Nutritional assessment and intervention in lung cancer patients undergoing treatment

INTRODUCTION: Nutrition has an important role in prevention and management of cancer. It also prolongs the life. It gives the essential elements needed for the cell survival. Providing better nutrition to cancer patient while on treatment helps to reduce the treatment related adverse effects and treatment delays. Malignancy had an impact on food intake symptoms like; dry mouth, alteration in taste and smell of food, pain, dyspnoea and fatigue also affect food intake. Lung cancer is usually managed by chemotherapy and radiotherapy rarely by surgical resection. These treatments also affect food intake. These leads further deterioration of patient’s nutritional condition. ARMS OF THE STUDY: ARM 1: USUAL CARE which consists of one-to-one dietary counselling in person once prior to starting and every cycle of chemotherapy for between 15 to 30 minutes each. This patients takes usual diet only. ARM 2: MEDICAL NUTRITION THERAPY. This will involve indivualised one-to-one dietary counselling in person once prior to starting, and every cycle of chemotherapy. Each session will be between 15 to 30 minutes duration depending on the degree of nutritional issues identified. Patients in this group advised to take FDA approved nutrient dense high protein oral supplement that provides 450Kcal and 34 g protein per day for minimum of 8 weeks. MATERIALS AND METHODS: Study Period: From October 2012 to February 2013. Study Design : Randomized control trial. ELIGIBILITY CRITERIA: Forty nine patients with lung cancer who satisfied the following eligibility criteria were included in this study. 1. Age >18 years, 2. Gender : Both male and Females, 3. Histologically diagnosed of lung cancer on chemotherapy with or without Radiotherapy, 4. Performance status 3 or less according to ECOG score, 5. Life expectancy > 2 months. EXCLUSION CRITERIA: 1. Lung cancer patients on supportive care only. 2. Performance status -4 according to ECOG score. 3. Patients with a cognitive impairment or psychiatric illness. RESULTS: Out of the 782 cancer patients treated between October 2012 and February 2013 in our Medical Oncology Department, 76 (9.7%) patients are presented with Lung cancer. PGSGA score 8 or more at time of enrolment was used to select the patients both in the usual care (control arm) and medical nutritional therapy (study or interventional arm) groups. Total of 49 Lung cancer patients who met the eligibility criteria entered into this study. Among them 6 patients were removed from the study due to early death, poor follow up and poor compliance to intervention. CONCLUSION: In our study, about 65% of the enrolled patients had more than 10% weight loss at presentation which is a worst scenario. Dietary counselling alone or dietary counselling with oral supplements definitely gives a benefit in improving appetite, weight gain, energy intake, and QOL separately. Both group of patients tolerated the chemotherapy and its toxicity well and completed the course without any delay. In conclusion, all patients with lung cancer definitely need dietary counselling at least to improve the weight gain and treatment tolerability

Evaluation of 6GY Single Dose Radiotherapy in comparison with 8GY Single Dose Radiotherapy in the treatment of painful bone metastases

