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1.
Gene Ther ; 13(5): 389-99, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16292351

ABSTRACT

The full realization of conditionally replicative adenoviruses (CRAds) for cancer therapy has been hampered by the limited knowledge of CRAd function in vivo and particularly in an immunocompetent host. To address this issue, we previously proposed a canine adenovirus type 2 (CAV2)-based CRAd for clinical evaluation in canine patients with osteosarcoma (OS). In this study, we evaluated infectivity-enhancement strategies to establish the foundation for designing a potent CAV2 CRAd with effective transduction capacity in dog osteosarcoma cells. The results indicate that the native CAV2 fiber-knob can mediate increased binding, and consequently gene transfer, in both canine osteosarcoma immortalized and primary cell lines relative to previously reported Ad5 infectivity-enhancement strategies. Gene delivery was further enhanced by incorporating a polylysine polypeptide onto the carboxy terminus of the CAV2 knob. This vector demonstrated improved gene delivery in osteosarcoma xenograft tumors. These data provide the rationale for generation of infectivity-enhanced syngeneic CAV2 CRAds for clinical evaluation in a dog osteosarcoma model.


Subject(s)
Dog Diseases/therapy , Genetic Therapy/methods , Oncolytic Virotherapy/methods , Osteosarcoma/therapy , Transduction, Genetic/methods , Adenoviridae/genetics , Adenoviridae Infections/virology , Animals , Caveolin 2/genetics , Cell Line, Tumor , Dog Diseases/virology , Dogs , Flow Cytometry , Genetic Vectors/administration & dosage , Genetic Vectors/genetics , Humans , Mice , Mice, Nude , Microscopy, Fluorescence , Models, Animal , Neoplasm Transplantation , Osteosarcoma/veterinary , Osteosarcoma/virology , Recombinant Proteins/administration & dosage , Recombinant Proteins/genetics , Transplantation, Heterologous , Virus Replication
2.
J Small Anim Pract ; 42(6): 298-300, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11440399

ABSTRACT

Phosphofructokinase (PFK) deficiency is an autosomal recessive inherited disorder in dogs causing haemolytic crises and exertional myopathy. The clinical signs may be confused with those of recurrent immune-mediated haemolytic anaemia. The deficiency has been commonly observed in field trial (working) English springer spaniels (ESSPs), but also in the conformation line of ESSPs in the USA over the past two decades. This report documents the first family of ESSPs found with PFK deficiency in Europe. Two related adult ESSPs in Denmark had intermittent signs of pigmenturia after exercise (hunting) and had evidence of a regenerative haemolytic anaemia. Based upon DNA sequencing data, both dogs had the previously described nonsense point mutation in the muscle-type PFK gene (delta2228G-->A). Study of 17 related family members using a simple and accurate PFK-DNA test revealed one additional PFK-deficient dog (with minor exercise intolerance), nine carriers and seven normal (or 'clear') ESSPs. Recently, the authors have also identified PFK carriers and affected ESSPs in the UK. Screening for PFK deficiency is recommended for ESSPs with suspicious clinical signs and before using any for field trials or breeding in order to prevent the further spread of this hereditary disorder.


Subject(s)
Anemia, Hemolytic, Congenital/veterinary , Dog Diseases/diagnosis , Glycogen Storage Disease Type VII/veterinary , Phosphofructokinase-1/deficiency , Anemia, Hemolytic, Congenital/etiology , Animals , Breeding , Diagnosis, Differential , Dog Diseases/genetics , Dogs , Electrophoresis, Polyacrylamide Gel/veterinary , Erythrocytes/enzymology , Female , Glycogen Storage Disease Type VII/complications , Glycogen Storage Disease Type VII/diagnosis , Male , Pedigree , Phosphofructokinase-1/blood , Phosphofructokinase-1/genetics , Point Mutation , Polymerase Chain Reaction/veterinary
3.
J Expo Anal Environ Epidemiol ; 10(6 Pt 2): 776-88, 2000.
Article in English | MEDLINE | ID: mdl-11138670

