Change of Hemoglobin Level among Exclusively Breastfed Term and Preterm Babies up to Six Months of Age.

There is progressive increase of Hb levels is observed during course of intrauterine development of fetus but high concentrations found at birth. In preterm neonate normal Hb is characteristically deviated from term neonate. Breast milk is the only natural ideal food for both term and preterm babies from birth up to 6 months. Preterm milk was found to contain significantly higher concentrations nutrients particularly iron than term milk. Preterm human milk is more suitable for the premature infant than term human milk. As Hb concentration varies in term and preterm babies in different counties in different feeding practices. The purpose of this longitudinal descriptive study is to find out the pattern of changes in the Hb level among exclusively breastfed preterm and term infants during the first six months of life. This study was carried in the Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital (MMCH), Mymensingh from September 2016 to February 2018. One hundred fifty (150) neonates both term and preterm were included in this study and followed up to 6 months of age. After admission informed written consent was taken from parents, thorough history taking and clinical examination were done. Data were collected in a pre-designed case record form. All the babies of Group A provided 2mg/kg iron supplementation from 6 weeks for 2 months for universal recommendation. Hb level was measured of all exclusively breast feed babies at admission after birth then next follow-up at 6 weeks, 3 months and 6 months. All information regarding history, anthropometrics measurement, Hb level was recorded in structural questionnaire. Data analysis was done by SPSS version 20.0. Male were predominant in both groups. Most of the preterm (72.0%) and term babies (65.3%) were delivered by vaginal route. Mean Hb level was found significantly higher among preterm babies than term babies after birth were 16.55g/dl and 15.98g/dl respectively. Sharp fall of Hb concentration was observed after birth up to 6 weeks in both preterm and term babies but Hb level was found significantly lower in preterm in comparison to term babies (9.27gm/dl vs. 9.58gm/dl). In term babies, even after 6 weeks fall of Hb level continued to 3 months of age followed by gradual increase up to 6 months without iron supplementation. Hb level of in preterm babies gradually increased from 6 weeks up to 6 months with universal iron supplementation. Hb level fall sharply up to 6 weeks in both exclusively breastfed term and preterm babies but even after 6 weeks term babies experienced gradual fall of Hb levels up to 3 months. Hb level increases in exclusively breast-fed term babies without iron supplementation from 3 months of age. Hb level in exclusively breastfed preterm babies increase from 6 weeks onward might be effect of universal iron supplementation.

Improved survival outcomes for liver transplantation.

UNLABELLED: Liver transplantation is the treatment of choice for end stage liver disease and fulminant hepatic failure. Outcome of the procedure may be dependent on multiple factors including patient selection, donor selection, and centre experience. AIM: To determine whether the outcome for liver transplantation has improved over the time for the Irish National Liver Transplant Unit since its initial set up in 1993. METHODS: All patients who underwent liver transplantation between Jan 1993 to Oct 2004 were included. Patients were sub-divided into three sequential cohorts of 90 patients each. Survival outcomes were compared between the groups. RESULTS: 270 patients (male = 137) underwent 323 liver transplants (median age 49 yrs, range 16-68 yrs). Indications included primary biliary cirrhosis (14.1%), alcohol related liver disease (6.2%), fulminant hepatic failure (14.2%), primary sclerosing cholangitis (10.1%), chronic active hepatitis (9.5%), viral hepatitis (9.5%) and cryptogenic cirrhosis (7.1%). Most procedures (85.8%) were elective. Re-transplantation rates within the first 3 months of primary procedure were 9%, 5%, and 5% for the three chronological groups. Overall calculated 3-month, 1-year and 3 year survival rates for group 1 were 87%, 82% and 77%. For the groups 2 and 3 the figures were 86%, 81%, 77% and 89%, 89%, and 81% respectively. One- and 3-year survival rates were significantly better for group 3 compared to group 1 (p < 0.05). CONCLUSIONS: Survival outcome has improved significantly over the past 12 years and is likely attributed to increasing experience of the transplant centre.

MELD score as a prognostic model for listing acute liver failure patients for liver transplantation.

