In ovo administration of the Marek's disease vaccine in conjunction with 25-hydroxyvitamin D3 and its subsequent effects on the performance and immunity-related characteristics of Ross 708 broiler hatchlings1,2,3.

The combined effects of the in ovo injection of commercial Marek's disease vaccine (MDV) and various levels of 25-hydroxyvitamin D3 (25OHD3) on the hatch variables, immunological measurements, and gene expression of Ross 708 hatchling broilers were investigated. A total of 5 in ovo injection treatments that were applied at 18 d of incubation (doi) included: 1) noninjected (control); or a 50 µL solution volume of 2) MDV alone; or MDV combined with 3) 0.6 µg of 25OHD3; 4) 1.2 µg of 25OHD3; or 5) 2.4 µg of 25OHD3. At hatch, hatchability of set and live embryonated eggs, hatchling body weight, hatch residue analysis, serum IgY and alpha-1 acid glycoprotein (AGP) concentrations, and the expression of genes related to immunity (INFα, INFß, INFγ, TLR-3, and TLR-21) and vitamin D3 activity (1 α-hydroxylase, 24 hydroxylase, and vitamin D receptor) were determined. No significant treatment differences were observed for hatchability of set and live embryonated eggs, or for serum IgY and AGP concentrations. However, hatchling body weight was higher when MDV was combined with either 1.2 or 2.4 µg of 25OHD3 than when MDV was provided alone or in combination with 0.6 µg of 25OHD3. Also, in comparison to the noninjected treatment group, the expression of the genes for 1 α-hydroxylase and 24 hydroxylase was improved when MDV was combined with either 1.2 or 2.4 µg of 25OHD3. Lastly, expression of the genes linked to viral detection (TLR-3) and antibody production (INF-ß) was increased in those treatments that contained any level of 25OHD3. These results indicate that in comparison to controls, the effects of MDV were observed to be greater on hatchling BW and splenic gene expression when it was administered in combination with the 1.2 or 2.4 µg doses of 25OHD3. Further research is needed to determine the posthatch effects of the administration of various levels of 25OHD3 in combination with MDV.

Enteral feeding in head and neck cancer patients at a UK cancer centre.

BACKGROUND: Patients undergoing radiotherapy or chemoradiotherapy treatment for head and neck cancer have an increased risk of malnutrition, and may require enteral feeding via nasogastric or gastrostomy tube. The aim of this audit was to examine current enteral feeding practice, mortality, morbidity and 6-month outcome data of head and neck cancer patients receiving radical (chemo)radiotherapy at a regional cancer centre and to compare the results with a regional head and neck cancer gastrostomy audit. METHODS: A 2-year audit was conducted (2006-2008). Inclusion criteria were all adult patients diagnosed with squamous cell carcinoma of the head and neck, receiving radical radiotherapy or chemoradiotherapy treatment. The first-year data were collected retrospectively, and the second-year data were collected prospectively. Data were collected on all patients requiring enteral feeding with 6-month outcome data relating to route of nutrition. RESULTS: Approximately 14% (n = 32/223) of patients were admitted for nasogastric feeding as a result of inadequate oral alimentation. On admission, 94% were at risk of refeeding syndrome, taking a mean (SD) of 11 (4.9) days to reach full nutritional requirements. Mean (SD) length of hospital stay was 13 (5.1) days. No major complications from nasogastric tube insertion were found. The mean (SD) length of nasogastric feeding was 72 (20.1) days with 89.6% managing full nutritional requirements orally at 6 months. CONCLUSIONS: Patients requiring enteral feeding during treatment were fed via a nasogastric tube, rather than via a prophylactic gastrostomy tube. Compared with the regional gastrostomy audit results, our patients had a lower clinical risk/complication rate, with a greater proportion tolerating full oral intake at 6 months. Therefore, nasogastric feeding, rather than prophylactic gastrostomy tube feeding, could be a more appropriate method of enteral feeding in this patient group.

The effect of a polymeric enteral formula supplemented with a mixture of six fibres on normal human bowel function and colonic motility.