ABSTRACT

In support of a study to relate developmental and cognitive effects with prenatal exposure to selected environmental toxicants, we developed and applied an analytical method to determine the concentration of two persistent pesticides, hexachlorobenzene (HCB) and p,p'-dichlorodiphenyldichloroethylene (DDE), and 32 specific polychlorinated biphenyl (PCB) congeners in 316 umbilical cords taken in 1986-1987 from women of the Faroe Islands. The analytical method consisted of homogenization of the cords, partitioning, microsilica gel column chromatography for clean-up, and dual-column capillary gas chromatography (DB-5 and DB-1701) with electron capture detection. Several quality control parameters were followed to monitor the performance of the method. Important criteria used before reporting unknown data were the recovery of in vitro-spiked analytes from a bovine umbilical cord (BUC) and the percentage lipid obtained for a Certified Reference Material (CRM)-350 of mackerel oil (MO). Recoveries of analytes that had been spiked at two concentration ranges (0.26-0.95 ng/g whole weight; 0.35-2.42 ng/g whole weight) into bovine cords ranged from 38.5% to 158% and from 50.4% to 145%, respectively, with a median recovery of 77.7%. Measurement of the percentage lipid for CRM-350 ranged from 73.8% to 107% with a median lipid value of 96.0%. The most prevalent analytes detected (%) in unknown umbilical cords were HCB (100), DDE (100), Ballschmiter/Zell PCBs 153 (100), 138 (98), 180 (98), 170 (93), 118 (88), 187 (86), and 146 (83), with corresponding median concentrations (ng/g whole weight) of 0.17, 1.19, 0.38, 0.30, 0.17, 0.11, 0.12, 0.09, and 0.07, respectively. Total PCB--sum of all measurable PCB congeners--had a median concentration of 1.37 ng/g whole weight. The analytes, which were very low in lipid content were also quantified on a lipid-adjusted basis, which provided an analytical challenge in these umbilical cord samples. The gravimetrically measured lipids in the human specimens ranged from 0.01% to 1.43% (median of 0.18%). In the pooled BUCs, our lipid measurements varied from 0.05% to 0.33% with a median value of 0.13%. The utility of using the umbilical cord as a matrix to assess in utero exposure to persistent environmental pollutants, compared with the use of umbilical cord blood or mother's blood, is worthy of debate.


Subject(s)
Environmental Pollutants/analysis , Pesticides/analysis , Polychlorinated Biphenyls/analysis , Prenatal Exposure Delayed Effects , Umbilical Cord/chemistry , Adult , Animals , Cattle , Chromatography, Gas/methods , Environmental Exposure , Environmental Pollutants/adverse effects , Female , Humans , Infant, Newborn , Lipids/chemistry , Male , Pesticides/adverse effects , Polychlorinated Biphenyls/adverse effects , Pregnancy , Sensitivity and Specificity
4.
Dig Dis Sci ; 44(8): 1619-25, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10492143

ABSTRACT

Gallbladder carcinoma is an uncommon, but highly fatal disease. Its symptoms frequently mirror those of gallstone disease, and in most instances, diagnosis is an incidental finding at surgery. While risk factors have been suggested for this cancer, many may in reality simply be a consequence of the older age of the population. This study is one of the few to approach this question by using a case-control study design comparing gallbladder carcinoma patients with a gallstone population, coupled with multivariate analysis to determine age-independent risk factors. Univariate analyses showed gallbladder carcinoma patients to be older than gallstone patients and to have many age-associated diseases. Following multiple regression adjustment for age, this disease was associated with female gender and with a previous history of gallstone symptoms. Carcinoma patients were less likely to have cholesterol gallstones in their gallbladders at surgery. A previous history of smoking was a substantial risk but of borderline statistical significance. Previous studies report associations that may be due to the older age of the gallbladder carcinoma patient. Our results show that after adjusting for age with multivariate analysis, gallbladder cancer subjects were predominantly female, more likely to report previous gallstone symptomology, and to smoke. While gallstones were not universally isolated from carcinoma patients at cholecystectomy, when present, they were less frequently classified as cholesterol gallstones based on visual inspection. Further cohort studies which target these populations will allow us to gain a more solid consensus on the risk factors for this disease.


