Urachal carcinoma: a large retrospective multicentric study from the French Genito-Urinary Tumor Group.

Introduction: Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and Methods: data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results: The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion: UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed.

Exploiting digital droplet PCR and Next Generation Sequencing technologies to determine the relative abundance of individual Eimeria species in a DNA sample.

DNA-based diagnostic assays for detecting infections with Eimeria species have been limited to providing identification and presence/absence data for samples containing oocysts. Modern technologies that generate quantitative data, such as droplet digital PCR (ddPCR) and Next Generation Sequencing (NGS), utilize a relatively short amplicon size containing sufficient species-specific variation for reliable species level identification. Targeting the cytochrome c oxidase subunit III gene in the mitochondrial genome, we established protocols using these technologies to determine the relative abundance of the number of copies/µL of Eimeria species in a sample. Samples from chickens of known and unknown Eimeria species composition were analyzed to determine the suitability of these technologies as diagnostic assays. All technologies demonstrated robust capability of identifying and quantifying the Eimeria species in samples. The new quantitative assays described herein will produce invaluable detail of Eimeria species infections for an array of situations in commercial chicken production systems, enabling further characterization of the disease profile and allowing for the development or enhancement of new intervention strategies.

Restoration of anticoccidial sensitivity to a commercial broiler chicken facility in Canada.

Increasing resistance of Eimeria species to anticoccidial medications is an issue in the broiler chicken industry. Using drug-sensitive strains in live-coccidiosis vaccines has been shown to improve anticoccidial effectiveness in US-based broiler production. In Canada, litter is removed between flocks, which differ from the US industry practice. Thus, we investigated the use of drug-sensitive vaccine strains in a Canadian broiler production facility with suspected anticoccidial resistance. Weekly fecal samples were collected from flocks before, during, and after vaccine seeding to determine oocyst shedding patterns; following the vaccine seeding, OPG counts from similar aged birds were lower than flocks before live-coccidiosis vaccine use. Eimeria species isolates, collected before and after vaccine seeding, were used in 2 anticoccidial sensitivity tests to evaluate their susceptibility to commercially available anticoccidial medications; a low-dose challenge to define parasite replication, and a high-dose challenge to monitor broiler performance. In both experiments, isolates collected after seeding were more susceptible to almost every anticoccidial medication evaluated compared with the isolates collected before seeding. These results demonstrate an improvement in sensitivity to many anticoccidials after the use of live-coccidiosis vaccines at this facility. However, the regulated removal of litter at the end of each flock required under Canadian broiler chicken production management rules could limit the establishment of vaccine-strain Eimeria species in broiler facilities and could shorten the longevity of improved drug sensitivity observed in this study.

Monitoring coccidia in commercial broiler chicken flocks in Ontario: comparing oocyst cycling patterns in flocks using anticoccidial medications or live vaccination.

Coccidiosis, the parasitic disease caused by Eimeria spp., is controlled during broiler chicken production through the inclusion of in-feed anticoccidial medications. Live-coccidiosis vaccination has become an increasingly common alternative to these medications. Monitoring infections with Eimeria spp. in flocks can be accomplished through determining the concentration of oocysts excreted in the fecal material (i.e., oocysts per gram; OPG). The purpose of our study was to sample commercial Ontario broiler chicken flocks at various times of the year to determine weekly OPG counts for flocks that use either an in-feed anticoccidial medication or a live-coccidiosis vaccine. Weekly sampling of 95 flocks from placement to market permitted documentation of oocyst cycling patterns typical of conventional and antibiotic-free flocks, and variation of these patterns in summer and winter. Medicated flocks had higher and later peak oocyst shedding compared with vaccinated flocks. Flocks reared in the summer peaked in oocyst shedding earlier than flocks reared in the winter. Despite what appears to be poorer coccidiosis control in the medicated flocks, the performance data were similar for these flocks compared with vaccinated flocks. This is the first study describing typical patterns of parasite shedding in Ontarian commercial broiler chicken flocks; these data will provide a baseline of expected Eimeria spp. infections in Canadian broiler chicken flocks to ensure optimal coccidiosis prevention.