INTRODUCTION: Bone metastases often present as the first evidence of disseminated disease. The incidence of bone metastases varies significantly depending on the primary site, with breast and prostate cancer accounting for up to 70% of patients with metastatic disease. Even though the ultimate prognosis is poor, a proportion of the patients may survive for several months or even years and will require active treatment because of symptoms related to their bone metastases. Pain, pathologic fractures, hypercalcemia, neurologic deficits, and immobility decrease the quality of remaining life for these patients. Associated depression and anxiety may further compromise the quality of survival. Radiation therapy is considered as the treatment of choice for palliation of painful bone metastases for many years Its main aim is relief of bone pain, prevention of pathological bone fractures as well as its healing, with anticipated effect upon improving mobility, function, and quality of life. Also, data from retrospective studies and prospective randomized trials showed that single fraction treatments may be as effective as multifraction regimens. Since single fraction treatment may be advantageous for both patient and institution, various single dose fraction schedules have been investigated. Yet, optimal single dose of RT required for pain relief is unknown, although one study showed that 8 Gy gives a higher probability of pain relief than 4 Gy. Furthermore, a dose level in - between the 4 Gy and 8 Gy (namely, 6 Gy) also appeared to be effective in achieving pain relief, not very different from that achieved with 8 Gy. In order to define the “lowest” optimal single dose of RT in the treatment of patients with metastatic bone pain, we underwent a prospective randomized trial comparing two single-fraction regimens of RT exploring dose-response effect in this trial setting. AIM OF THE STUDY: The present study aims at comparing pain relief obtained with (trial arm) 6Gy single fraction radiotherapy against 8Gy single fraction radiotherapy (control arm) in painful bone metastases. The study also aims at comparing the Toxicity , Infield Events involved with the above two therapeutic protocols. MATERIALS AND METHODS: STUDY PERIOD : From July 2008 up to June 2009. ELIGIBITY CRITERIA: sixty patients with painful bone metastases who satisfied the following eligibility criteria were included in this study. 1. Age > 18 years, 2. Genders: Both Male and Females, 3. Performance status: ECOG 0 – 3, 4. Histological or cytological diagnosis of malignancy associated with radiological evidence of painful bone metastases from any primary tumor site. 5. If patients with two sites of pain requiring separate treatment are to be entered, the same randomized treatment option will be used for both sites, but response at each site will be scored and analyzed separately. 6. Anticipated remaining life of at least 12 weeks (3 months). 7. Pain due to bone metastases. 8. Evaluable pain history. 9. Informed consent. EXCLUSION CRITERIA : 1. Primary histology myeloma. 2. Sites of previous RT or previous radioisotope treatment. 3. Bisphosphonate treatment. 4. Previous surgical intervention at the same locus. 5. Complicated bone metastases (pathological fractures, metastatic spinal cord compression) conditions or circumstances, which may interfere with treatment or follow-up. RESULTS: Out of the 1802 Cancer patients treated between July- 2008 and June- 2009 in our Radio therapy dept, 85 (4.7%) presented with bone metastases. A total of 60 patients with single and multiple bone metastases who met the eligibility criteria entered into this study at the time they developed their first painful bone metastases. Any subsequent metastases and its treatment was not included in the study and every effort was made to distinguish the pain that first occurred from that of any subsequent metastatic site, even in the cases of pain recurrence at the original site in the presence of painful second or any other additional metastatic bone site. CONCLUSION: The following conclusions can been drawn from this prospective trial which compared 6Gy single fraction radiotherapy with already proven 8Gy single fraction radiotherapy in the treatment of painful bone metastases. The 6Gy single fraction radiotherapy produces similar , time to the first occurrence of any pain relief, duration of response in responders, complete response rate, overall response rate, retreatment rate and toxicity with 8Gy single fraction radiotherapy in the treatment of painful bone metastases. We conclude that single fraction 6Gy radiotherapy is good option in palliation of painful bone metastases

INVESTIGATION OF CLOUDS AND CLOUD RADIATIVE FORCING ON THE WINDWARD SIDE OF THE MADAGASCAR MOUNTAIN CHAINS

Clouds affect the radiative energy balance of the earth–atmosphere system by reflecting and trapping the radiation. The cooling occurs over the earth by reflecting the incoming solar radiation and warming by trapping the outgoing longwave terrestrial radiation. In this paper an attempt has been carried out to understand the clouds and cloud radiative forcing over the windward side of the Madagascar mountain chain. The study was carried out using the Clouds and Earth’s Radiant Energy System (CERES) data June–September from 2000 to 2016. Over the windward side, clouds tend to cool whereas on the leeward side, clouds tend to warm marginally. During this period, peak value of shortwave cloud forcing and the longwave cloud forcing are −45 W m−2 and +15 W m−2 respectively. Generally, the clouds are restricted to low level in the windward side. We also examined the association between the cloud radiative forcing and cloud physical properties such as cloud optical depth, cloud, cloud top temperature and cover amount. The cloud optical depth (−0.74 correlation value) and cloud cover amount (−0.51 correlation value) show better correlation with net cloud radiative cooling. The surface pressure of the Madagascar is also correlated with the net cooling over the windward side

A two dimensional nanopatterned thin metallic transparent conductor with high transparency from the ultraviolet to the infrared

Cataloged from PDF version of article.The optical properties of a two-dimensional nanohole patterned aluminum thin film in hexagonal lattice are studied. The transmission dip can be moved out from the visible range by manipulating the lattice constant. The resulting nanopatterned thin film is demonstrated to exhibit a high transparency in a wide wavelength range. The origins of the transmission dip and the transmission drop are explained. For constant resistance, thicker films with a larger filling ratio lead to better transmittance in the visible range. Angular response of the nanopatterned metallic film is also analyzed, and transmittances using several other metals are compared. (C) 2012 American Institute of Physics. [http://dx.doi.org/10.1063/1.4765341

Chemical engineering of adamantane by lithium functionalization: A first-principles density functional theory study