Subject(s)
Gallbladder Neoplasms/etiology , Aged , Case-Control Studies , Cholelithiasis/complications , Female , Gallbladder Neoplasms/epidemiology , Humans , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Risk Factors , Sex Distribution , Smoking/adverse effects
5.
Biotechniques ; 27(2): 356-61, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10457844

ABSTRACT

A sensitive assay for adenovirus quantitation in vitro was developed using the flow microsphere immunoassay (FMIA) approach. Polystyrene microspheres were covalently coated with purified anti-adenoviral antibodies and incubated with virus-containing samples. After incubation, the samples were stained with DNA-specific fluorescent dyes, and microsphere-associated fluorescence was quantitated with a flow cytometer. The adsorption of virus to microspheres was examined under different experimental conditions. The flow cytometric assay was determined to be as accurate in detecting adenovirus as titering on 293 cells. The proposed method can be used to quantify virus in viral stocks and in biological samples.


Subject(s)
Adenoviridae/isolation & purification , Immunoassay/methods , Adenoviridae/immunology , Adsorption , Antibodies, Monoclonal/immunology , Binding Sites , Escherichia coli , Fluorescent Dyes/chemistry , Microspheres , Thiazoles/chemistry , Time Factors
6.
Avian Dis ; 43(2): 251-61, 1999.
Article in English | MEDLINE | ID: mdl-10396638

ABSTRACT

Virulence mechanisms of six isolates of Mycoplasma synoviae (MS), previously classified as pathogenic (K1968), moderately pathogenic (WVU 1853, K1858, 92D8034, and F10-2AS), and mildly pathogenic (FMT) in chickens, were examined. The most virulent isolate, K1968, had been found to invade systematically and produce lesions following eye-drop inoculation. In the present study, all isolates were evaluated for presence of a possible cytadhesin and for functional attachment to host cells as indicated by hemagglutination and hemadsorption. Three representative isolates, K1968, 92D8034, and FMT, were evaluated for attachment and colonization in cultured chick tracheal rings and tendon cell monolayers by direct transmission electron microscopic examination and by quantitative polymerase chain reaction assay. Ciliostasis was compared in tracheal organ culture. Previously found differences in pathogenicity of these isolates for chickens could not be explained as differences in attachment and were only partially explained by differences in colonization. Pathogenicity of the most virulent isolate of MS was suspected to be multifactorial, involving attachment and colonization of the upper respiratory tract plus additional unidentified factors associated with systemic invasion and lesion production.


Subject(s)
Mycoplasma Infections/veterinary , Mycoplasma/pathogenicity , Poultry Diseases/microbiology , Animals , Blotting, Western/veterinary , Cells, Cultured , Chickens , Hemadsorption , Hemagglutination , Microscopy, Electron/veterinary , Mycoplasma/classification , Polymerase Chain Reaction/veterinary , Rabbits , Tendons/microbiology , Trachea/microbiology
7.
Muscle Nerve ; 22(4): 460-6, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10204780

ABSTRACT

Muscle makes up the largest tissue volume of the body, yet its size makes muscle-specific therapy difficult. This becomes particularly relevant when approaches to gene therapy for inherited myopathies are evaluated. Thus, a mechanism to target constructs or pharmaceuticals to muscle following intravenous injection would be advantageous. By screening a random phage display library we have identified a heptapeptide sequence, ASSLNIA, with enhanced in vivo skeletal and cardiac muscle binding. Phage carrying this peptide showed a 9- to 20-fold (depending on control tissue) increase in muscle selectivity compared with phage with no insert. When the injected individual phage clone was localized by immunohistochemistry, it was found within focal areas of the membrane of myofibers. Thus, the peptide identified represents a ligand that is capable of accessing skeletal and cardiac muscle from the lumen of blood vessels and could therefore readily be exploited for targeted delivery to muscle cells.


