Adventist Health Glendale

Abstract Objective – To review the human and veterinary literature on the biology of apoptosis in health and disease. Data Sources – Data were examined from the human and veterinary literature identified through Pubmed and references listed in appropriate articles pertaining to apoptosis. Human Data Synthesis – The role of apoptosis in health and disease is a rapidly growing area of research in human medicine. Apoptosis has been identified as a component of human autoimmune diseases, Alzheimer's disease, cancer, and sepsis. Veterinary Data Synthesis – Research data available from the veterinary literature pertaining to apoptosis and its role in diseases of small animal species is still in its infancy. The majority of veterinary studies focus on oncologic therapy. Most of the basic science and human clinical research studies use human blood and tissue samples and murine models. The results from these studies may be applicable to small animal species. Conclusions – Apoptosis is the complex physiologic process of programmed cell death. The pathophysiology of apoptosis and disease is only now being closely evaluated in human medicine. Knowledge of the physiologic mechanisms by which tissues regulate their size and composition is leading researchers to investigate the role of apoptosis in human diseases such as cancer, autoimmune disease and sepsis. Because it is a multifaceted process, apoptosis is difficult to target or manipulate therapeutically. Future studies may reveal methods to regulate or manipulate apoptosis and improve patient outcome.

PURPOSE: The purpose of this study was to determine the rate of return to play and to quantify the effect on the basketball player's performance after surgical reconstruction of the anterior cruciate ligament (ACL). METHODS: Surgical injuries involving the ACL were queried for a 10-year period (1993-1994 season through 2004-2005 season) from the database maintained by the National Basketball Association (NBA). Standard statistical categories and player efficiency rating (PER), a measure that accounts for positive and negative playing statistics, were calculated to determine the impact of the injury on player performance relative to a matched comparison group. Over the study period, 31 NBA players had 32 ACL reconstructions. Two patients were excluded because of multiple ACL injuries, one was excluded because he never participated in league play, and another was the result of nonathletic activity. RESULTS: Of the 27 players in the study group, 6 (22%) did not return to NBA competition. Of the 21 players (78%) who did return to play, 4 (15%) had an increase in the preinjury PER, 5 (19%) remained within 1 point of the preinjury PER, and the PER decreased by more than 1 point after return to play in 12 (44%). Although decreases occurred in most of the statistical categories for players returning from ACL surgery, the number of games played, field goal percentage, and number of turnovers per game were the only categories with a statistically significant decrease. Players in the comparison group had a statistically significant increase in the PER over their careers, whereas the study group had a marked, though not statistically significant, increase in the PER in the season after reconstruction. CONCLUSIONS: After ACL reconstruction in 27 basketball players, 22% did not return to a sanctioned NBA game. For those returning to play, performance decreased by more than 1 PER point in 44% of the patients, although the changes were not statistically significant relative to the comparison group. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

BACKGROUND: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. AIMS: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). METHODS: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. RESULTS: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. CONCLUSION: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.

The purposes of this study were to expand the data base of active range of motion (ROM) in the upper and lower extremities of older persons measured by goniometry and to determine if differences exist related to age, sex, and physical activity. Active ROM was measured with a clinical goniometer in 28 joint motions of the upper and lower extremities of the right side in 60 older subjects. Thirty men and 30 women were equally divided in two age groups of 60 to 69 and 75 to 84 years of age. Multivariate analysis of variance showed no significant differences in ROM that were attributable to sex and age. In univariate tests, however, 12 motions were significantly different (p less than .05) between the sexes, but only in 4 motions was the difference greater than intertester error. Physical activity, as assessed by a questionnaire and a rating scale, was not related to specific changes of joint range. Within the older subjects, however, a significant relationship between ROM and age or ROM and physical activity cannot be assumed. These results suggest that a data base of normative values is needed for older individuals.

