Quality control of surgical technique in a multicenter, prospective, randomized, controlled study on the surgical treatment of gastric cancer.

To evaluate the effect of lymph node dissection on gastric cancer patients operated upon with curative intent, we are carrying out a multicenter, prospective, randomized, controlled study in the Netherlands. The trial compares conventional gastrectomy to gastrectomy with extended lymph node dissection. In the first four months, a Japanese supervisor attended all the extended surgery and instructed many Dutch surgeons, including the eight consulting surgeons; since then, all extended gastrectomies have been attended by one of the consulting surgeons. The study coordinator attended all conventional cases. This assured that the quality of the extended surgery was as good as the Japanese standard, of which excellent results have been reported. To achieve this quality control, randomization before surgery was obligatory for practical reasons. Curability assessment at laparotomy, however, is done quite objectively with histological proof, except for the judgement of irresectability. Although this has resulted in many non-curative cases being randomized but subsequently not given the allocated surgery, the sample size should be sufficient to allow analysis according to randomization or the initial "intention to treat." This is the first protocol for a multicenter trial in surgical oncology to have such excellent surgical quality control and to assure a quality as high as that in the original report with uniformity in the level of technique. In studies comparing surgical techniques, it is vital that attention should be given to surgical quality control, otherwise survival rates may show little improvement and fail to make any impact on surgical practice.     

Quantified ultrastructural study of spermatozoa in unexplained failure of in vitro fertilization

Failure of in vitro fertilization or very low cleavage rates may occur even though oocyte and semen parameters seem satisfactory. Quantified ultrastructural study of spermatozoa was performed in such cases of failure (n =6) or low cleavage rate (<20%; n =4). Through 1 to 11 retrievals, the number of inseminated oocytes ranged from 14 to 145. The results were compared to those of six fertile men. Quantification was achieved by cataloguing cell defects of the spermatozoon heads and mid-/principal pieces of the flagella. Using the data from each specimen, the percentages of total cellular abnormalities in the head/mid-/principal pieces were established. At the level of the head overall percentages for six groups of defects were determined. The overall percentage of combined head abnormalities, defined as the presence of at least three of these six defects on the same spermatozoon head, was established. Statistical differences among control and patient groups were analyzed by nonparametric Mann—Whitney Utest. The percentages of anomalies of the midpiece and of the principal piece were not significantly different between patients and controls. Motility assessed by spermogram was considered functionally uncompromised. In eight patients the percentage of cell alterations of the head (93–100 vs 77.3 ± 6.4%) and the percentage of combined anomalies of the head (78.1–100 vs 60.8 ± 8.5%) were significantly different between patients and controls. In two cases, the percentages established for all head parameters considered were not globally different from those observed in controls. Thus in 8 cases of 10, electron microscopy with quantified analysis supplied valuable evidence about the poor quality of these sperm samples judged as normal under light microscopy and may provide an explanation for their impaired fertilizability. In the two other cases the fact that the sperm appeared to be ultrastructurally normal does not rule out functional sperm pathology. Alternatively, defects in the oocyte may also account for unexplained failures of in vitro fertilization.     

Differential control of in-phase and anti-phase coupling of rhythmic movements of ipsilateral hand and foot

Summary Rhythmic flexion-extensions of ipsilateral hand and foot are easily performed (easy association) when the two segments are moved in phase (isodirectionally), whereas great care and attention are required (difficult association) to move them in phase opposition. We searched for features distinguishing the two types of coupling by analyzing, on ten subjects: 1) the frequency limit in each association; and, 2) if coupling is modified by inertial or elastic loading of the hand. 1) Subjects were asked to oscillate hand and foot at various paced frequencies, in the easy or in the difficult association for one minute at least. In the easy coupling, the task was performed up to 2.0–2.5 Hz, the duration being thereafter shortened by muscular fatigue. In the difficult coupling when the frequency was increased above 0.7–1.7 Hz, the performance rapidly shortened, not because of fatigue but because of an inevitable reversal to the in-phase movement. The frequency-duration curve always followed a similar decay, although it covered different frequency ranges in the various subjects. 2) The effect of charging the hand with inertial or elastic loads was studied at the subject's preferred frequency, chosen when the hand was unloaded. Without loading, in the easy association the hand cycle slightly lagged the foot cycle while in the difficult one an almost perfect phase opposition was maintained. Under inertial load (inertial momentum: 9 gm²), in the easy association the hand lag was increased by 10° to 45°, despite a compensatory advanced activation of the forearm EMG; in the difficult association, instead, the hand lag was small (less than 10°), thanks to an even earlier onset of the forearm EMG. The elastic load (torque: 4 gm) had negligible effects on the phase relation between movements but improved the phase relation between EMGs. These findings show that coupling is tighter in the difficult than in the easy association, a feature that is emphasized by the effect of the load. This supports the idea that kinaesthetic afferences have more pronounced influences on control of the anti-phase than the in-phase coupling.     

