Trends in donor milk banking in the United States.

Modern donor milk banking was conceived in the US in the early 1900s as a medicalized version of wet nursing. Over the course of the century the fortunes of donor milk banking have varied considerably. In the last 20 years donor milk banking has been negatively affected by the development of specialty formulas, safety issues related to viral transmission, and lack of clinical research. To survive, US milk banks have been receptive to clinical uses considered as "alternative medicine," and have cooperated with governmental agencies to develop standards for safety. A qualitative analysis of collected case histories of US donor milk recipients demonstrates that donor human milk banking can be critical to survival and the well-being of at-risk infants, children, and the occasional adult. By analyzing national data collected by survey method and examining the literature, the researcher compared German and US milk banks and distribution data. German milk banks use donor milk exclusively for premature infants and have less stringent operating standards, yet dispense volumes of milk greatly in excess of the US milk banks. While statistics are lacking for the total recipient population in the US, a projected analysis (based on German consumption) of the potential volume that could be dispensed in the US is presented, indicating that the population in need of this crucial public health service is currently under-served in the US.

Pyrrolo[2,3-d]pyrimidines containing an extended 5-substituent as potent and selective inhibitors of lck I.

Pyrrolo[2,3-d]pyrimidines containing a 5-(4-phenoxyphenyl) substituent are potent and selective inhibitors of Ick in vitro; some compounds are selective for lck over src. Data are shown for two compounds demonstrating that they are potent and selective inhibitors of IL2 production in cells.

Inhibition of epidermal growth factor receptor-associated tyrosine phosphorylation in human carcinomas with CP-358,774: dynamics of receptor inhibition in situ and antitumor effects in athymic mice.

Phosphorylation of tyrosine residues on the epidermal growth factor (EGF) receptor (EGFr) is an important early event in signal transduction, leading to cell replication for major human carcinomas. CP-358,774 is a potent and selective inhibitor of the EGFr tyrosine kinase and produces selective inhibition of EGF-mediated tumor cell mitogenesis. To assess the pharmacodynamic aspects of EGFr inhibition, we devised an ex vivo enzyme-linked immunosorbent assay for quantification of EGFr-specific tyrosine phosphorylation in human tumor tissue specimens obtained from xenografts growing s.c. in athymic mice. When coupled with pharmacokinetic analyses, this measurement can be used to describe the extent and duration of kinase inhibition in vivo. CP-358,774 is an effective, orally active inhibitor of EGFr-specific tyrosine phosphorylation (ED(50) = 10 mg/kg, single dose). It has a significant duration of action, producing, on average, a 70% reduction in EGFr-associated phosphotyrosine over a 24-h period after a single 100 mg/kg dose. Inhibition of EGFr phosphotyrosine in an ex vivo assay format effectively estimates the potency and degree of inhibition of EGFr-dependent human LICR-LON-HN5 head and neck carcinoma tumor growth. Substantial growth inhibition of human tumor xenografts was achieved with p.o. doses of the compound (ED(50) = 10 mg/kg q.d. for 20 days). Combination chemotherapy with cisplatin produced a significant response above that of cisplatin alone with no detectable effects on body weight or lethal toxicity. Taken together, these observations suggest that CP-358,774 may be useful for the treatment of EGFr-driven human carcinomas.

Donor milk banking in China: the ultimate step in becoming baby friendly.

Milk banking is alive and well in China in small in-house milk banks in Baby Friendly Hospitals, especially those where staff has had little contact with western medical training. Donor milk banking is a logical extension of Step 6 of the Baby Friendly Hospital Initiative and is a good indicator of a hospital's respect for breastfeeding and its understanding of the unique components of human milk.

PIP: In April 1996, an international delegation of breast-feeding experts traveled to China to exchange information and assess China's progress in becoming a "Baby Friendly" country. China's one-child policy makes it extremely important for women to produce healthy babies and has led to a high rate of patient demand for Cesarean section births. This emphasis on healthy babies also means that premature infants or those with diseases or disabilities may receive less intensive care than is given in the US. Field trips to Beijing, Hangzhou, and Shanghai revealed that hospitals in Beijing have made the most progress in implementing the Baby Friendly Hospital Initiative, with 91/92 hospitals participating. Overall, China had an estimated 2957 Baby Friendly hospitals by 1996. In Baby Friendly hospitals in Beijing, rooming-in is the only option, and postpartum stays range from 7 to 10 days. Posters promote successful breast feeding, and breast-feeding rates are virtually 100%. Hospitals have informal donor milk banks with milk collected only from mothers in the postpartum hospital unit (resulting in age-appropriate colostrum and transitional milk). Use of donor milk was not apparent, however, at the pediatric specialty referral hospital in Hangzhou where premature infants are fed manufactured milks. The director of this hospital was very interested in incorporating milk banking into planned new facilities, however. In Shanghai, where many physicians received training in Europe, premature infants are fed their mothers' milk if available after it has been pasteurized, and donor milk is never used. Commercial milk company advertisements for dietary supplements for pregnant and lactating women were displayed in Shanghai.