The effect of alternative feeding strategies on the feeding motivation of broiler breeder pullets.

Due to genetic selection for fast growth and high breast meat yield, commercial strains of broiler chickens and broiler breeders are predisposed to high feed intake; however, feeding broiler breeders ad libitum impairs their health and reproductive performance. Broiler breeders are feed-restricted throughout rearing to maintain health and performance, yet feed restriction results in hunger, feeding frustration and lack of satiety. The objective of this study was to examine the effect of alternative feeding strategies, including feed additives (separately or combined) and a fixed non-daily feeding schedule, on the feeding motivation and welfare of broiler breeders during rearing. At 3 weeks of age, 180 Ross 308 breeder pullets were allocated to 90 cages and fed with one of five isocaloric treatments: (1) daily control diet (control), (2) daily calcium propionate diet (CaP), (3) daily soybean hull diet (SBH), (4) daily alternative diet (alternative: CaP + SBH) and (5) 4/3 control diet (four on-feed days and three non-consecutive off-feed days per week). The CaP diet included calcium propionate at 1.4% from 3 to 6 weeks of age, and at 3.2% from 7 to 12 weeks of age, and the SBH diet contained soybean hulls included at 40%. The alternative diet included both soybean hulls and calcium propionate at the same inclusion rate as the SBH and CaP diets, respectively. Pullets were weighed and scored for feather coverage every week. A feed intake test was conducted at 3, 4, 8, 10 and 11 weeks of age for 10 min during on- and off-feed days. At 12 weeks of age, feather samples were analysed for fault bars. Data were analysed using linear mixed regression models, with cage nested in the models and age as a repeated measure. At 4 weeks of age, pullets fed soybean hull-enriched diets (SBH and alternative diets) and those on the 4/3 schedule had lower feed intake than control pullets (P = 0.02). Feathers from pullets fed the SBH diet had fewer fault bars than those fed the CaP diet (P = 0.04). The results indicated that the inclusion of soybean hulls (alone or combined with calcium propionate) and a 4/3 feeding schedule can reduce feeding motivation of broiler breeders during early rearing.

The effect of alternative feeding strategies for broiler breeder pullets: 2. Welfare and performance during lay.

Feeding broiler breeders to satiety has negative consequences on their health and reproduction. Alternative feeding strategies during rearing can improve welfare, although their implications during lay are not well understood. The objective was to examine the effect of rearing feeding treatments on the reproductive performance and feeding behavior of broiler breeders under simulated commercial conditions. At 3 wk of age, 1,680 Ross 308 pullets were allocated to 24 pens under 1 of 4 isocaloric treatments: 1) daily control diet; 2) daily alternative diet (40% soybean hulls and 1 to 5% calcium propionate); 3) 4/3 control diet (4 on-feed days, 3 non-consecutive off-feed days per week); and 4) graduated control diet. Feeding frequency of the graduated treatment varied with age and finished on a daily basis. At 23 wk of age, group sizes were adjusted to 40 hens, and 5 mature Yield Plus Males roosters were introduced to each pen. Pens were under the same daily feeding management and same diet during lay. The performance of broiler breeders (growth rate, body weight uniformity, and reproductive performance) was determined until 64 wk of age. At the end of lay, feeding motivation was examined with a feed intake test and a compensatory feeding test. Data were analyzed using linear mixed regression models, with pen nested in the models and age as a repeated measure. The laying rate of hens reared on the graduated treatment decreased slower compared to control hens, resulting in a higher cumulative egg production (178.2 ± 3.8 eggs/hen) than control hens (165.2 ± 3.8 eggs/hen, P < 0.01) by 64 wk of age. Hens reared on non-daily feeding treatments laid lighter eggs with relatively heavier yolks and had higher feed intake at the end of lay than hens fed daily during rearing (P = 0.02). In conclusion, rearing feeding treatments impacted the growth rate and body weight uniformity during lay, feeding motivation at the end of lay, and the laying rate and hatchability depending on hens' age.