INTRODUCTION: Intracardiac delay optimization of biventricular and dual-chamber pacing devices currently relies on time-consuming echocardiographic measurements. A novel intracardiac electrogram (IEGM) method for atrioventricular (AV/PV) and interventricular (VV) delay optimization was developed, which can be performed during routine device follow-up. METHODS AND RESULTS: In this prospective, nonrandomized, multi-center trial, patients previously implanted with St. Jude Medical cardiac resynchronization therapy defibrillator (CRT-D) devices or dual-chamber implantable cardioverter defibrillators (ICDs) underwent standard AV/PV and/or VV delay optimization guided by Doppler echocardiogram measurements of the maximum aortic velocity time integral (aortic VTI). Aortic VTI measurements applying the IEGM method recommended delays were then obtained in all patients. Fifty-eight patients (age: 68 +/- 11 years; 81% male; 74% ischemic) and 57 patients (age: 71 +/- 10 years; 74% male; 71% ischemic) were enrolled for AV/PV and VV delay evaluation, respectively. An independent core lab determined the maximum aortic VTIs. Data analysis of the AV, PV, and VV delays demonstrated the concordance correlation coefficient (CCC) between the standard method aortic VTI values and the IEGM method aortic VTI values was 97.5%, 96.1%, and 96.6%, respectively. All analyses demonstrated that the CCC > 90% (P < 0.05). CONCLUSION: The automated programmer-based IEGM method provides a reliable and simpler alternative to standard techniques for the optimization of AV/PV and VV delay settings in patients with CRT-D devices and dual-chamber ICDs.

We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = -0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression in persons with chronic medical illness. Efficacy, as well as adherence, may be affected by client religiosity.

Shoulder arthroscopy has become a routine outpatient surgery. Pain control is a limiting factor for patient discharge after surgery, and several modalities are used to provide continued analgesia postoperatively. Regional anesthetic blocks and shoulder pain pumps are common methods to provide short-term pain control. Shoulder pain pumps can be used either in the subacromial space or within the glenohumeral joint. Several clinical studies suggested--which was confirmed by a bovine and rabbit cartilage study--that there is significant chondrotoxicity from bupivacaine, a local anesthetic commonly used in pain pumps. Postarthroscopic glenohumeral chondrolysis is a noninfectious entity associated with factors including use of radiofrequency thermal instruments and intra-articular pain pumps that administer bupivacaine, but there have been no cases reported with subacromial pain pump placement. Treatment options are difficult in a young patient with postarthroscopic glenohumeral chondrolysis, and understanding the literature with regard to risk factors is paramount to counseling patients and preventing this devastating complication.

The effects of global ischemia (45 min) and reperfusion (30 min) on left-ventricular developed pressure (LVDP), HR, and end-diastolic pressure were studied on isolated perfused rat heart. The following postconditioning protocols were used: 1) 3 cycles of reperfusion (10 sec) and ischemia (10 sec), total cycle duration 20 sec; 2) 6 cycles reperfusion of reperfusion (10 sec) and ischemia (10 sec), total cycle duration 20 sec; 3) 3 cycles of reperfusion (20 sec) and ischemia (20 sec), total cycle duration 40 sec; 4) 6 cycles of reperfusion (20 sec) and ischemia (20 sec), total cycle duration 40 sec; 5) 3 cycles of reperfusion (30 sec) and ischemia (30 sec), total cycle duration 60 sec. The use of several cycles of a total duration of 20 sec had no effect on LVDP, but reduced EDP throughout the reperfusion period. Postconditioning protocol consisting of three 40-sec cycles promoted LVDP recovery during the reperfusion, but had no effect on EDP and decelerated HP normalization. Six 40-sec cycles had no effect on LVDP and EDP, but impeded HR recovery during the reperfusion period. Postconditioning protocol consisting of three 60-sec cycles promoted LVDP increase during the reperfusion and reduced contracture, but these transient effects were accompanied by decelerated HP normalization.