OBJECTIVES: The King's College Hospital (KCH) criteria are widely used for listing patients with acute liver failure (ALF) for liver transplantation (LT). Recent reports have suggested that the Model for End-Stage Liver Disease (MELD) score may be useful in assessing prognosis in ALF (nonparacetamol). This study compares prognostic accuracy of the two systems in patients with paracetamol (POD)-induced ALF treated in this unit. METHODS: Seventy-two patients (average age 38 years; F:M ratio 2:1) admitted from 1994 to 2005 with POD-related ALF were studied. Clinical and biochemical parameters were recorded. The effect of applying a MELD score of greater than 30 as listing criteria for LT was calculated and compared with the KCH criteria. Outcomes were defined as LT, death, or full recovery. RESULTS: Thirty-one patients (43%) recovered with medical therapy, 29 (40%) patients died, and 12 (17%) underwent LT. Sixty five percent of patients had a MELD > 30 and therefore could potentially be listed on admission; however, using KCH criteria only 24% patients were listed immediately. Sensitivity and negative predictive value of MELD was higher then KCH; however, we found KCH to have much higher specificity and positive predictive value. CONCLUSION: MELD has higher sensitivity and negative predictive value for POD-induced ALF than the KCH criteria. However, the high false-positive rate associated with MELD limits its clinical utility. The high negative predictive value of MELD score may allow it to be used in conjunction with KCH criteria to avoid unneeded LT in patients who will likely recover spontaneously.

Dietary beta carotene and lung cancer risk in U.S. nonsmokers.

BACKGROUND: Approximately 15% of all lung cancer deaths in the United States (about 22,350 deaths annually) may not be directly attributable to active cigarette smoking. Consumption of beta carotene, which is derived almost exclusively from intake of fruits and vegetables, has been associated with a reduced risk of lung cancer in smokers. However, studies examining this association in nonsmokers, particularly nonsmoking men, are limited. PURPOSE: The purpose of this study was to examine whether dietary factors including beta carotene and retinol are associated with a reduced risk for lung cancer in nonsmoking men and women. METHODS: A population-based, matched case-control study of lung cancer in nonsmokers was conducted in New York State from 1982 to 1985. Dietary interviews were completed for 413 individually matched case-control pairs of subjects. To determine whether the relationship between dietary intake from specific food groups and lung cancer differed by type of interview, smoking history, sex, age, or histologic type, we examined data on the case-control pairs from each subgroup separately. The intake of beta carotene and retinol was calculated as the weighted sum of the monthly frequencies of consumption of food items containing these nutrients, where the weights correspond to the nutrient content of a typical portion of the food items. RESULTS: Consumption of greens (P for trend < .01), fresh fruits (P for trend < .01), and cheese (P for trend < .05) was associated with a significant dose-dependent reduction in risk for lung cancer, whereas consumption of whole milk (P for trend < .01) was associated with a significant dose-dependent increase in risk. Use of vitamin E supplements was also protective (odds ratio = 0.55; 95% confidence interval [CI] = 0.35-0.85). Increased consumption of the following food groups was associated with a reduction in risk among females: vegetables (P for trend < .025), raw fruits and vegetables (P for trend < .005), and dairy products (P for trend < .025). In males, increased consumption of raw fruits and vegetables was associated with a reduced risk for lung cancer (P for trend < .005). Dietary beta carotene (OR = 0.70; 95% CI = 0.50-0.99), but not retinol (OR = 0.98; 95% CI = 0.82-1.17), was significantly associated with risk reduction. CONCLUSIONS: This is the largest study to date of dietary factors and lung cancer in nonsmokers; results suggest that dietary beta carotene, raw fruits and vegetables, and vitamin E supplements reduce the risk of lung cancer in nonsmoking men and women.

Pathologic complete response in advanced non-small-cell lung cancer following preoperative chemotherapy: implications for the design of future non-small-cell lung cancer combined modality trials.