Relationship between obstructive sleep apnea and difficulty of anesthesia induction in children undergoing tonsillectomy.

OBJECTIVE: To determine whether anesthesiologists need to rely on polysomnography (PSG) when predicting need for airway intervention during induction in patients with sleep-disordered breathing (SDB). METHODS: Prospective case-control observational study at a tertiary care pediatric hospital. Children between the ages of 2-17 undergoing tonsillectomy were divided into three groups: those presenting with OSA observed by history and/or physical examination alone (SDB; n = 33), those with OSA determined by preoperative PSG (OSA; n = 32), and a control group (n = 35) undergoing tonsillectomy for recurrent tonsillitis. An anesthesiologist ranked each case on the level of intervention required to maintain ventilation. RESULTS: Age, height and BMI were associated with greater induction difficulty (r's > .225, p's < .025). Compared to controls, induction difficulty was significantly greater for the SDB group (mean difference = -0.751, 95% confidence interval [CI] = -1.241, -0.261, p = .003), but not for the OSA group (p = .061). No significant difference in induction difficulty was observed between SDB and OSA groups. In a subgroup analysis of the OSA group, an apnea-hypopnea index (AHI) > 10 correlated with increased level of intervention during induction (r = .228, p = .022). Race was also associated with AHI >10 (odds ratio = 3.859, 95% CI = 1.485, 10.03, p = .006). CONCLUSION: Children with OSA undergoing tonsillectomy require more airway intervention during induction than children with recurrent tonsillitis. Age and BMI were correlated with greater induction difficulty, suggesting that PSG data should be considered in light of these clinical characteristics to ensure an optimal postoperative course for children undergoing tonsillectomy.

A targeted genotyping approach enhances identification of variants in taste receptor and appetite/reward genes of potential functional importance for obesity-related porcine traits.

Taste receptors (TASRs) and appetite and reward (AR) mechanisms influence eating behaviour, which in turn affects food intake and risk of obesity. In a previous study, we used next generation sequencing to identify potentially functional mutations in TASR and AR genes and found indications for genetic associations between identified variants and growth and fat deposition in a subgroup of animals (n = 38) from the UNIK resource pig population. This population was created for studying obesity and obesity-related diseases. In the present study we validated results from our previous study by investigating genetic associations between 24 selected single nucleotide variants in TASR and AR gene variants and 35 phenotypes describing obesity and metabolism in the entire UNIK population (n = 564). Fifteen variants showed significant association with specific obesity-related phenotypes after Bonferroni correction. Six of the 15 genes, namely SIM1, FOS, TAS2R4, TAS2R9, MCHR2 and LEPR, showed good correlation between known biological function and associated phenotype. We verified a genetic association between potentially functional variants in TASR/AR genes and growth/obesity and conclude that the combination of identification of potentially functional variants by next generation sequencing followed by targeted genotyping and association studies is a powerful and cost-effective approach for increasing the power of genetic association studies.

Particulate matter adheres to human hair exposed to severe aerial pollution: consequences for certain hair surface properties.