Integration in trigeminal premotor interneurones in the cat

Seventy-one (n = 71) premotor interneurones have been localized by extracellular recordings within the subnucleus-gamma of the oral nucleus of the spinal trigeminal tract (NVspo-gamma) in nineteen chloralose anaesthetized cats. The neurons were antidromically activated by microstimulation (minimum = 3 microA) applied to the digastric motoneurone subnucleus of the trigeminal motor nucleus. Fifty-one (n = 51) of the interneurones were discharged from the ipsi- and nineteen (n = 19) from the contralateral digastric subnucleus. One neurone out of four tested was antidromically activated from both stimulation sites suggesting a bifurcated axon. The identified premotor neurones had a unique convergence profile of oral and perioral primary afferents. Latency calculations indicated that at least 55% of these interneurones were monosynaptically activated by low stimulus strength applied to the inferior alveolar (minimum = 1.0 T) and/or the lingual nerve (minimum = 1.0 T). The thresholds for evoking the neuronal discharges coincided statistically with those required to evoke a jaw opening reflex response by stimulation of the same nerves. It is suggested that the specific group of NVspo-gamma interneurones under different contexts mediates the disynaptic reflex and participates in the centrally and reflexly evoked "patterning" adjustments of the digastric jaw opening motoneurones during ongoing jaw movements. A companion paper reports the convergence of descending cortical, tectal and ascending cervical inputs, as well as of oro-facial and neck primary afferent inputs onto an unselected population of interneurones in the NVspo-gamma (Westberg and Olsson 1991).     

The importance of employing stringent methods to recruit fertile male controls

Two methods of recruiting fertile male controls were evaluated and compared. The first group was recruited from the partners of women attending an antenatal clinic without obtaining details of their reproductive history. The second group was recruited after obtaining a detailed reproductive history from the couple and employing stringent entry criteria. Entry criteria for the second group included a length of exposure to the risk of pregnancy of not more than 12 months and no previous episode of involuntary infertility for either partner. There were significant differences between the distributions of semen parameters obtained from the two groups, indicating that the selection criteria for "fertile" men significantly influence results obtained and therefore that it is important to employ stringent criteria for the recruitment of fertile male controls. The group which was recruited by stringent criteria (mean length of exposure to the risk of pregnancy of 3 months) was characterised by a significantly higher median concentration of spermatozoa which exhibited slow linear or nonlinear motility. This confirms the findings of a previous study which suggested that slow linear or nonlinear motility are superior forms of spermatozoal motion.     

“坤月安”治疗经前期综合征的临床观察

38例经前期综合征患者,经基础体温测定或宫内膜活检。诊断为黄体功能不健33例（86．89％）,无排卵月经周期5例。其中原发不孕5例,继发不孕19例,均有典型的经前期综合征症状。其中30例用自行研制的中药“坤月安”冲剂治疗。每次服坤月安1所,每日2次,于月经来潮前10天开始服用,10天为一疗程,均服用3个疗程,痊愈10例（33．43％）,显效13例（43．33％）,好转6例（20％）,无效1例（3．33％）,总有效率96．67％。     

The natural history of somatosensory and autonomic nerve dysfunction in relation to glycaemic control during the first 5 years after diagnosis of Type 1 (insulin-dependent) diabetes mellitus