Using first-principle density functional theory, we investigated the hydrogen storage capacity of Li functionalized adamantane. We showed that if one of the acidic hydrogen atoms of adamantane is replaced by Li/Li+, the resulting complex is activated and ready to adsorb hydrogen molecules at a high gravimetric weight percent of around ~ 7.0 %. Due to polarization of hydrogen molecules under the induced electric field generated by positively charged Li/Li+, they are adsorbed on ADM.Li/Li+ complexes with an average binding energy of ~ -0.15 eV/H2, desirable for hydrogen storage applications. We also examined the possibility of the replacement of a larger number of acidic hydrogen atoms of adamantane by Li/Li+ and the possibility of aggregations of formed complexes in experiments. The stabilities of the proposed structures were investigated by calculating vibrational spectra and doing MD simulations.Comment: 8 pages, 6 figures, 2 tables, accepted for publication in Physical Review

Excitonic Transitions and Off-resonant Optical Limiting in CdS Quantum Dots Stabilized in a Synthetic Glue Matrix

Stable films containing CdS quantum dots of mean size 3.4 nm embedded in a solid host matrix are prepared using a room temperature chemical route of synthesis. CdS/synthetic glue nanocomposites are characterized using high resolution transmission electron microscopy, infrared spectroscopy, differential scanning calorimetry and thermogravimetric analysis. Significant blue shift from the bulk absorption edge is observed in optical absorption as well as photoacoustic spectra indicating strong quantum confinement. The exciton transitions are better resolved in photoacoustic spectroscopy compared to optical absorption spectroscopy. We assign the first four bands observed in photoacoustic spectroscopy to 1se–1sh, 1pe–1ph, 1de–1dhand 2pe–2phtransitions using a non interacting particle model. Nonlinear absorption studies are done using z-scan technique with nanosecond pulses in the off resonant regime. The origin of optical limiting is predominantly two photon absorption mechanism

Natural convection in a square cavity with uniformly heated and/or insulated walls using marker-and-cell method

In this study, a numerical investigation has been performed using the computational Harlow-Welch MAC (Marker and Cell) finite difference method to analyse the unsteady state two-dimensional natural convection in lid-driven square cavity with left wall maintained at constant heat flux and remaining walls kept thermally insulated. The significant parameters in the present study are Reynolds number (Re), thermal Grashof number (Gr) and Prandtl number (Pr) and Peclét number (Pe =PrRe). The structure of thermal convection patterns is analysed via streamline, vorticity, pressure and temperature contour plots. The influence of the thermophysical parameters on these distributions is described in detail. Validation of solutions with earlier studies is included. Mesh independence is also conducted. It is observed that an increase in Prandtl number intensifies the primary circulation whereas it reduces the heat transfer rate. Increasing thermal Grashof number also decreases heat transfer rates. Furthermore the isotherms are significantly compressed towards the left (constant flux) wall with a variation in Grashof number while Peclét number is fixed. The study is relevant to solar collector heat transfer simulations and also crystal growth technologies

Assessment of trace metal contamination in a historical freshwater canal (Buckingham Canal), Chennai, India

The present study was done to assess the sources and the major processes controlling the trace metal distribution in sediments of Buckingham Canal. Based on the observed geochemical variations, the sediments are grouped as South Buckingham Canal and North Buckingham Canal sediments (SBC and NBC, respectively). SBC sediments show enrichment in Fe, Ti, Mn, Cr, V, Mo, and As concentrations, while NBC sediments show enrichment in Sn, Cu, Pb, Zn, Ni, and Hg. The calculated Chemical Index of Alteration and Chemical Index of Weathering values for all the sediments are relatively higher than the North American Shale Composite and Upper Continental Crust but similar to Post-Archaean Average Shale, and suggest a source area with moderate weathering. Overall, SBC sediments are highly enriched in Mo, Zn, Cu, and Hg (geoaccumulation index (Igeo) class 4– 6), whereas NBC sediments are enriched in Sn, Cu,Zn, and Hg (Igeo class 4–6). Cu, Ni, and Cr show higher than Effects-Range Median values and hence the biological adverse effect of these metals is 20%; Zn, which accounts for 50%, in the NBC sediments, has a more biological adverse effect than other metalsfound in these sediments. The calculated Igeo, Enrichment Factor, and Contamination Factor values indicate that Mo, Hg, Sn, Cu, and Zn are highly enriched in the Buckingham Canal sediments, suggesting the rapid urban and industrial development of Chennai MetropolitanCity have negatively influenced on the surrounding aquatic ecosystem