BACKGROUND: The deposit and adherence of particulate matter (PM) from aerial pollution onto the surface of human hair is a poorly studied phenomenon. OBJECTIVES: (i) To reproduce in vitro the deposit of known PM on standardized hair swatches in a closed box, (ii) to compare in vitro data with those obtained under 'real-life' conditions of severe aerial pollution and (iii) to assess the changes of the hair surface properties, potentially caused by the adherence of airborne PM onto the hair. METHODS: In vitro: a PM was sprayed onto untreated or sebum-coated hair swatches. Real-life conditions: other swatches were exposed to a severely polluted environment, for 24 to 72 h, in Baoding (PR China). In both cases, swatches were examined using scanning electron microscopy. The shine, the frictional properties and the level of metals were measured and compared to those same properties for the unexposed swatches. RESULTS: This work clearly indicates that, under real-life conditions, a large number of PM of various sizes are deposited onto the hair surface. This phenomenon is increased by the presence of sebum and longer exposure times. The in vitro level of PM deposited onto the hair surface is comparable to the in vivo level. The presence of sebum seems to favour the deposit of larger PM. The shine of the exposed swatches is significantly decreased, whereas their respective friction coefficients are significantly increased. Both the presence of sebum and length of exposure time increased the amount of analysed metals present on the exposed hair surface (Al, Fe, Cu, Ba and Zn). CONCLUSION: This work indicates that a very high amount (e.g. billions) of PM can be deposited on a full head of hair for subjects living in a severely aerially polluted environment. This process can be reproduced in vitro. In real-life, pollution has a strong impact on hair surface properties, leading to a modification of the visual aspect (loss of shine) and the alteration of hair surface (increase in friction force). This work may be used to pave the way for prevention and cleansing studies in the field of hair care.

Opportunities for exercise during pullet rearing, Part II: Long-term effects on bone characteristics of adult laying hens at the end-of-lay.

Osteoporosis in laying hens has been a production and welfare concern for several decades. The objective of this study was to determine whether differing opportunities for exercise during pullet rearing influences long-term bone quality characteristics in end-of-lay hens. A secondary objective was to assess whether differing opportunities for exercise in adult housing systems alters bone quality characteristics in end-of-lay hens. Four flock replicates of 588 Lohmann Selected Leghorn-Lite pullets were reared in either conventional cages (Conv) or an aviary rearing system (Avi) and placed into conventional cages (CC), 30-bird furnished cages (FC-S), or 60-bird furnished cages (FC-L) for adult housing. Wing and leg bones were collected at the end-of-lay to quantify bone composition and strength using quantitative computed tomography and bone breaking strength (BBS). At the end-of-lay, Avi hens had greater total and cortical cross-sectional area (P < 0.05) for the radius and tibia, greater total bone mineral content of the radius (P < 0.001), and greater tibial cortical bone mineral content (P = 0.029) than the Conv hens; however, total bone mineral density of the radius (P < 0.001) and cortical bone mineral density of the radius and tibia (P < 0.001) were greater in the Conv hens. Hens in the FC-L had greater total bone mineral density for the radius and tibia (P < 0.05) and greater trabecular bone mineral density for the radius (P = 0.027), compared to hens in the FC-S and CC. Total bone mineral content of the tibia (P = 0.030) and cortical bone mineral content of the radius (P = 0.030) and tibia (P = 0.013) were greater in the FC-L compared to the CC. The humerus of Conv hens had greater BBS than the Avi hens (P < 0.001), and the tibiae of FC-L and FC-S hens had greater BBS than CC hens (P = 0.006). Increased opportunities for exercise offered by the aviary rearing system provided improved bone quality characteristics lasting through to the end-of-lay.

Rearing system affects prevalence of keel-bone damage in laying hens: a longitudinal study of four consecutive flocks.