Objective: Our goal was to develop a comprehensive measure of religious involvement for those affiliated with monotheistic religious traditions that fully captures the centrality of religion in life. Methods: A convenience sample of female caregivers of those with chronic disabling illness, recruited from North Carolina and California, completed a questionnaire including a new 10-item scale called the Belief into Action (BIAC) scale (possible score range: 10 - 100). Psychometric properties of the BIAC were examined. Results: 231 participants completed the BIAC (87% Christian). The average score was 46.3 (range: 10 - 90). Cronbach alpha was 0.89 (95% CI 0.86 - 0.91) and the intra-class correlation coefficient between two administrations (n = 60) was 0.919 (95% CI 0.869 - 0.951). Convergent validity was demonstrated by high correlations between the BIAC and existing religiosity scales; divergent validity by weak correlations with mental, social, and physical health outcomes; construct validity by high correlations between individual items and total scale score (r’s 0.58 - 0.80); factor analytic validity by a single factor that explained 94.4% of the scale’s variance; and predictive validity by small to moderate correlations with psychosocial outcomes in expected directions. Conclusion: The BIAC is a reliable and valid scale for comprehensively assessing religious involvement in female caregivers affiliated with monotheistic religions, Christianity in particular. Psychometric properties of the scale need to be established in other populations.

Telomere length (TL) is an indicator of cellular aging associated with longevity and psychosocial stress. We examine here the relationship between religious involvement and TL in 251 stressed female family caregivers recruited into a 2-site study. Religious involvement, perceived stress, caregiver burden, depressive symptoms, and social support were measured and correlated with TL in whole blood leukocytes. Results indicated a U-shaped relationship between religiosity and TL. Those scoring in the lowest 10% on religiosity tended to have the longest telomeres (5743 bp ± 367 vs. 5595 ± 383, p = 0.069). However, among the 90% of caregivers who were at least somewhat religious, religiosity was significantly and positively related to TL after controlling for covariates (B = 1.74, SE = 0.82, p = 0.034). Whereas nonreligious caregivers have relatively long telomeres, we found a positive relationship between religiosity and TL among those who are at least somewhat religious.

BACKGROUND: We compared the effectiveness of religiously integrated cognitive behavioral therapy (RCBT) versus standard CBT (SCBT) on increasing optimism in persons with major depressive disorder (MDD) and chronic medical illness. METHODS: Participants aged 18-85 were randomized to either RCBT (n = 65) or SCBT (n = 67) to receive ten 50-min sessions remotely (94% by telephone) over 12 weeks. Optimism was assessed at baseline, 12 and 24 weeks by the Life Orientation Test-Revised. Religiosity was assessed at baseline using a 29-item scale composed of religious importance, individual religious practices, intrinsic religiosity, and daily spiritual experiences. Mixed effects growth curve models were used to compare the effects of treatment group on trajectory of change in optimism. RESULTS: In the intention-to-treat analysis, both RCBT and SCBT increased optimism over time, although there was no significant difference between treatment groups (B = -0.75, SE = 0.57, t = -1.33, P = .185). Analyses in the highly religious and in the per protocol analysis indicated similar results. Higher baseline religiosity predicted an increase in optimism over time (B = 0.07, SE = 0.02, t = 4.12, P < .0001), and higher baseline optimism predicted a faster decline in depressive symptoms over time (B = -0.61, SE = 0.10, t = -6.30, P < .0001), both independent of treatment group. CONCLUSIONS: RCBT and SCBT are equally effective in increasing optimism in persons with MDD and chronic medical illness. While baseline religiosity does not moderate this effect, religiosity predicts increases in optimism over time independent of treatment group.