Subject(s)
Bacteriophages/genetics , Muscles/metabolism , Animals , Cell Line , Immunohistochemistry , Mice , Peptide Library , Protein Binding
8.
Gene Ther ; 5(7): 865-8, 1998 Jul.
Article in English | MEDLINE | ID: mdl-9813656

ABSTRACT

A nucleic acid vaccine encoding human carcinoembryonic antigen (CEA) was administered to 10 juvenile dogs, 10-15 weeks of age, by four parenteral routes. The routes tested were intramuscular injection using a needle and syringe, intramuscular injection using the Biojector needleless injection device, intradermal injection or intravenous injection. All groups received 150 micrograms of plasmid DNA on weeks 0, 4, 7 and 13. All dogs were bled weekly for 17 weeks and tested for antibody against human CEA. Dogs given plasmid intramuscularly either by needle and syringe or Biojector showed significant antibody responses by week 9 which peaked by week 15. Dogs receiving plasmid intravenously showed slight, unsustained increases in antibody titers while dogs receiving plasmid intradermally had significant titers, but at levels approximately one log less than those induced by intramuscular injection. The five dogs immunized by intramuscular delivery of plasmid DNA were examined for cellular immune responses to human CEA by lymphoblast transformation (LBT) assay. All five showed significant CEA-specific lymphoproliferation when compared with unvaccinated dogs. Physical examination, clinical chemistry, hematology and histopathology examinations revealed no abnormalities associated with nucleic acid immunization.


Subject(s)
Antibody Formation , Carcinoembryonic Antigen/genetics , Immunity, Cellular , Vaccines, DNA/administration & dosage , Animals , Antibodies, Monoclonal/blood , Carcinoembryonic Antigen/immunology , Dogs , Humans , Injections, Intradermal , Injections, Intramuscular/instrumentation , Injections, Intramuscular/methods , Injections, Intravenous , Lymphocyte Activation , Neoplasms/therapy
9.
Vaccine ; 16(6): 601-7, 1998 Apr.
Article in English | MEDLINE | ID: mdl-9569471

ABSTRACT

Nucleic acid vaccines (NAVs) use expression vectors encoding one or more antigen genes to transfect host cells inducing both humoral and cellular immunity against the expressed antigen. NAV offers major advantages over conventional vaccines for the protection of humans and animals. This study shows that a plasmid DNA (pGT36VP1) encoding the full length VP1 region of canine parvovirus (CPV) induces immunity that protects dogs against challenge with virulent virus. Five dogs without anti-CPV antibodies were injected at 9 months of age with increasing doses of pGT36VP1 or saline. NAV vaccinated dogs showed an increase of serum IgG titer starting 1 week post-injection which peaked at week 2 and remained detectable for at least 14 weeks. A second dose of NAV resulted in an anamnestic response within 1 week. IgG titers peaked at week 3 and 4 after the second injection. All pGT36VP1 vaccinated dogs were protected against infection after virulent CPV challenge regardless of dose and the unvaccinated control dog was fully susceptible. This study demonstrated for the first time that a NAV can protect dogs against an infectious disease.


Subject(s)
Capsid Proteins , Dog Diseases/prevention & control , Parvoviridae Infections/prevention & control , Parvoviridae Infections/veterinary , Parvovirus, Canine/immunology , Vaccines, DNA/therapeutic use , Animals , Antibodies, Viral/biosynthesis , Antibodies, Viral/blood , Capsid/genetics , Capsid/immunology , Cats , Cloning, Molecular , Dog Diseases/virology , Dogs , Immunoglobulin G/biosynthesis , Immunoglobulin G/blood , Neutralization Tests , Parvovirus, Canine/genetics , Parvovirus, Canine/pathogenicity , Polymerase Chain Reaction , Vaccination , Vaccines, DNA/genetics , Virulence
11.
J Pediatr Psychol ; 22(1): 45-58, 1997 Feb.
Article in English | MEDLINE | ID: mdl-9019047