High flock-level prevalence of keel-bone fractures and deviations in laying hens are commonly reported across various housing systems; however, few longitudinal studies exist, especially for furnished and conventional cage systems. Load-bearing exercise improves bone strength and mineral composition in laying hens and has the potential to reduce keel-bone damage, especially if exercise is allowed during critical periods of bone growth throughout the pullet rearing phase. The objective of this study was to determine the prevalence of keel-bone damage in laying hens housed in furnished and conventional cages, and assess whether opportunities for exercise during the pullet rearing phase influenced the prevalence of keel-bone damage throughout the laying period. Four flock replicates of 588 Lohmann Selected Leghorn-Lite pullets/flock were reared in either conventional cages (Conv) or an aviary rearing system (Avi) and placed into conventional cages (CC), 30-bird furnished cages (FC-S) or 60-bird furnished cages (FC-L) for adult housing. Keel-bone status was determined by palpation at 30, 50, and 70 wk of age. Age (P < 0.001) and rearing system (P < 0.001) had an effect on the presence of keel-bone fractures. The presence of fractures increased with age, and hens raised in the Avi system had a lower percentage of fractures (41.6% ± 2.8 SE) compared to hens reared in the Conv system (60.3% ± 2.9 SE). Adult housing system did not have an effect on the percentage of keel fractures (P = 0.223). Age had an effect on the presence of deviations (P < 0.001), with deviations increasing with age. Rearing system (P = 0.218) and adult housing system (P = 0.539) did not affect the presence of deviations. Keel fractures and deviations were strongly associated with each other at all ages: 30 wk: (P < 0.001); 50 wk: (P < 0.001); and 70 wk: (P < 0.001). Increased opportunities for exercise provided by an aviary rearing system reduced the prevalence of keel-bone fractures through the end-of-lay.

Opportunities for exercise during pullet rearing, Part I: Effect on the musculoskeletal characteristics of pullets.

Increased load-bearing exercise improves bone quality characteristics in a variety of species, including laying hens. Providing increased opportunities for exercise during the pullet rearing phase, a period of substantial musculoskeletal growth, offers a proactive approach to reducing osteoporosis by improving bone composition. The main objective of this study was to determine whether differing opportunities for exercise during rearing influences pullet musculoskeletal characteristics. Two flock replicates of 588 Lohmann Selected Leghorn-Lite pullets were reared in either standard, conventional cages (Conv) or an aviary rearing system (Avi) from day-old chicks until 16 wk of age. The keel bone and the muscles and long bones of the wings and legs were collected at 16 wk to measure muscle growth differences between rearing treatments and quantify bone quality characteristics using quantitative computed tomography (QCT) and bone breaking strength (BBS) assessment. Keel bone characteristics and muscle weights were adjusted for BW and analyses for QCT and BBS included BW as a covariate. At 16 wk of age, rearing system had an effect on the majority of keel bone characteristics (P < 0.05). The length of the keel metasternum, caudal tip cartilage length, and the overall percentage of cartilage present on the keel at 16 wk was greater in the Avi pullets compared to the Conv pullets (P < 0.01). Wing and breast muscle weights of the Avi pullets were greater than the Conv pullets (P < 0.001), but leg muscle weights were greater in the Conv pullets (P = 0.026). Avi pullets had greater total bone density, total cross-sectional area, cortical cross-sectional area, total bone mineral content, and cortical bone mineral content than Conv pullets for the radius, humerus, and tibia (P < 0.001). Avi pullets had greater BBS compared to the Conv pullets for the radius, humerus, and tibia (P < 0.01). Increased opportunities for exercise offered by the aviary rearing system increased muscle and bone growth characteristics in pullets at 16 wk of age.

Spatial Clustering of Escherichia coli with Reduced Susceptibility to Cefotaxime and Ciprofloxacin among Dairy Cattle Farms Relative to European Starling Night Roosts.

European starlings (Sturnus vulgaris) have been implicated in the dispersal of zoonotic enteric pathogens. However, their role in disseminating antimicrobial-resistant organisms through their home range has not been clearly established. The aim of this study was to determine whether starling night roosts served as foci for spreading organisms with reduced susceptibility to antimicrobials among dairy cattle farms. Bovine faecal pats were collected from 150 dairy farms in Ohio. Each farm was visited twice (in summer and fall) between 2007 and 2009. A total of 1490 samples (10 samples/farm over two visits) were tested for Escherichia coli with reduced susceptibility to cefotaxime and ciprofloxacin. Using a spatial scan statistic, focal scans were conducted to determine whether clusters of farms with a high prevalence of organisms with reduced susceptibility to cefotaxime and ciprofloxacin surrounded starling night roosts. Faecal pats 13.42% and 13.56% of samples carried Escherichia coli with reduced susceptibility to cefotaxime and ciprofloxacin, respectively. Statistically significant (P < 0.05) spatial clusters of faecal pats with high prevalence of Escherichia coli showing reduced susceptibility to cefotaxime and ciprofloxacin were identified around these night roosts. This finding suggests that the risk of carriage of organisms with reduced susceptibility to antimicrobials in cattle closer to starling night roosts was higher compared to cattle located on farms further from these sites. Starlings might have an important role in spreading antimicrobial-resistant E. coli to livestock environments, thus posing a threat to animal and public health.