Ezogabine is an antiepileptic medication approved in June 2011 by the US Food and Drug Administration (FDA) as an adjunctive treatment for partial seizures. Minimal drug interactions and a novel mechanism of action made ezogabine an appealing new treatment option. However, adverse effects reported during clinical trials and following drug approval have been alarming. A Risk Evaluation Mitigation Strategy (REMS) program has been established for urinary retention. A safety alert was published in April 2013 warning ezogabine may cause retinal pigment abnormalities and/or blue-gray discoloration, most notably on or near the lips, nail beds, sclera and conjunctiva with long-term use. In October 2013, the FDA announced a formal label change to ezogabine to include a black boxed warning emphasizing the previously reported warnings of eye and skin discoloration and permanent vision changes. Given the unknown nature of the pathophysiology, consequences and potential for reversibility of these effects, GlaxoSmithKline and the FDA have published recommendations for patients currently receiving ezogabine. Further data from published case reports and long-term safety trials in the future may lend additional insight into these concerning effects.

The Omnibus Budget Reconciliation Act (OBRA) of 1987 limited the use of psychotropic medications in residents of long-term care facilities. Updates of OBRA guidelines have liberalized some dosing restrictions, but documentation of necessity and periodic trials of medication withdrawal are still emphasized. Antidepressant drugs are typically underutilized in nursing homes. Tricyclic antidepressants have many side effects and thus are not preferred medications in elderly patients. Anxiety and insomnia are common problems in the institutionalized elderly. If behavioral measures are not successful, antidepressant medications with shorter half-lives may avoid drug accumulation, which can lead to excessive sedation, cognitive impairment and an increased risk for falls. In the elderly, antipsychotic medications can cause serious side effects, such as extrapyramidal symptoms and tardive dyskinesia. Newer antipsychotic drugs are less often associated with these side effects, but they should be used only for specific diagnoses and when behavioral and environmental measures are unsuccessful.

Objectives To examine the relationship between religious involvement ( RI ) and adaptation of women caring for family members with severe physical or neurological disability. Design Two‐site cross‐sectional study. Setting Community. Participants A convenience sample of 251 caregivers was recruited. RI and caregiver adaptation (assessed by perceived stress, caregiver burden, and depressive symptoms) were measured using standard scales, along with caregiver characteristics, social support, and health behaviors. Bivariate and multivariate analyses were conducted to identify relationships and mediating and moderating factors. Results Religious involvement (RI) was associated with better caregiver adaptation independent of age, race, education, caregiver health, care recipient's health, social support, and health behaviors (B = −0.09, standard error = 0.04, t = −2.08, P = .04). This association was strongest in caregivers aged 58–75 and spouses and for perceived stress in blacks. Conclusion Religious involvement (RI) in female caregivers is associated with better caregiver adaptation, especially for those who are older, spouses of the care recipients, and blacks. These results are relevant to the development of future interventions that provide support to family caregivers.

Background: Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines. Methods: We examine the effects of religious cognitive behavioral therapy (RCBT) vs. conventional CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory cytokines TNF-α, IL-1β, IFN-γ, IL-6, IL-12-p70), anti-inflammatory cytokines (IL1ra, IL-4, IL-10), and stress hormones (urinary cortisol, epinephrine, norepinephrine) were assessed at baseline, 12 weeks, and 24 weeks. Differential effects of baseline religiosity on treatment response were also examined, along with effects of religiosity on changes in biomarkers over time independent of treatment group. Biomarker levels were log transformed where possible to normalize distributions. Mixed models were used to examine trajectories of change. Results: CRP increased and IL-4, IL-10, and epinephrine decreased over time, mostly in the opposite direction expected (except epinephrine). No significant difference between RCBT and CCBT was found on average trajectory of change in any biomarkers. Religiosity interacted with treatment group in effects on IL-6, such that CCBT was more effective than RCBT in lowering lL-6 in those with low religiosity whereas RCBT appeared to be more effective than CCBT in those with high religiosity. Higher baseline religiosity also tended to predict an increase in pro-inflammatory cytokines INF-γ and IL-12 (p70) and urinary cortisol over time. Conclusions: RCBT and CCBT had similar effects on stress biomarkers. CCBT was more effective in reducing IL-6 levels in those with low religiosity, whereas RCBT tended to be more effective in those with high religiosity. Unexpectedly, higher baseline religiosity was associated with an increase in several stress biomarkers.

