.7%, respectively. Mortality and morbidity from all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and surgical problems were as follows. The incidences of cardiac arrest (per 10,000 cases of anesthesia) were 1.11, 3.26, 12.25, 54.60, 0.77, 4.46, 21.08 and 217.75 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 6.89, 20.22, 62.18, 148.21, 6.71, 20.38, 106.72 and 592.21 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7 postoperative days) after cardiac arrest were 0.26, 0.77, 3.69, 41.60, 0.00, 1.06, 9.42 and 163.31 per 10,000 cases of anesthesia in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.32, 1.38, 9.75, 70.20, 0.26, 2.12, 29.15 and 353.02 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthesia than in elective anesthesia. ASA-PS correlated well with overall mortality and morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.23, 0.50, 1.32, 0.00, 0.00, 0.85, 2.69 and 4.95 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 3.13, 5.56, 11.46, 5.20, 3.87, 5.94, 13.90 and 14.85 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after cardiac arrest totally attributable to anesthesia were 0.03, 0.03, 0.00, 0.00, 0.00, 0.21, 0.45 and 3.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.03, 0.06, 0.00, 0.00, 0.00, 0.21, 0.45 and 6.60 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rate totally attributable to anesthesia among patients with good physical status (ASA-PS of I, II, I E, II E) was 0.05. Anesthetic management was mainly responsible for critical events in patients with good physical status, while coexisting diseases were in those with poor physical status. Surgical problems including procedures and massive hemorrhage were the leading causes of mortality in patients with good physical status. We reconfirmed that ASA-PS is useful to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation in those with poor physical status. Reducing mortality and morbidity from surgical problems is also required for improving perioperative mortality.     

Perioperative mortality and morbidity in 1999 with a special reference to age in 466 certified training hospitals of Japanese Society of Anesthesiologists--report of Committee on Operating Room Safety of Japanese Society of Anesthesiologists

Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, were studied retrospectively. Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with a special reference to the age group. The total number of anesthetics available for this analysis was 732,788. All cases were divided in to 7 groups; group A(< 1 months), group B(< 12 months), group C(< 5 years), group D(< 18 years), group E (< 65 years), group F(< 85 years), and group G(> 85 years). The incidences of all critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 168.14, 47.86, 24.63, 14.65, 28.43, 50.4, and 43.68 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The overall mortality rate (death during anesthesia and within 7th postoperative day) were 74.10, 6.63, 3.30, 3.07, 4.82, 13.74, and 11.84 per 10,000 anesthetics in patients with group A, B, C, D, E, F, and G, respectively. The incidences of cardiac arrest were 54.15, 8.84, 5.08, 2.56, 4.84, 11.02, and 6.66 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The mortality rates after cardiac arrest were 42.75, 2.95, 2.54, 1.70, 2.00, 6.56, and 5.18 in patients with group A, B, C, D, E, F, and G, respectively. The incidences of all critical events, the incidence of cardiac arrest, and the overall mortality rate were much higher in group A than other groups and lower in group D. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of all critical events attributable to co-existing disease were the highest in these four groups, and 94.04, 15.46, 7.87, 6.13, 7.26, 17.38, and 16.29 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidences of all critical events attributable to anesthetic management were 31.35, 16.94, 4.60, 6.09, 10.77, and 14.07 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of cardiac arrest in group A was much more attributable to co-existing disease and operation than other causes. The incidences of cardiac arrest attributable to anesthetic management were 0.00, 1.47, 0.25, 0.34, 0.83, 0.92, and 0.22 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The mortality rates in these groups were 0.00, 0.00, 0.00, 0.17, 0.07, 0.05, and 1.48, and no death was found in cases under 5 years of age. The two cases of death in G group were due to too high anesthesia levels in spinal anesthesia. Other causes including overdose of anesthetics, toxic effect of local anesthetic, improper management of airway, and incompatible blood transfusion were preventable with the anesthesiologists' effort in protocol development and skilled assistance.     

