ENTERAL VERSUS PARENTERAL NUTRITION AFTER OESOPHAGOGASTRIC SURGERY: A PROSPECTIVE RANDOMIZED COMPARISON

Background: There appears to be an emerging consensus that early postoperative nutritional support benefits the high-risk patient by decreasing septic morbidity, maintaining immunocompetence and improving wound healing. Enteral nutrition via a feeding jejunostomy has been associated with serious complications, with a reported mortality rate as high as 10%. while total parenteral nutrition has also been associated with a wide variety of complications. Methods: Ninety-seven patients undergoing oesophagectomy or gastrectomy underwent pre-operative nutritional assessment and were randomized to receive either total parenteral nutrition (47 patients) or enteral nutrition (50 patients). Results: There was no significant difference in the number of catheter-related complications between the two groups, but 9 (45%) patients in the total parenteral nutrition group had major morbidity (potentially fatal in two patients) requiring active intervention. Conclusions: This study demonstrates enteral nutrition to be safe and associated with mainly reversible minor complications. It is probable that immediate postoperative enteral feeding conserves the gut's integrity. Whether this leads to a reduction in postoperative septic complications has not been demonstrated by this study although there appears to be a trend in this direction, supporting the concept of enteral feeding as ‘primary therapy’. This can be safely, simply and economically achieved using a feeding jejunostomy placed at the time of surgery.     

Clinical importance,statistical significance and the assessment of economic and quality-of-life outcomes

The assessment of economic and quality-of-life outcomes of health care interventions is moving into a new era, with such assessments increasingly being made within the context of controlled clinical trials. Traditionally the measurement of many variables in economic evaluations, particularly costs, has been deterministic. In the context of clinical trials the measurement of variables is stochastic, with the standard principles of statistical inference being applied to analyse differences between treatments in terms of effectiveness. Economists participating in clinical research are therefore being called upon to specify the sample size for the economic component of the evaluation and to undertake statistical tests for differences in cost or cost-effectiveness. This paper discusses the current methodological issues surrounding stochastic measurement in clinical trials, discusses the additional issues raised by the assessment of economic and quality-of-life outcomes and specifies the challenges facing economists if they are to answer the questions now being posed about economic analysis by statisticians and clinical researchers. It is concluded that application of the standard principles of statistical inference to economic data is not straightforward and will require value judgements to be made about statistical significance and economic importance, which may differ from those already made in purely clinical studies.     

The Evaluation of Routine Andrological Parameters in Human Semen/Auswertung der Routine-Parameter der Andrologie am Sperma

A study was carried out to evaluate the andrological parameters in 540 human semen specimens divided into groups according to sperm counts. The parameters were: motility percentage and grade, percentage of viability and of morphologically normal sperm and immature cells. The Duncan multiple range test and the Kruskal-Wallis test with multiple comparison of ranks were used in the statistical analyses. Of particular interest, among other our findings, were the significant differences obtained by comparing the group with sperm counts up to 5 x 10(6) per ml semen and that with counts ranging from 5.1 to 10 x 10(6) per ml semen. This was true for all parameters with the exception of semen volume. Comparison of the oligozoospermic groups (up to 20 x 10(6)/ml) with those having higher sperm counts also showed significant differences. There was a trend towards improvement of the examined parameters with the increase in sperm density, but with a remarkable heterogeneity particularly within the oligozoospermic groups. In all groups motility, viability and morphological normality of sperm showed a positive correlation with each other. "Normal values" of the parameters studied could be derived from scatterplot charts over the entire range of sperm counts and from the statistical evaluation of the grouped material.     

全喉切除术中保留甲状软骨膜对手术进程和术后恢复影响的探讨

目的：探讨保留甲状软骨膜对全喉切除手术进程和病人术后恢复情况的影响。方法：在甲状软骨膜下游离甲状软骨并切断其上角。不结扎和切断舌骨下肌群和喉上动脉。保留之甲状软骨膜用以加强修复咽壁黏膜。结果：本组病例较经典全喉切除术手术时间缩短30min以上。手术中出血在100ml以下。患者术后第2d下床活动，第4d开始进食流质。手术创口均一期愈合。结论：全喉切除术中保留甲状软骨膜可有效地简化手术步骤，减少创伤和出血。利用甲状软骨膜加强咽壁黏膜缝合口，进一步减少了咽漏的发生.     