BACKGROUND: Efficacy and tolerability of intranasal ketorolac (SPRIX(R)) was assessed in abdominal surgery patients. METHODS: Adult patients were randomly assigned to receive ketorolac 31.5 mg (n = 214) or placebo (n = 107) every 6 hr after surgery for 48 hr, then up to 4 times/day for up to 5 days. Morphine sulfate via patient controlled analgesia was available in both groups as needed. RESULTS: Least square mean 6 hr summed pain intensity difference scores were significantly greater in the ketorolac group indicating better analgesic efficacy compared to placebo (117.4 vs. 89.9, p = 0.032; difference 27.6, 95% CI 2.5-52.7). Pain intensity difference indicated significantly better pain relief in the ketorolac group at 20 min after the first dose (p = 0.01). Morphine use over 48 hr decreased 26% in the ketorolac group compared to placebo (p = 0.004). Day 1 global pain control scores were significantly higher in the ketorolac group compared to placebo (p = 0.009). Quality of analgesia was rated significantly higher (p = 0.009) in the ketorolac group by 20 min after first dose. Adverse event and serious adverse event incidences were similar in both groups. Rhinalgia and nasal irritation, generally mild and transient in nature, occurred more frequently in the ketorolac group. CONCLUSION: Intranasal ketorolac was well tolerated and provided effective pain relief within 20 minutes with reduced opioid analgesia use. While IN ketorolac was assessed in an inpatient, conventional surgery setting in this study, IN ketorolac use may have more relevance for use in outpatient settings and ambulatory surgery or fast-track surgical procedures.

BACKGROUND: Intravenous (IV) acetaminophen provides rapid and effective analgesia in the postoperative and inpatient settings. The utility and efficacy of acetaminophen is well established; however, due to chronic excessive dosing of over-the-counter acetaminophen products and prescription opioid combination products resulting in the potential for hepatic toxicity, concerns remain about acetaminophen safety. In order to evaluate the safety of IV acetaminophen 1,000mg q6h or 650mg q4h with repeated dosing for 5 days, a randomized, open-label study assessed the safety and tolerability of repeated doses used to treat acute pain or fever in 213 adult inpatients was conducted. METHODS: Subjects were randomized (3:3:1) to receive IV acetaminophen (1,000mg q6h or 650mg q4h) or standard-of-care treatment for pain or fever. Safety was assessed according to spontaneous reports of adverse events (AEs) and clinically meaningful changes from baseline laboratory parameters. RESULTS: Overall, IV acetaminophen was shown to be safe and well tolerated in adult inpatients when given as repeated doses for up to 5 days. Owing to the comorbidities in the study population, the frequency of AEs reported was high. However, the majority of treatment-emergent adverse events (TEAEs) were unrelated to treatment, and only 8% of the study population withdrew because of TEAEs. No major hepatic issues associated with IV acetaminophen warranted concern, and most hepatic events were likely related to underlying medical conditions or recent trauma/surgery. CONCLUSIONS: Consistent with the tolerability and safety results, both treatment groups (1,000mg q6h and 650mg q4h) demonstrated statistically significantly better ratings for the Subject Global Evaluations for the level of satisfaction with side effects related to study treatments as compared with the control group. The findings from this trial support the use of IV acetaminophen as a safe therapy in adult patients.