Autologous blood predeposit for elective surgery: An Italian experience

A program of predeposit autotransfusion in elective surgery was implemented with the main purpose of decreasing the incidence of posttransfusion hepatitis and of conserving homologous blood. Specific procedures and computer programs were designed to monitor the transfusion practice by key indicators, and the incidence of posttransfusion hepatitis and HTLV-III infections. Arrangements were devised to ensure the proper management of autologous and homologous units. In 1985, autologous units accounted for 13.5% of all units transfused in elective surgery. While encouraging, our results indicate that efforts have to be made to improve organization and increase awareness of the benefits of autotransfusion in the medical and lay communities.

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Resumen Un programa de autotransfusión predepositada en cirugía electiva ha sido organizado con el propósito de rebajar la incidencia de hepatitis postransfusional y de conservar sangre homôloga. Se diseñaron procedimientos especiales y programas de computación para la monitoría de las prácticas de transfusión por medio de indicadores claves, y la incidencia de hepatitis postransfusional y de infección por HTLV-III. Se establecieron arreglos especiales para asegurar el debido manejo de las unidades autólogas y homologas. En 1985, las unidades autólogas representaron el 13.5% de la totalidad de las unidades transfundidas en cirugía electiva. Aunque promisorios, los resultados indican que deben emprenderse esfuerzos orientados a mejorar la organización y a incrementar el conocimiento de los beneficios de la autotransfusión tanto entre los médicos como en la comunidad general.

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Résumé Un programme de transfusion reposant sur l'emploi du propre sang du malade (sang autologue) prélevé avant l'intervention a été mis en oeuvre au cours de la chirurgie élective. Son but principal est de réduire la fréquence de l'hépatite posttransfusionnelle et l'utilisation de sang homologue. Des méthodes spécifiques et programmées sur ordinateur ont été mises au point de manière à contrôler la pratique de la transfusion en fonction d'éléments clefs et aussi de contrôler la fréquence de l'hépatite post-transfusionnelle et des infections HTLV-III. Des dispositions ont été établies pour assurer l'emploi adéquat d'unités de sang du malade ou de sang homologue. En 1985, la méthode a été employée dans 13.5% des cas au cours de la chirurgie élective. Bien qu'encourageants, les résultats obtenus indiquent que les efforts doivent être poursuivis pour améliorer l'organisation de ce mode d'auto-transfusion et aussi pour améliorer ses résultats.

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Members of the Autotransfusion Team, 1985 B. Andreoni, F. Annoni, A. Anselmi, C. Arienta, C. Bagni, M. Baiguini, L. Baldini, L. Beretta, S. Berra, G. Bevilacqua, R. Biffi, L. Bigatello, V. Buzzetti, G. Cantaluppi, G. Cantoni, L. Ceretti, D. Chiurazzi, M. Citterio, C. Confalonieri, E. Consonni, E. Contessini Avesani, A. Cortelezzi, C. Crosta, Jr., M. Cugnasca, G. Damia, C. De Luca, P. De Rai, A. De Sanctis, S. Doldi, M. Erba, C. Ferrari, O. Ferri, N. Fraschini, S.M. Gaini, P.L. Giorgetti, G. Giuffrida, G. Gonnella, G. Granata, A. Inzaghi, G.L. Legnani, T. Longo, A. Mandressi, A. Mantovani, R. Marconato, M. Marinoni, R. Massei, A. Mattioli, M. Marzotto, M. Meriggi, M. Mezzetti, S. Miani, G. Miserocchi, W. Montorsi, A. Morbidelli, L. Morelli, R. Mozzana, E. Mozzi, A. Nespoli, M. Nosotti, A. Odero, N. Olivari, G.F. Pellegrini, G. Petrini, G. Pezzuoli, E. Pisani, M.N. Pizzi, S. Poma, P. Rampini, R. Ravagnan, E. Ronchetti, R. Rosati, R. Rossi, U. Ruberti, R. Russo, P. Salvini, M.G. Sandri, L. Santambrogio, V. Scortecci, R. Scorza, P. Settembrini, P. Setti Carraro, E. Sibilla, G. Signoroni, V.A. Sironi, A. Tajana, L. Tarenzi, A.M. Taschieri, P. Tombolini, G. Tomei, M. Tos, R. Trazzi, A. Trimboli Cataldo, A. Trinchieri, L. Vicentini, R. Villani, G. Vincre, A. Vinci, C.P. Voci, and M. Zavannone.