ABSTRACT

Investigated the prevalence of anticipatory nausea and vomiting (ANV) among 59 pediatric cancer patients who had routinely received ondansetron (Zofran) antiemetic therapy and determined patient- and treatment-related factors associated with ANV. Of the sample, 59% indicated at least mild ANV symptoms, suggesting that a significant number of patients report ANV and are bothered by it, despite the use of Zofran. These children were compared to those reporting no ANV symptoms. Most ANV symptomatology was consistent with a traditional classical conditioning model although cognitive processes may also play a role. Children with greater expectations of severe postchemotherapy vomiting and those who were more distressed by nausea and vomiting were more likely to experience ANV symptoms. Implications for psychological and pharmacological treatments of ANV are discussed.


Subject(s)
Antiemetics/therapeutic use , Nausea/psychology , Neoplasms/drug therapy , Ondansetron/therapeutic use , Vomiting, Anticipatory/psychology , Adolescent , Case-Control Studies , Child , Conditioning, Classical , Female , Humans , Male , Nausea/drug therapy , Nausea/etiology , Nausea/prevention & control , Neoplasms/psychology , Vomiting, Anticipatory/drug therapy , Vomiting, Anticipatory/etiology , Vomiting, Anticipatory/prevention & control
12.
J Biol Chem ; 271(33): 20070-4, 1996 Aug 16.
Article in English | MEDLINE | ID: mdl-8702726

ABSTRACT

Muscle type phosphofructokinase (M-PFK) deficiency is a rare inherited glycogen storage disease in humans that causes exertional myopathy and hemolysis. The molecular basis of canine M-PFK deficiency, the only naturally occurring animal homologue, was investigated. Lack of M-PFK enzyme activity was caused by a nonsense mutation in the penultimate exon of the M-PFK gene, leading to rapid degradation of a truncated (40 amino acids) and therefore unstable M-PFK protein. A polymerase chain reaction-based test was devised to identify M-PFK-deficient and carrier animals. This represents one of only a few inborn errors of metabolism where the molecular defect has been identified in a large animal model which can now be used to develop and assess novel therapeutic strategies.


Subject(s)
Dog Diseases/genetics , Glycogen Storage Disease/genetics , Muscles/enzymology , Phosphofructokinase-1/deficiency , Animals , Base Sequence , Disease Models, Animal , Dogs/genetics , Gene Expression Regulation, Enzymologic , Heterozygote , Molecular Sequence Data , Pedigree , Phosphofructokinase-1/genetics , Phosphofructokinase-1/metabolism , Point Mutation , RNA, Messenger/genetics
13.
Gene ; 168(2): 275-6, 1996 Feb 12.
Article in English | MEDLINE | ID: mdl-8654960

ABSTRACT

The canine muscle-type-phosphofructokinase-encoding gene (M-PFK) was sequenced by using a combination of cDNA cloning and RT-PCR amplification. The canine M-PFK sequence shares 88 and 90% identity with rabbit and human M-PFK, respectively. The canine ORF was determined to be 6-bp longer than either human or rabbit M-PFK due to a 6-bp insertion at the end of exon 13.


Subject(s)
Dogs/genetics , Isoenzymes/genetics , Muscle, Skeletal/enzymology , Phosphofructokinase-1/genetics , Amino Acid Sequence , Animals , Base Sequence , DNA Transposable Elements , DNA, Complementary , Gene Library , Humans , Molecular Sequence Data , Polymerase Chain Reaction , Rabbits , Sequence Homology, Amino Acid , Sequence Homology, Nucleic Acid
14.
Med Pediatr Oncol ; 25(5): 379-88, 1995 Nov.
Article in English | MEDLINE | ID: mdl-7674995