Background: Religious practices/experiences (RPE) may produce positive physiological changes in patients with major depressive disorder (MDD) and chronic medical illness. Here, we report cross-sectional relationships between depressive symptoms, RPE and stress biomarkers (pro-/anti-inflammatory measures and stress hormones), hypothesizing positive associations between depressive symptoms and stress biomarkers and inverse associations between RPE and stress biomarkers. Methods: We recruited 132 individuals with both MDD and chronic illness into a randomized clinical trial. First, stress biomarkers in the baseline sample were compared to biomarker levels from a community sample. Second, relationships between depressive symptoms and biomarkers were examined, and, finally, relationships between RPE and biomarkers were analyzed, controlling for demographics, depressive symptoms, and physical functioning. Results: As expected, inflammatory markers and stress hormones were higher in our sample with MDD compared to community participants. In the current sample, however, depressive symptoms were largely unrelated to stress biomarkers, and were unexpectedly inversely related to proinflammatory cytokine levels (TNF-α, IL-1β). Likewise, while RPE were largely unrelated to stress biomarkers, they were related to the anti-inflammatory cytokine IL-1RA and the stress hormone norepinephrine in expected directions. Unexpectedly, RPE were also positively related to the proinflammatory cytokine IFN-γ and to IFN-γ/IL-4 and IFN-γ/IL-10 ratios. Conclusions: Little evidence was found for a consistent pattern of relationships between depressive symptoms or religiosity and stress biomarkers. Of the few significant relationships, unexpected findings predominated. Future research is needed to determine whether religious interventions can alter stress biomarkers over time in MDD.

We examined the effects of religious cognitive-behavioral therapy (RCBT) compared to conventional CBT (CCBT) on purpose in life (PIL) in clients with major depression and chronic illness. Participants were randomized to either RCBT (n=65) or CCBT (n=67) to receive ten 50-min sessions over 12 weeks. PIL was measured at baseline, 12, and 24 weeks. Growth curve models examined the effects of treatment group on trajectory of change in PIL. While no significant difference was found between RCBT and CCBT on PIL trajectories in the overall sample, RCBT was more effective than CCBT on increasing PIL in clients who were highly religious (group by time interaction B=-5.87, SE=2.57, p=0.026, Cohen’s d=0.64). Furthermore, baseline religiosity correlated positively with baseline PIL (r=0.34, p<0.0001) and predicted an increase in PIL over time (B=0.23, SE=0.05, p<0.0001). RCBT does not appear to increase PIL more than CCBT, although this may depend on the religiosity of the client.

OBJECTIVE: To evaluate the complications and outcome associated with different nasogastric tube (NGT) feeding techniques in cats with suspected acute pancreatitis. DESIGN: Descriptive retrospective case series. SETTING: Small animal emergency and referral hospital. ANIMALS: The patient database (2001-2006) was searched for cats with suspected acute pancreatitis that received NGT liquid enteral feeding within 72 hours of admission and ≥12 hours during hospitalization. MEASUREMENTS AND MAIN RESULTS: Signalment, history, clinical signs, laboratory data and abdominal ultrasonographic examinations were used for suspected diagnosis. Cats were grouped based upon whether they received bolus feeding or continuous rate infusion (CRI) of a liquid diet via the NGT, and whether or not administration of an intravenous amino acid and carbohydrate solution occurred prior to NGT feeding (AAS and non-AAS group, respectively). Fifty-five cats were included. For all cats, NGT feeding was initiated at a mean of 33.5 ± 15.0 hours and the target caloric intake (1.2 X {(30 X BW [kg]) +70}) was reached at 58.0 ± 28.4 hours from presentation. There was a significantly longer time from admission to the initiation of NGT feeding in the 34/55 cats in the AAS group vs. the 21/55 cats in the non-AAS group (P = 0.009). The 8 bolus-fed cats took longer to reach target caloric intake vs. the 47 CRI-fed cats (P = 0.002). Complications associated with NGT feeding for all cats included: mechanical problems (13%), diarrhea (25%), vomiting following NGT placement (20%) and vomiting following NGT feeding (13%). Mean time to discharge for all cats occurred after 78.6 ± 29.5 hours with an overall weight gain of 0.08 ± 0.52 kg. Fifty cats survived 28 days post-discharge. CONCLUSIONS: NGT feeding in this group of cats with suspected acute pancreatitis was well tolerated, and associated with a low incidence of diarrhea, vomiting, and mechanical complications.