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See Acknowledgment for members of the Autotranfusion Team.

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Supported in part by a grant from Ministero della Sanità, Rome, Italy.     

多沙普仑,纳络酮对血流动力学影响的实验研究

观察了全麻催醒药多沙普仑（ｄｏｘａｐｒａｍ），纳络酮（ｎａｌｏｘｏｎｅ）对血流动力学的影响。犬分为多沙普仑组和纳络酮组，每组５只。采用Ｓｗａｎ－Ｇａｎｚ漂浮导管及心脏电脑监护仪等方法，观察动物用药前后血流动力学的变化。结果多沙普仑组（２ｍｇ／ｋｇ）用药后５分钟ＣＯ、ＣＩ、ＳＶ、ＬＶＳＷ、ＬＶＳＷＩ均明显高于用药前，外周阻力（ＳＶＲ）明显低于用药前，４５分钟后基本恢复至用药前水平。纳络酮组（０．０１５ｍｇ／ｋｇ）用药后５分钟ＣＯ、ＣＩ、ＳＶ、ＬＶＳＷ、ＬＶＳＷＩ明显低于用药前，ＳＶＲ则明显高于用药前，４５分钟尚未恢复至用药前水平。提示多沙普仑对血流动力学的影响优于纳络酮。     

No evidence for genotype/phenotype correlation in<Emphasis Type="Italic"> NPHS1</Emphasis> and<Emphasis Type="Italic"> NPHS2</Emphasis> mutations