A longitudinal study of feed contamination by European starling excreta in Ohio dairy farms (2007-2008).

The objectives of this study were to understand the temporal pattern of contamination of cattle feed by starling excrement on dairy farms and to evaluate the temporal pattern in recovering Escherichia coli O157:H7 or Salmonella in relation to the absolute mass of excrement recovered. A longitudinal study was conducted on 15 dairy farms in Ohio from July 2007 to October 2008. One open-topped tray filled with bird feed was placed near a cattle feeding site; bird excrement from the tray was weighed monthly for 12 consecutive months. Linear regression models with a random intercept for farm were computed to examine the association between the absolute weight of excrement recovered each month or the farm-specific standard score for weight of excrement, and month or season. Exact logistic regression was used to determine whether an association between recovering E. coli O157:H7 or Salmonella was present and the amount of excrement recovered and season. A spatial scan statistic was used to test for evidence of space-time clustering of excrement, based on the standard score for the weight of the excrement, among our study farms. A total of 5 of 179 excrement samples (2.79%) were positive for E. coli O157:H7 and 2 (1.12%) were positive for Salmonella. A significantly higher level of contamination with excrement was observed during the winter. The odds of recovering a pathogen increased with the amount of excrement recovered and decreased if the excrement was collected in the winter. A spatio-temporal cluster of contamination with excrement was detected. These findings provide basic information for future quantitative microbial risk assessments concerning the role of starlings in spreading enteric pathogens on dairy farms.

Physiopathology of necrobiotic xanthogranuloma with monoclonal gammopathy.

RATIONALE: Xanthomatosis associated with monoclonal gammopathy includes hyperlipidaemic xanthoma (HX), normolipidaemic xanthoma (NX) and necrobiotic xanthogranuloma (NXG). All three pathologies are characterized by skin or visceral lesions related to cholesterol accumulation, monoclonal immunoglobulin (MIg) and hypocomplementemia. The pathophysiology underlying NXG remains unknown although the involvement of MIg is suspected. OBJECTIVE: To provide further insights into the pathophysiology of NXG, we evaluated the plasma lipid phenotype, mechanisms involved in cellular cholesterol accumulation and role of MIg in an analysis of blood and plasma markers of inflammation in 16 patients with xanthomatosis [NXG (n = 8) and NX (n = 8)] associated with monoclonal IgG relative to the relevant controls. RESULTS: The lipid profile of patients with NXG was characterized by a low HDL-C phenotype and an abnormal distribution of HDL particles. Sera from patients with NXG induced cholesterol accumulation in human macrophages. This accumulation was due in part to a significant reduction in the HDL capacity to promote cholesterol efflux from macrophages, which was not found in the case of NX. The MIg of NXG and NX patients was tested positively by ELISA to recognize a large spectrum of lipoproteins. High plasma levels of pro-inflammatory cytokines (TNFα and IL-6), soluble cytokine receptors (sIL-6R, sTNFRI and sTNFRII), adhesion molecules (VCAM-1 and ICAM-1) and chemokines (MCP-1, IL-8 and MIP-1α) were observed in both patients with NXG and NX, revealing a specific xanthoma inflammatory signature which was inversely correlated with plasma levels of anti-inflammatory HDL. However, patients with NXG were distinguished by elevated levels of IL-15 and a marked increase in the rate of intermediate CD14++CD16+ monocytes. CONCLUSION: This study revealed that NXG is characterized by impaired macrophage lipid homeostasis associated with a systemic inflammatory profile that may result from the interaction of MIg and lipoproteins.

