Validating owner-reporting of feather condition of pet Psittaciformes using photographs

Reporting of outcome variables by caregivers in welfare studies is commonplace but is open to subjective bias and so requires validation. Biases can occur in either direction: familiarity with an animal allows a deeper insight into welfare problems, but also can lead to reticence in admitting that an animal in one's care is experiencing problems. Here, we aim to validate owner-reporting of plumage condition of pet parrots, including those with self-inflicted feather-damaging behaviour (FDB), by comparing owners' scores of feather condition with those of two independent raters, blind to the owners' and each other's assessments. We surveyed pet parrot owners to collect data on basic demographics and feather condition, and requested four standardised photographs of birds. We received 259 responses (17% of the 1,521 people contacted); 78 sets of images of appropriate quality for assessment by raters were provided. Mean percentage agreement between owners' and raters' scores was mostly fair to substantial using Cohen's kappa; however, raters scored a greater proportion of feather damage than did owners. Overall, our results indicate owner-reporting of feather condition, including FDB, to be generally reliable and consistent with independent assessment of photographs. As the use of photographs can be limited by image quality, a failure to represent the long-term state of a parrot, and the potential for incorrect recording if assessed without relevant information (eg on moulting), this evidence that owner-reports can be reliable opens the door for larger-scale surveys of the extent of welfare-relevant problems.

Inflammatory breast cancer defined: proposed common diagnostic criteria to guide treatment and research

PURPOSE

Inflammatory breast cancer is a deadly and aggressive type of breast cancer. A key challenge relates to the need for a more detailed, formal, objective definition of IBC, the lack of which compromises clinical care, hampers the conduct of clinical trials, and hinders the search for IBC-specific biomarkers and treatments because of the heterogeneity of patients considered to have IBC.

METHODS

Susan G. Komen, the Inflammatory Breast Cancer Research Foundation, and the Milburn Foundation convened patient advocates, clinicians, and researchers to review the state of IBC and to propose initiatives to advance the field. After literature review of the defining clinical, pathologic, and imaging characteristics of IBC, the experts developed a novel quantitative scoring system for diagnosis.

RESULTS

The experts identified through consensus several "defining characteristics" of IBC, including factors related to timing of onset and specific symptoms. These reflect common pathophysiologic changes, sometimes detectable on biopsy in the form of dermal lymphovascular tumor emboli and often reflected in imaging findings. Based on the importance and extent of these characteristics, the experts developed a scoring scale that yields a continuous score from 0 to 48 and proposed cut-points for categorization that can be tested in subsequent validation studies.

CONCLUSION

To move beyond subjective 'clinical diagnosis' of IBC, we propose a quantitative scoring system to define IBC, based on clinical, pathologic, and imaging features. This system is intended to predict outcome and biology, guide treatment decisions and inclusion in clinical trials, and increase diagnostic accuracy to aid basic research; future validation studies are necessary to evaluate its performance.

Cancer blues? A promising judgment bias task indicates pessimism in nude mice with tumors

In humans, affective states can bias responses to ambiguous information: a phenomenon termed judgment bias (JB). Judgment biases have great potential for assessing affective states in animals, in both animal welfare and biomedical research. New animal JB tasks require construct validation, but for laboratory mice (Mus musculus), the most common research vertebrate, a valid JB task has proved elusive. Here (Experiment 1), we demonstrate construct validity for a novel mouse JB test: an olfactory Go/Go task in which subjects dig for high- or low-value food rewards. In C57BL/6 and Balb/c mice faced with ambiguous cues, latencies to dig were sensitive to high/low welfare housing: environmentally-enriched animals responded with relative 'optimism' through shorter latencies. Illustrating the versatility of this validated JB task across different fields of research, it further allowed us to test hypotheses about the mood-altering effects of cancer in male and female nude mice (Experiment 2). Males, although not females, treated ambiguous cues as intermediate; and males bearing subcutaneous lung adenocarcinomas also responded more pessimistically to these than did healthy controls. To our knowledge, this is the first evidence of a valid mouse JB task, and the first demonstration of pessimism in tumor-bearing animals. This task still needs to be refined to improve its sensitivity. However, it has great potential for investigating mouse welfare, the links between affective state and disease, depression-like states in animals, and hypotheses regarding the neurobiological mechanisms that underlie affect-mediated biases in judgment.

Post-mortem confirmation of fetal brain abnormalities: challenges highlighted by the MERIDIAN cohort study

OBJECTIVES

To assess and analyse the concordance between post-mortem findings and in utero magnetic resonance imaging (iuMRI) in the MERIDIAN (MRI to enhance the diagnosis of fetal developmental brain abnormalities in utero) cohort.

DESIGN

Prospective cohort study.

SETTING

Fetal medicine units in the UK.

POPULATION

Pregnant women with a diagnosis of fetal brain abnormality identified on ultrasound at 18 weeks of gestation or later.

METHODS

All pregnancies from the MERIDIAN study that resulted in a abortion were included and the rate of uptake and success of post-mortem examinations were calculated. In the cases in which diagnostic information about the fetal brain was obtained by post-mortem, the results were compared with the diagnoses from iuMRI.