PURPOSE: This report determines the incidence of pathologic complete response in patients with locally advanced non-small-cell lung cancer (NSCLC) treated with mitomycin, vinca alkaloid, and high-dose cisplatin (MVP) chemotherapy, and estimates the effect of MVP on survival. PATIENTS AND METHODS: We have identified and reviewed the course of 21 patients with advanced NSCLC who achieved a pathologic complete response following a median of three preoperative MVP combination chemotherapy courses including vinblastine or vindesine, cisplatin (120 mg/m2), and mitomycin (n = 19). RESULTS: All patients had a major objective response following preoperative chemotherapy and nine (43%) had a clinical complete response. Nine patients with pathologic complete responses were among 73 entered on a preoperative chemotherapy program, yielding an incidence estimate of 12% (95% confidence interval, 6% to 22%). The median survival duration for all 21 patients has not been reached. The median follow-up duration is now 68 months (range, 17 to 109). Survival estimates are 90% at 1 year, 62% at 3 years, and 54% at 5 years. Nine patients have relapsed with initial sites of recurrence as follows: brain (n = 5), other systemic sites (n = 3), and locoregional (n = 1). One patient died in the postoperative period. Eleven patients remain disease-free and all have excellent functional status. CONCLUSION: We have observed pathologic complete responses in approximately 12% of advanced NSCLC patients treated with preoperative MVP chemotherapy. These pathologically determined responses were seen only in patients with major objective responses clinically. Pathologic complete response predicts excellent survival and functional level and should be considered a major end point in the evaluation of preoperative chemotherapy programs.

Laser from Optically Pumped Quantum Dot CdSe/ZnS in a Colloidal Liquid.

In this study, we had investigated the amplified spontaneous emission (ASE) characteristics of CdSe/ZnS quantum dot (QDs) in a colloidal liquid. A third harmonic of Nd:YAG laser (355 nm) was used to produce laser-induced fluorescence (LIF) at 605 nm with a spectral width of 0 nm [full width at half maximum (FWHM)]. When the pump power and focusing were carefully optimized, an ASE at 610 nm with a spectral width of Δλ = 8 nm (FWHM) could be obtained. The beam was directional with a divergence of 10 milli radians (mrad); but the conversion efficiency was about 0.05%.

Pulmonary Kaposi's sarcoma in the acquired immune deficiency syndrome. Clinical, radiographic, and pathologic manifestations.

Pulmonary Kaposi's sarcoma related to the acquired immune deficiency syndrome (AIDS) has not been well characterized. To define the clinical, radiographic, and pathologic features of this entity, 11 autopsy-proved cases of pulmonary Kaposi's sarcoma were reviewed. The most common clinical symptoms were dyspnea and cough, but hemoptysis and stridor were also found. Nodular infiltrates and pleural effusions were the most commonly found radiographic abnormalities. Pulmonary function tests were sensitive in detecting the pulmonary abnormalities due to Kaposi's sarcoma. A low diffusion capacity, lack of arterial desaturation with exercise, and obstruction to airflow were suggestive of pulmonary involvement with this malignancy. Although endobronchial Kaposi's sarcoma was visualized at bronchoscopy as cherry-red, slightly raised lesions, bronchial biopsy specimens always showed no abnormalities. Transbronchial brushings and biopsy specimens and analysis of pleural fluid were also not helpful in establishing a diagnosis. In the seven subjects with extensive parenchymal Kaposi's sarcoma at autopsy, the pleura was always involved. Eight subjects had involvement of the tracheobronchial tree. In all of the subjects, pulmonary Kaposi's sarcoma was a significant cause of morbidity, and in three of 11 subjects (27 percent) it was the direct cause of death.

Radiologically occult in situ and incipient invasive epidermoid lung cancer: detection by sputum cytology in a survey of asymptomatic cigarette smokers.