Keel fracture assessment of laying hens by palpation: inter-observer reliability and accuracy.

The objective of this study was to assess the interobserver reliability (agreement) and accuracy of keel palpation for the purpose of detecting old fractures in an end-of-lay flock of commercial laying hens. The low level of invasiveness and the relative speed at which this evaluation can be carried out lends itself well to use in a welfare audit, but only if the results are reliable and accurate from various assessors. The palpation technique first described by Wilkins and others (2004) was used to manually palpate for keel fractures. The technique was modified in that only keel fractures were considered. Eight assessors with varying laying hen experience palpated 100 live ISA Brown hens that had been in lay for 49 weeks. The hens were then euthanased and examined by dissection to establish whether there had been a keel fracture present (yes/no). The accuracy for individual assessors ranged from 87.1 to 96.8 per cent, with a mean of 91.8 per cent among all eight assessors. The interobserver reliability among all eight assessors was moderate (κ=0.44). Accuracy and κ values were 84.8 per cent and 0.41 for the first 50 hens, and 99.5 per cent and 0.47 for the last 50 hens, respectively, indicating that there was increased accuracy and agreement as the assessors became more experienced at palpation. This level of agreement, and the high level of accuracy, would make this technique an acceptable measure of keel fracture prevalence in a welfare audit.

Informed consent in refractive eye surgery: learning from patients and the courts.

Refractive eye laser surgery involves ablation of the cornea using excimer laser to correct short or long sightedness and thus negate the need for glasses and/or contact lenses. With the doctrine of informed consent often central to claims of medical negligence in this area, we examine the attitudes, understanding and recall of patients to consent for refractive surgery and outline the relevant law. 102 patients undergoing first time refractive surgery were analysed to examine their understanding and recall of the consenting process. Only 2 patients remembered all 5 risks outlined preoperatively, while 11 remembered no risks at all. 65% of patients consulted the internet to learn more about the operation. Our study demonstrates that patient understanding and recall remains poor. A signed consent form is not, of itself a full defence to allegations of uninformed consent, and the consent process must be comprehensive.

[Usefulness of topical cidofovir treatment for recalcitrant molluscum contagiosum in immunocompromised children]. / Utilité du cidofovir topique dans le traitement des molluscums contagiosums en contexte d'immunosuppression thérapeutique chez l'enfant.

Molluscum contagiosum (MC) is common and often numerous and recalcitrant in immunocompromised children. The response to available treatments is frequently unsatisfactory. Cidofovir is a nucleoside analog of the deoxycytidine antiviral drug approved for the intravenous treatment of cytomegalovirus retinitis in AIDS patients. We report four cases of children, 5-8 years old, who developed extensive MC in the context of chemotherapy for acute lymphoid leukemia and who were treated with a cream containing cidofovir 1%. In all patients, the lesions began to regress within 2 to 4 months. For three patients, complete regression was observed in 7 to 9 months, and the children remained clear of recurrence. For one patient, partial regression was obtained after 17 months of treatment. No side effects have been observed. Treatment of MC in immunocompromised children is difficult because the usual treatments are inappropriate. Successful use of either topically or intralesionally administered cidofovir in several virally induced cutaneous diseases has been demonstrated and recently documented in the treatment of MC in immunocompromised adults. Conversely, its use in children is not documented. Although intravenous use of cidofovir may lead to severe adverse effects, one single case of a systemic side effect has been reported after topical use at a greater concentration, but no changes in laboratory data were observed. Topical cidofovir offers an effective and well-tolerated therapeutic alternative option for the treatment of MC in immunosuppressed children.