Summary The natural evolution of neural dysfunction was studied prospectively over 5 years following diagnosis of Type 1 (insulin-dependent) diabetes in 32 patients aged 12–36 years. Motor and sensory nerve conduction velocities, heart rate variation at rest and during deep breathing, and pupillary function were measured at diagnosis and after 3,12, 24,48, and 60 months. Thermal and vibration sensation thresholds were determined after 24, 48, and 60 months of diabetes. Mean HbA₁ levels of months 3–60 within the normal range of <8.3% (7.3±0.2%) were observed in 13 patients (Group 1), while a mean HbA₁ of months 3–608.3% (10.0±0.3%) was found in 19 patients (Group 2). Mean nerve conduction was significantly diminished in Group 2 as compared with Group 1 in at least 4 out of 6 nerves tested during months 12–60 (p<0.05). Both tests of heart rate variation were significantly impaired in Group 2 as compared with Group 1 after 24 and 60 months (p<0.05), but no differences in pupillary function were observed between the groups. Thermal discrimination but not vibration perception thresholds on the foot were significantly higher in Group 2 than in Group 1 at 40 and 60 months (p<0.05). Abnormalities in nerve conduction, thermal discrimination, and heart rate variation, but not vibration perception threshold and the pupillary function tests were significantly more frequent in Group 2 than in Group 1 at 60 months (p<0.05). After 60 months, none of the patients of Group 1, but 6 and 4 patients of Group 2 developed subclinical or symptomatic neuropathy, respectively (p<0.05). These findings suggest that the evolution of subclinical and symptomatic neuropathy during the first 5 years after diagnosis of Type 1 diabetes may be predicted by poor glycaemic control and prevented by near-normoglycaemia.     

Chromosomal study after radioactive synoviorthesis for haemophilic haemarthrosis

Summary Twenty joints in 19 haemophiliacs were treated by radioactive synoviorthesis with gold (Au 198) to prevent recurrent haemarthrosis. Twelve knees, six elbows and two ankles were treated in two separate groups (29. 9. 76 and 9. 5. 77).In eight cases (40%) no further haemarthrosis occurred. A diminution of bleeding was obtained in nine cases (45%), a total of 85% good results with 15% failures. One failure in the first group (an elbow) had a second synoviorthesis and was included in the second group also.Prior to synoviorthesis the joint was scanned with technetium (Tc99m) to compare the inflammation of the synovium with that of six months later. The technique including the dosage of Tc99m, Au 198, and factor VIII cover is presented.A leucocyte culture was performed in 16 cases to study any chromosomal breakage, by banding and fluorescent techniques.Paper read at the SICOT meeting in Kyoto, Japan, October 1978     

Does smoking cessation improve mental health?

There is a possibility that cessation of smoking improves mental health, but there are no studies that have demonstrated this. A cohort study was performed for 1 year in 18 males who spontaneously stopped smoking (cessation group) and 173 who continued to smoke (smoking group). The mental health state was evaluated using the Japanese version of the 30-item General Health Questionnaire (GHQ-30) before the cessation of smoking and 6 months and 1 year after smoking cessation. Changes in the GHQ score were compared between the cessation and smoking groups. In order to control the effects of confounding factors, multiple regression analyses were performed using the GHQ score after 6 months and 1 year as dependent variables. The GHQ score in the cessation group significantly decreased 6 months and 1 year after smoking cessation (P < 0.04 and 0.01, respectively, by paired t-test). In the smoking group, the GHQ score slightly decreased. Repeated measure analysis of variance revealed that the decrease in the GHQ score in the cessation group was significantly larger than in the smoking group. Multiple regression analysis revealed significant effects of smoking cessation on mental health after controlling for other confounding factors. It can be concluded that smoking cessation may improve mental health.     

新生儿高胆红素血症的临床研究

目的　探讨新生儿高胆红素血症的临床表现、发病因素和防止并发症 ,降低致残率。方法　对 99例新生儿高胆红血症患儿临床及实验室资料进行回顾性分析。结果　 99例新生儿黄疸经光疗等综合治疗除 4例放弃治疗和死亡外 ,其余均痊愈出院。结论　新生儿高胆红素血症病因复杂 ,致残率高 ,应重视予防 ,加强围产保健 ,防止感染和核黄疸发生 ,措施可行。