健康成人血液流变学与血脂相关性的实验研究

目的：研究健康成人血液流变学指标与血脂之间的相关性。方法：抽取西安市某单位健康查体人群各项检查结果齐全的资料117例，其中男性79例，女性38例，将采集的数据进行统计分析。结果：男性和女性之间，TG、HBV、LBV、HRV、LRV、CV、CY均有显著差异（P〈0.05）；女性资料中，血脂指标与血液流变学指标的相关性无统计学意义（P〉0．05）；男性资料中，血液流变学指标与血脂指标有相关性（P〈0．05）。结论：控制血液粘度和血脂水平是防止和减低心脑血管疾病发生的重要环节。     

应用检验信息系统在医院检验科实现全面质量管理

本文介绍了全面质量管理的概念，并认为TQM实际上是一个数据驱动的管理活动。检验信息系统的优点就在于能够提供各种检验数据，文中阐述了如何利用检验信息系统的这一优点，使其成为医院检验科进行全面质量管理的重要工具。     

Enzyme spectrum of the pancreas in chronic stress

The enzyme spectrum of pancreatic homogenate was studied in acute experiments on male albino rats during adaptation for 30 days to muscular exertion (forced swimming in water at a temperature of 32±1°C), heat (hyperthermia to 40–41°C), and cold (cooling to 3–4°C) for 3 h. The initial periods of adaptation to these factors (second-twelfth day) were shown to be characterized by a considerable decrease in activity of all the enzymes studied, but later, with adaptation of the animals to these factors, enzyme activity was restored to its original level (18th–24th day), and remained more or less constant until the end of the experiment (30th day). It is suggested that changes in the enzyme spectrum of the pancreas are brought about through the participation of the hypothalamo-hypophyseo-adrenal system in accordance with the principle of the general adaptation syndrome.Laboratory of the Physiology of Digestion and Laboratory of General Physiology, Institute of Physiology, Academy of Sciences of the Uzbek SSR, Tashkent. (Presented by Academician of the Academy of Sciences of the USSR O. G. Gazenko.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 87, No. 5, pp. 412–414, May, 1979.     

Induction of erythroid differentiation in K562 cells and natural killer cell-mediated lysis: distinct effects at the level of recognition and lysis in relation to target cell proliferation

The erythroleukemic K562 cell line was induced to erythroid differentiation by a variety of agents, including hemin, bleomycin, and cytosine arabinoside. The sensitivity of induced cells to binding and lysis by non-sensitized peripheral blood mononuclear cells (MNC) in agarose was studied in relation to the target cell division rate. Differentiated K562 cells formed a lower proportion of conjugates with MNC, when compared with non-induced controls. The reduction correlated significantly with the level of differentiation, irrespective of the inducer and the proliferative status. The differentiation-induced alterations of lysis, however, were strongly influenced by the modification of target cell growth rate which was caused by the differentiating agent. These data suggest that target cell differentiation has distinct effects upon the steps of recognition and lysis by natural killer cells.     

人体熵流的数学模型

伊·普利高津的耗散结构理论中，有一个著名的总熵变公式ｄｓ＝ｄｓｅ＋ｄｓｉ把上述公式用于人体研究，国内外尚未见报导。在前人对人体热力学系统研究的基础上，本文建立了一个人体熵流的数学模型，为进一步展开研究，提供了有力工具并奠定了可靠的理论基础。     

Genetic control of serum IgE levels: a study of low molecular weight protein tyrosine phosphatase

Protein tyrosine phosphatases (PTPases) have recently been recognized as important modulators of various signal transduction pathways in immune cells. Genetic polymorphisms have been described in genes codifying for members of this family of enzymes, and the genetics of PTPases is predicted to play an important role in the etiology of immune diseases and of their clinical variability. The low molecular weight protein tyrosine phosphatase (ACP1 or LMPTP) is one of the few PTPases with a known genetic polymorphism, and has been proposed to be associated with atopic dermatitis in a small sample from an Italian population. In this paper we describe the association of the ACP1 polymorphism with total IgE levels in two independent samples from English and Italian populations. In both the samples the mean value of serum IgE is lower among subjects carrying the BC genotype than in other ACP1 genotypes. The BC genotype is associated with the highest total ACP1 enzymatic activity. Our data suggest that one or both of the ACP1 isoforms exert an inhibitory role on some signal transduction pathway relevant for IgE hyperproduction.