BACKGROUND AND AIMS: Fibres with varying fermentability may improve bowel function during enteral feeding. Two studies in healthy volunteers aimed to 1) investigate effects of Nutrison Multi Fibre (NMF) on gastrointestinal function, and 2) compare effects of NMF administered orally and nasogastrically on distal colonic motor activity. METHODS: (1) Ten subjects were randomly assigned to 3x7 days self-selected diet (SSD), 2 litres Nutrison Standard (NS), or 2 l NMF. Objective and subjective indices were measured. (2) Two groups (n=6) received 2x250 ml boluses of NMF 2 hourly either nasogastrically or orally. Distal colonic motility was measured for 8 h (3 pre/5 post) first bolus. RESULTS: Whole gut transit time was prolonged during NS (P<0.05) compared with SSD or NMF. Stool wet weight was higher during SSD (P<0.05) than during NS or NMF. Bowel frequencies were comparable. NMF was well tolerated. 2. Colonic activity index was maintained after oral administration with no associated diarrhoea. Activity index decreased after nasogastric bolus (P<0.05), but recovered to higher than fasting levels (P<0.05). 5 subjects had watery stools. CONCLUSIONS: Oral NMF is well tolerated, normalises whole gut transit time and maintains colonic motility. Recovery of colonic activity after nasogastric bolus suggests a putative protective effect of NMF over a longer period of feeding.

Clinical evaluation of a newly designed nasogastric enteral feeding tube.

Concerned with reports in the literature of a rising incidence of enteral feeding tube clogging, we initiated a design programme in an attempt to improve the clinical efficacy of nasogastric and nasoenteric enteral feeding tubes. Tube design has been based on a remodelling of the outflow part of a polyurethane feeding tube previously developed in our unit. The tip of the newly designed 8F enteral feeding tube is shorter in length with a rounded end to minimize discomfort during intubation. The port itself incorporates a tapered outflow design with the side walls now extending below the mid-point of the internal flow lumen resulting in a 28% increase in port area compared to the equivalent and originally designed tube. The performance of the newly designed polyurethane feeding tube was assessed under controlled trial conditions using as references two widely used 8F polyurethane nasogastric feeding tubes whose design has been based on different principles (Flexiflo, weighted tip, open-ended with two side ports; Freka, occluded tip, two simple large side ports). Eighty-eight of 90 patients entered into the study were successfully intubated with no significant differences being noted in intubation times in the three groups. Significantly less discomfort occurred during intubation of patients with the Radius tube as compared to the Freka tube (P < 0.05). Although there were no clear differences between the Flexiflo and Freka tubes either in regard to the number of attempts required for intubation or aspiration or discomfort during intubation or ease of aspiration, fewer attempts at insertion and aspiration were needed and intubation and aspiration were easier for patients randomised to the Radius group than those to the Flexiflo and Freka groups (P < 0.05). We conclude that the clinical performance of the newly designed Radius enteral feeding tube compares favourably with that of the reference tubes. Only one of the new tubes (3.3%) blocked during the course of the study. High rates of non-elective extubation were observed in the three study groups (Radius 80.0%, Flexiflo 73.3%, Freka 73.3%). Design modifications are unlikely to influence non-elective nasogastric feeding tube extubation rates which remain a major clinical problem.

Prospective randomized comparison of two different sized percutaneous endoscopically placed gastrostomy tubes.

We performed a prospective randomised study of two different sized percutaneous endoscopic gastrostomy (PEG) tubes to determine if tube size influenced the incidence of PEG-related complications. Patients were given prophylactic cefuroxime, if not already on antibiotics at the time of PEG insertion. Fifty-two PEGs were successfully placed, 26 in each group. Most patients who required a PEG had suffered a cerebrovascular event (82.7%). There were no procedure-related deaths. The mean ages (standard deviation) for the 12 and 20 French Gauge (FG) groups were 78.7 (8.9) and 73.9 (14.4) years, respectively, with no statistical difference. There were no significant differences in mortality (9 deaths in the 12 FG and 11 deaths in the 20 FG groups), number of peristomal infections (8 infections in the 12 FG and 12 infections in the 20 FG groups), episodes of leakage (12 leakages in the 12 FG and 17 leakages in the 20 FG groups) or tube blockage (2 blockage episodes in the 12 FG and 1 blockage episode in the 20 FG groups) between the two groups over a follow-up period of 190 days. The incidence of insertion- and feeding-related complications was thus not influenced by tube size. As the smaller PEG tubes were easier and less traumatic to insert we conclude that there are grounds for considering the more widespread use of the narrower diameter 12 FG PEG tubes.