ABSTRACT

Nutritional problems often result from malignancies and aggressive multimodal treatment. Early identification of reliable risk factors associated with malnutrition and need for nutritional support is necessary for development of preventative approaches. Nutritional and treatment-related characteristics were examined for 173 pediatric oncology patients referred for nutritional support and a comparison sample of 43 patients matched on treatment protocol and/or diagnosis who had never been referred for nutritional support. Abnormally low serum albumin levels, poor oral intake, mucositis, prior radiation therapy, and increased gastrointestinal toxicity were significantly more frequent among referred than non-referred patients. A discriminant function analysis indicated that poor oral intake was the single best predictor of need for nutritional support. Patients with solid tumors were more nutritionally depleted at the time of referral; all bone marrow transplant patients received nutritional support. Patients with central nervous system (CNS) tumors required nutritional support for longer time periods. We conclude that routine documentation of poor oral intake (i.e., observation of change in a child's eating patterns) is the most reliable indicator of children who eventually require nutritional support and who may benefit from interventions that could delay or prevent nutritional problems. Prophylactic interventions should be tailored to meet the specific needs of individual diagnostic groups.


Subject(s)
Neoplasms/therapy , Nutritional Status , Nutritional Support , Referral and Consultation , Adolescent , Bone Marrow Transplantation , Case-Control Studies , Central Nervous System Neoplasms/therapy , Child , Child Nutritional Physiological Phenomena , Clinical Protocols , Discriminant Analysis , Eating , Female , Gastrointestinal Diseases/etiology , Humans , Male , Mucous Membrane/pathology , Neoplasms/radiotherapy , Nutrition Disorders/prevention & control , Retrospective Studies , Risk Factors , Serum Albumin/analysis
17.
Gastroenterology ; 104(5): 1515-23, 1993 May.
Article in English | MEDLINE | ID: mdl-8482463

ABSTRACT

BACKGROUND: Gallbladder mucin accelerates cholesterol crystal nucleation, an early step in the pathogenesis of gallstones. To examine the role of gallbladder mucin in postnucleation gallstone maturation, the influence of mucin on cholesterol monohydrate crystal growth was studied in a novel model system. METHODS: Cholesterol crystals of a uniform size were incubated in model biles at 37 degrees C with varying cholesterol saturation indices. Crystal size was quantitated by measuring the width and length of individual crystals under polarizing light microscopy and calculating average crystal area. RESULTS: Crystal growth was dependent on the degree of cholesterol supersaturation of bile. Bovine gallbladder mucin (0.5-8 mg/mL) accelerated crystal growth in supersaturated model bile in a concentration- and time-dependent fashion compared with control incubations with bovine serum albumin or model bile alone (P < 0.05). Cholesterol crystal growth was accompanied by a progressive decrease in cholesterol saturation and an increase in total cholesterol crystal mass. Crystal growth was also accompanied by a decrease in total crystal number, suggesting net transfer of cholesterol to larger crystals. CONCLUSIONS: The acceleration of cholesterol crystal growth by gallbladder mucin may be of pathophysiological importance in the postnucleation maturation of cholesterol gallstones.


Subject(s)
Bile/metabolism , Cholesterol/chemistry , Cholesterol/metabolism , Gallbladder/metabolism , Mucins/chemistry , Animals , Cattle , Crystallization , Crystallography , Mucins/metabolism
18.
Dig Dis Sci ; 38(5): 960-2, 1993 May.
Article in English | MEDLINE | ID: mdl-8482197

ABSTRACT

AIDS-related cholangiopathy is an increasingly recognized syndrome associated with significant morbidity and mortality. The mechanism of cholangiopathy is unknown but is assumed to be related to infectious pathogens such as CMV and cryptosporidia. The case of a Haitian with HIV and long-standing intestinal cryptosporidiosis who presented with cholangitis and protuberant intrabiliary filling defects is reported. Histopathological examination of biliary biopsies revealed previously unreported extensive squamous metaplasia of the bile duct epithelium, and the histogenesis of this condition is discussed. Chronic cryptosporidial infestation may be directly pathogenic resulting in squamous metaplasia that mimics biliary malignancy.