Primary steroid-resistant nephrotic syndrome (SRNS) is characterized by childhood onset of proteinuria and progression to end-stage renal disease. In 26% of cases it is caused by recessive mutations in NPHS2 (podocin). Congenital nephrotic syndrome (CNS) is caused by mutations in NPHS1 (nephrin) or NPHS2. In three families mutations in NPHS1 and NPHS2 had been reported to occur together, and these tri-allelic mutations were implicated in genotype/phenotype correlations. To further test the hypothesis of tri-allelism, we examined a group of 62 unrelated patients for NPHS1 mutations, who were previously shown to have NPHS2 mutations; 15 of 62 patients had CNS. In addition, 12 CNS patients without NPHS2 mutation were examined for NPHS1 mutations. Mutational analysis yielded three different groups. (1) In 48 patients with two recessive NPHS2 mutations (11 with CNS), no NPHS1 mutation was detected, except for 1 patient, who had one NPHS1 mutation only. This patient was indistinguishable clinically and did not have CNS. (2) In 14 patients with one NPHS2 mutation only (4 with CNS), we detected two additional recessive NPHS1 mutations in the 4 patients with CNS. They all carried the R229Q variant of NPHS2. The CNS phenotype may be sufficiently explained by the presence of two NPHS1 mutations. (3) In 12 patients without NPHS2 mutation (all with CNS), we detected two recessive NPHS1 mutations in 11 patients, explaining their CNS phenotype. We report ten novel mutations in the nephrin gene. Our data do not suggest any genotype/phenotype correlation in the 5 patients with mutations in both the NPHS1 and the NPHS2 genes.Members of the Study Group of the Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN) participating in this study: J. Thaarup (Aalborg, Denmark); P. Henning (Adelaide, Australia); I. Attrach (Aleppo, Syria); A. Bakkaloglu (Ankara, Turkey); C. Rudin (Basel, Switzerland); R. Bogdanovic (Belgrade, Yugoslavia); S. Briese, J. Gellermann, T. Lennert, U. Querfeld, Sacherer, M. Schürmann, and M. Zimmering (Berlin, Germany); C. Roth, C. Schröter, and B. Utsch (Bonn, Germany); Matthes (Bremen, Germany); A. Heilmann and G. Kalvoda (Dresden, Germany); F. Wegner (Düren, Germany); V. Schumacher (Düsseldorf, Germany); Bär, B. Bosch, M. Kamm, S.M. Karle, K. Nüsken, C. Plank, W. Rascher, and B. Zimmermann (Erlangen, Germany); K. E. Bonzel, M. Bald, P. Hoyer, and U. Vester (Essen, Germany); U. Neyer (Feldkirch, Austria); Rippel (Frankfurt, Germany); M. Brandis, A. Fuchshuber, K. Häffner, A. Kirchhoff, and M. Pohl (Freiburg, Germany); J. Steiss (Giessen, Germany); J.P. Haas (Greifswald, Germany); L. Patzer (Halle, Germany); M. Kemper, H. Altrogge, D.E. Müller-Wiefel, U. Peters, and K. Timmermann (Hamburg, Germany); J.H.H. Ehrich, H. Haller, and C. Strehlau (Hannover, Germany); M. Daschner, S. Hessing, Janssen, D. Kiepe, S. Köpf, O. Mehls, and B. Tönshoff (Heidelberg, Germany); F. Prüfer and L.B. Zimmerhackl (Innsbruck, Austria); U. John, J. Misselwitz, G. Rönnefarth, and J. Seidel (Jena, Germany); D. Blowey and J. Scheinman (Kansas City, Mo., USA); B. Beck, K. Frankenbusch, B. Hoppe, C. Licht, D. Michalk, T. Ronda, and L. Stapenhorst (Cologne, Germany); D. Drozdz and A. Pogan (Krakau, Poland); Froster, E. Vogel and S. Wygoda (Leipzig, Germany); R. Hettenger (Los Angeles, Calif., USA); H. Schriewer and H.-P. Weber (Lüdenscheid, Germany); R. Beetz (Mainz, Germany); M. Konrad (Marburg, Germany); H. Fehrenbach (Memmingen, Germany); M. Griebel and B. Klare (München, Germany); M. Bulla, S. Fründ, E. Kuwertz-Bröking, A. Schulze-Everding and Yelbuz (Münster, Germany); L. Monnens (Nijmegen, The Netherlands); J. Janda and T. Seemann (Prag, Czech Republic); G. Adomssent, G. Krüger, Lorenzen, J. Muscheites, H.-J. Stolpe and M. Wigger (Rostock, Germany); W. Sperl (Salzburg, Austria); R. Egger (Schaffhausen, Switzerland); V. Tasic (Skopje, Macedonia); M. Bald and H.-E. Leichter (Stuttgart); O. Amon (Tübingen, Germany); T. Arbeiter, C. Aufricht and K. Müller (Vienna, Austria); D. Bockenhauer and N. Siegel (New Haven, Conn., USA); and T. Neuhaus and A. Staub (Zürich, Switzerland)     

恶性骨肿瘤的误诊误治分析

作者于１９９１～１９９４年，共收治曾有过不同程度误诊、误治的恶性骨肿瘤病人２５例，其中７例误诊为良性肿瘤行刮除植骨术或误诊为炎性病变行病灶清除术，５例活检失当，余病人虽诊断明确但未采取系统、有效的方法治疗以至延误保肢手术时机。我们认为：骨肿瘤的诊断应以临床、放射、病理三者结合，避免将一些缺乏典型Ｘ线特点的恶性骨肿瘤误诊为良性肿瘤。缺乏经验的诊断性活检易造成切口肿瘤细胞种植，导致保肢手术困难，应尽量避免术前活检。对一些诊断困难的病例，应由有经验的医生从事慎重、细致的术前活检。在治疗上以手术治疗为主，辅以放疗、化疗及免疫治疗等。为避免恶性骨肿瘤的误诊误治，应尽快在国内建立数个骨肿瘤治疗中心及转诊作业系统