Approximately 8000 cigarette-smoking men over the age of 45 have entered into a lung cancer detection program in New York City. Cytologic examinations of sputum were carried out on 4000 subjects and lung cancer was found by this technique in nine men with normal chest x-rays. Seven had in situ or incipient invasive epidermoid carcinoma confined to the bronchus. These seven cases were studied by detailed histologic examinations of the bronchial tree in the resected specimens through sixth generation subsegmental bronchi. It was concluded that: 1) invasive epidermoid carcinoma arises from carcinoma in situ of bronchial surface epithelium or an extension of that neoplastic epithelium in bronchial glands; 2) the site of origin is a segmental bronchus in most instances; and 3) each carcinoma should be considered as unifocal in origin even though there is a continuing risk of another primary lung cancer. It seems unlikely that squamous metaplasia or basal hyperplasia is an essential step in carcinogenesis; rather, we believe that carcinoma may arise in bronchial epithelium without regard to the presence or absence of basal hyperplasia or squamous metaplasia, which should be considered nonspecific reactions to injury that may or may not accompany carcinogenesis.

Adenocarcinoma in Barrett's esophagus.

The association of adenocarcinoma with Barrett's esophagus stimulated a review of our experience to study the clinical presentation, pathology, and results of management. Nineteen patients (15 men and four women) satisfied the criteria of primary adenocarcinoma arising in columnar epithelium in the esophagus. The majority had dysphagia (95%) and weight loss (63%). Nearly three fourths of the patients also had a history of hiatus hernia or esophagitis. Diagnosis was confirmed preoperatively in all by endoscopic biopsy and/or cytologic study. Potentially curative resection was performed in 15 patients and palliative procedures in four. Fourteen patients had advanced (Stage III) disease and only five had Stage I or II disease. Multicentric disease within the esophagus was found in seven patients. Postoperative complications included empyema, hemothorax, and pneumonia (one case each). The only postoperative death resulted from complications of previously undetected brain metastases. The median survival of the 15 patients having resection for cure is 12 months. Four are alive, one with disease at 46 months and three free of disease at 19, 87, and 93 months. All four patients undergoing palliative procedures died within 8 months. The study demonstrates that multifocal presentation of the tumor is common in this group of patients and that long-term survival is possible when early tumors are managed aggressively.

Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections.

To further improve the diagnostic value of bronchoscopy in the immunosuppressed population presenting with diffuse pulmonary infiltrates, we prospectively investigated the utility of bilateral bronchoalveolar lavage (BAL). We performed 62 bronchoscopies on 52 immunosuppressed patients. Of the 52 patients, 33 had pulmonary infections. The yield for Pneumocystis carinii pneumonia on bilateral BAL was 94 percent (31/33), compared to the 84 percent (51/61) previously obtained with unilateral BAL in our institution. The recovery of P carinii was unilateral in four of five patients without AIDS and in four of 26 patients with AIDS. Transbronchial biopsy gave a yield of 85 percent (11/13). In ten patients with definitive cytomegalovirus (CMV) pneumonia, recovery of CMV by combined culture and cytology was 100 percent. Of nine bronchoscopies with positive cytology for CMV, five showed cytopathologic changes in the BAL from both sides and four in the BAL from one side only. No complications were seen in the 14 patients with thrombocytopenia or the five patients receiving mechanical ventilation. Our findings indicate that bilateral BAL significantly increases the yield for recovery of P carinii (p less than 0.02) and CMV (p less than 0.001) in immunosuppressed patients.

Treatment and prognosis in bronchial carcinoids involving regional lymph nodes.

From 1953 to 1992, 25 patients were surgically treated for bronchial carcinoids with metastases to regional lymph nodes (N1 or N2). The tumors were located centrally, involving main or lobar bronchi in 12 patients and were peripheral in 13. Histologically, 12 of the carcinoids were classified as typical and 13 as atypical (neuroendocrine carcinoma). Pneumonectomy was performed in 11 patients, sleeve lobectomy in one, lobectomy in seven and bilobectomy in six. A formal mediastinal lymph node dissection was done in 20 patients. At final staging, 10 had N1 disease and 15 had N2. No adjuvant treatment was given to the 10 patients with N1 disease. External radiation therapy was given after the operation to 9 of 15 patients with N2 disease. The overall 5-year survival (Kaplan-Meier) was 75% (median 62 months). No difference in survival was found between patients with N1 or N2 disease. However, survival and recurrence rate differed between typical and atypical carcinoids. In typical carcinoids, the 5-year survival was 92% and, in atypical carcinoids, it was 60% (p = 0.02). We conclude that complete resection for bronchial carcinoids results in long-term survival despite the presence of regional lymph node metastases. Recurrence appears to depend more on cell type than nodal status. Postoperative radiation therapy does not appear to be beneficial.