Subject(s)
AIDS-Related Opportunistic Infections/complications , Bile Ducts/pathology , Cholangitis/etiology , Cryptosporidiosis/complications , Adult , Cholangitis/pathology , Humans , Male , Metaplasia
19.
J Am Vet Med Assoc ; 201(10): 1569-71, 1992 Nov 15.
Article in English | MEDLINE | ID: mdl-1289336

ABSTRACT

A 3-year-old female American Cocker Spaniel with a chronic hemolytic disorder and hemolytic crises was found to have M-type phosphofructokinase deficiency. This inherited erythroenzymopathy and myopathy is commonly diagnosed in English Springer Spaniels, but the family study of this Cocker Spaniel, although supporting an autosomal recessive mode of inheritance, did not reveal any English Springer Spaniel ancestors. Molecular genetic studies did, however, identify the same mutation in this dog as we previously reported in the English Springer Spaniel breed, suggesting that this mutation originated prior to the separation of these 2 breeds.


Subject(s)
Anemia, Hemolytic/veterinary , Dog Diseases/genetics , Erythrocytes/enzymology , Phosphofructokinase-1/deficiency , Anemia, Hemolytic/enzymology , Anemia, Hemolytic/genetics , Animals , Breeding , Dog Diseases/blood , Dog Diseases/enzymology , Dogs , Female , Muscular Diseases/enzymology , Muscular Diseases/genetics , Muscular Diseases/veterinary , Mutation , Pedigree , Phosphofructokinase-1/blood , Phosphofructokinase-1/genetics , Syndrome
20.
Crit Care Med ; 20(10): 1377-87, 1992 Oct.
Article in English | MEDLINE | ID: mdl-1395657

ABSTRACT

OBJECTIVE: To compare nutritional status, gastric colonization, and rates of nosocomial pneumonia in ICU patients randomized to gastric tube feeding vs. patients fed by an endoscopically placed jejunal tube. DESIGN: Randomized, prospective study. SETTING: Medical and surgical ICUs at Boston City Hospital; surgical ICU at University Hospital. PATIENTS: Of the 38 study patients, 19 were randomized to gastric tube feeding and 19 were randomized to an endoscopically placed jejunal tube. The two groups were similar in age, sex, race, underlying disease, and type of surgery. RESULTS: The two patient groups were similar in number of days fed, duration of ICU stay, duration of mechanical ventilation, days of antibiotic therapy, and days with fever. Compared with the gastric group, the jejunal group had more patients with circulatory shock on admission (79% vs. 68.4%), higher admission Acute Physiology Score (24.0 vs. 21.7), and fewer patients with pneumonia at randomization (26.3% vs. 31.6%). The jejunal group received a significantly higher percentage of their daily goal caloric intake (p = .05), and had greater increases in serum prealbumin concentrations (p < .05) than the patients with gastric tube feeding. Although the jejunal tube group had more days of diarrhea (3.3 +/- 6.6 vs. 1.8 +/- 2.9), this difference was not statistically significant. Nosocomial pneumonia was diagnosed clinically in two (10.5%) patients in the gastric tube group and in no patients in the jejunal tube group. CONCLUSIONS: Patients fed by jejunal tube received a significantly higher proportion of their daily goal caloric intake, had a significantly greater increase in serum prealbumin concentrations, and had a lower rate of pneumonia than patients fed by continuous gastric tube feeding.


Subject(s)
Cross Infection/epidemiology , Enteral Nutrition/adverse effects , Gastrostomy/adverse effects , Jejunostomy/adverse effects , Nutritional Status , Pneumonia, Aspiration/epidemiology , Adult , Boston/epidemiology , Cross Infection/etiology , Cross Infection/microbiology , Endoscopy, Gastrointestinal , Energy Intake , Enteral Nutrition/methods , Female , Gastrostomy/nursing , Hospitals, University , Humans , Intensive Care Units , Jejunostomy/nursing , Male , Middle Aged , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/microbiology , Prealbumin/analysis , Prospective Studies , Risk Factors , Severity of Illness Index , Stomach/microbiology , Treatment Outcome
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