Screening for early lung cancer. Results of the Memorial Sloan-Kettering study in New York.

The Memorial Sloan-Kettering lung cancer screening program was begun in 1974 to evaluate sputum cytology as a supplement to the annual chest x-ray examination for early detection and diagnosis. The 10,040 adult, male cigarette smokers who enrolled were randomly assigned to receive annual chest x-ray examinations only or a dual screen with annual chest x-ray examination and four monthly sputum cytology evaluation. Over 40 percent of the 288 who developed lung cancer were diagnosed in stage I, and their survival was 76 percent at five years; overall survival was 35 percent. Nearly one third of the lung cancers detected on first examination on the dual screen, and 14 percent of those on subsequent examinations were found by cytologic examination. The same number of cancers developed in the x-ray screen only group, and were diagnosed at a later date. Despite the delay, survival and mortality were the same, suggesting that the squamous carcinomas detected by cytologic examination alone are very slow growing and tend to remain localized until detectable by x-ray examination.

The effects of preoperative chemotherapy on the resectability of non-small cell lung carcinoma with mediastinal lymph node metastases (N2 M0).

We have defined "clinical N2" disease in non-small cell lung cancer to mean the presence of enlarged metastatic mediastinal nodes evident on plain chest roentgenograms or widening of the carina at bronchoscopy. Forty-one patients with non-small cell carcinoma of the lung and clinical N2 M0 disease presumed operable received 2 to 3 cycles of high-dose cisplatin with vindesine (or vinblastine sulfate) with or without mitomycin-C. Following chemotherapy, 30 patients (73%) had a major radiographic response. Of these patients, 28 had thoracotomy, and 21 (75%) of them had complete resection of the disease, 8 of whom had total sterilization of the tumor proven histologically. An additional 4 patients had limited microscopic foci of residual tumor either in lung or lymph nodes. Survival at 3 years from diagnosis was 34% for all patients, 40% for those who completed the combined treatment (chemotherapy and surgery), and 54% for those who had complete resection with a median follow-up of 44 months and a median survival not yet attained.

Two different one-dimensional structural motifs in the same coordination polymer: a novel interpenetration of infinite ladders by bundles of infinite chains.

A coordination polymer with a novel structural motif consisting of stacks of infinite ladders interpenetrated by bundles of infinite chains is described; geometrical arguments are made for the requirements that can lead to such interpenetration as a function of ligand dimensions.

Pulmonary cytology.

Cytomorphologic criteria for the diagnosis and classification of primary pulmonary carcinomas are described and illustrated. Helpful hints for the differential diagnosis from benign entities and tumors and the cytologic limitations are stated. The fact that pulmonary cytologic interpretations must be made in the light of accurate clinical presentation is emphasized.

Impact of early detection on the clinical course of lung cancer.

The Memorial Sloan-Kettering Lung Cancer Detection Program is described, and data from this study are reported and analyzed. The program enrolled 10,040 cigarette-smoking men who were screened for at least 5 years by annual chest radiographs; half the men randomly selected also had 4-monthly sputum cytologic examinations. Of the 354 lung cancers that developed in these men during the screening period and a 2-year post-screening period, nearly half were adenocarcinomas and nearly one third were epidermoid (or squamous) carcinomas. Lung cancers detected by screening were more likely to be early stage (53 per cent) and resectable (65 per cent) than were those discovered by other means (for example, symptoms) or in the post-screening period (20 per cent early stage, 32 per cent resectable). Sputum cytology was most effective in detecting squamous carcinomas early; chest radiographs were most effective for detecting adenocarcinoma. However, sputum cytology did not reduce lung cancer mortality among these men who were in a program of annual chest radiographic examinations. Overall 5-year survival for all of the men who developed lung cancer was 35 per cent, compared with the national average of 13 per cent.

Extrathoracic metastatic malignant thymoma. Diagnosis by aspiration cytology.

A fine-needle aspirate from a hepatic mass in a 65-year-old white man was examined. The patient had a history of histologically confirmed thymoma with metastases in multiple thoracic sites. The smears showed a dimorphic population of epithelial cells and lymphocytes, characteristic of thymoma. The resemblance of the cytologic pattern to the primary neoplasm and positive reactivity with various immunohistochemical agents peculiar to thymomas confirmed the diagnosis. Aspiration cytology has been described in the diagnosis of primary thymoma. To our knowledge, this is the second reported case of a cytologic diagnosis of metastatic thymoma and the first one with immunohistochemical studies.

Transthoracic aspiration cytology of pulmonary lesions.

In a seven-year period (1974 to 1981), 1,390 patients had transthoracic aspiration biopsy for radiologically suspected pulmonary neoplasms. Of the 1,209 proven malignant neoplasms, 1,059 (88%) were cytologically diagnosed as malignant. There were only two (0.2%) false-positive diagnoses both due to florid bronchoalveolar hyperplasia associated with granulomatous disease. Cytologic and histologic correlations for primary lung cancers were 92% for adenocarcinoma, 87% for oat cell (small cell) carcinoma, and 83% for epidermoid carcinoma. Characteristic cytomorphology of pulmonary carcinomas, some metastatic neoplasms, and inflammatory lesions are described.

Negative predictive value of pulmonary fine needle aspiration cytology.

Percutaneous fine needle aspiration (FNA) for cytologic examination is an accepted and reliable technique for diagnosing neoplasia. It is less useful, however, in excluding that diagnosis. We performed a retrospective analysis of a consecutive series of pulmonary FNA specimens at Memorial Sloan-Kettering Cancer Center to determine the negative predictive value (NPV) of this technique in the setting of a large cancer hospital. Fifty-seven cases were studied. Six cases (10.5%) were initially diagnosed as negative but acellular and were not further analyzed, and another 6 were lost to follow-up; 24 cases (42.1%) were subsequently confirmed negative by tissue or clinical follow-up, and 21 of the cases (36.8%) were proven positive for malignancy by repeat aspiration, tissue diagnosis or clinical means. Of these 21 cases, 1 was misdiagnosed as negative, and review demonstrated malignant cells on the slide; 3 of the 21 cases should have been initially rejected as unsatisfactory, and 18 of the 21 contained material sufficient for a cytologic diagnosis but not representative of the lesion. On follow-up the false-negative cases showed primary adenocarcinoma, epidermoid carcinoma, lymphoma, metastatic breast carcinoma and metastatic sarcoma. Specific benign diagnoses were made on the initial cytologic preparation in three cases. No benign tumors were found. The NPV in our series was 53.3%, comparable to values in previous reports. The single largest factor contributing to false-negative diagnoses is sampling error, and we recommend repeat aspiration when no specific benign diagnosis is made. In addition, we suggest that the diagnoses of negative for malignant cells and insufficient for diagnosis or acellular be considered separate categories.

Photoluminescence spectra of CdSe/ZnS quantum dots in solution.

The spectral properties of CdSe/ZnS core-shell quantum dots (QDs) of 3 nm size have been studied under different organic solvents, concentrations and temperatures. Our results showed that the absorption spectra of CdSe/ZnS in benzene have two humps; one around 420 nm and another at 525 nm, with a steady increase in absorption along UV region, and the absorption spectral profile under a wide range of concentrations did not change. On the other hand, the photoluminescence (PL) spectra of CdSe/ZnS in benzene showed two bands one around 375 nm and the other around 550 nm. It could be seen that the band at 375 nm is due to the interaction between the shell (ZnS) with the solvent species in high excited state, and the band at 550 nm is due to core alone (CdSe).