MAIN OUTCOME MEASURE

Outcome reference diagnosis from post-mortem examination.

RESULTS

A total of 155 from 823 pregnancies (19%) ended in a termination of pregnancy and 71 (46%) had post-mortem brain examinations, 62 of which were diagnostically adequate. Hence, the overall rate of successful post-mortem investigation was 40%, and for those cases there was a concordance rate of 84% between iuMRI and post-mortem examination. Detailed information is provided when the results of the post-mortem examination and the iuMRI study differed.

CONCLUSIONS

We have shown tissue-validation of radiological diagnosis is hampered by a low rate of post-mortem studies in fetuses aborted with brain abnormalities, a situation further compounded by a 12% rate of autopsy being technically unsuccessful. The agreement between iuMRI and post-mortem findings is high, but our analysis of the discrepant cases provides valuable clues for improving how we provide information for parents. TWEETABLE ABSTRACT: iuMRI should be considered a reliable indicator of fetal brain abnormalities when post-mortem is not performed.

Inequality in socio-emotional skills: A cross-cohort comparison

We examine changes in inequality in socio-emotional skills very early in life in two British cohorts born 30 years apart. We construct comparable scales using two validated instruments for the measurement of child behaviour and identify two dimensions of socio-emotional skills: 'internalising' and 'externalising'. Using recent methodological advances in factor analysis, we establish comparability in the inequality of these early skills across cohorts, but not in their average level. We document for the first time that inequality in socio-emotional skills has increased across cohorts, especially for boys and at the bottom of the distribution. We also formally decompose the sources of the increase in inequality and find that compositional changes explain half of the rise in inequality in externalising skills. On the other hand, the increase in inequality in internalising skills seems entirely driven by changes in returns to background characteristics. Lastly, we document that socio-emotional skills measured at an earlier age than in most of the existing literature are significant predictors of health and health behaviours. Our results show the importance of formally testing comparability of measurements to study skills differences across groups, and in general point to the role of inequalities in the early years for the accumulation of health and human capital across the life course.

0087 Childhood Naps Promote Short-Term Destabilization but Long-Term Consolidation of Emotional Memories

Introduction

Early childhood naps have been shown to support emotional memory consolidation, but this benefit only emerges the following day. It is unknown whether consolidation occurs during the nap itself, or if napping only prepares memories for overnight consolidation. In this study, we used a forced-choice recognition task to determine whether naps protect emotional memories against post-nap interference, which would indicate the occurrence of consolidation.

Methods

Preschool children (33–67 months; N=63) viewed neutral faces paired with negative or neutral descriptions. Following a nap or an equal interval awake (within-subjects, order counterbalanced, ~1 week apart), half of these participants (N=33) were presented with an interfering set of faces and descriptions, while the other half (N=30) did not receive interference. For all participants, recognition of the original faces was probed after encoding, after the nap or wake interval, and the next morning.

Results

To assess the influence of napping on changes in emotional memory, 2 (stimulus valence: negative vs. neutral) x 2 (condition: nap vs. wake) repeated-measures ANOVAs were performed. Recall of negative and neutral items did not immediately differ between the nap and wake conditions for the participants who received no interference. 24 hours later, these children trended towards recalling negative and neutral items better if they had napped the previous day (condition main effect: F(1,29)=3.539, p=0.070). In contrast, participants who received interference recalled fewer negative items than neutral items immediately following a nap (p=0.034), while this difference did not emerge following an interval awake.

Conclusion

Our results suggest that naps initially destabilize emotional memories rather than protecting them against interference. However, this initial destabilization may reflect the partial processing of memories during naps, perhaps allowing for enhanced long-term consolidation. Overall, our findings provide important insight into the mechanism of nap-dependent emotional processing.

Support

Supported by NIH R01 HL111695 and an Honors Research Grant from Commonwealth Honors College

Humans can identify cats' affective states from subtle facial expressions

Although cats' popularity as pets rivals that of dogs, cats are little studied, and people's abilities to read this apparently 'inscrutable' species have attracted negligible research. To determine whether people can identify feline emotions from cats' faces, participants (n = 6,329) each viewed 20 video clips of cats in carefully operationalised positively (n = 10) or negatively valenced states (n = 10) (cross-factored with low and high activity levels). Obvious cues (eg open mouths or fully retracted ears) were eliminated. Participants' average scores were low (11.85/20 correct), but overall above chance; furthermore, 13% of participants were individually significantly successful at identifying the valence of cats' states (scoring ≥ 15/20 correct). Women were more successful at this task than men, and younger participants more successful than older, as were participants with professional feline (eg veterinary) experience. In contrast, personal contact with cats (eg pet-owning) had little effect. Cats in positive states were most likely to be correctly identified, particularly if active rather than inactive. People can thus infer cats' affective states from subtle aspects of their facial expressions (although most find this challenging); and some individuals are very good at doing so. Understanding where such abilities come from, and precisely how cats' expressions change with affective state, could potentially help pet owners, animal care staff and veterinarians optimise feline care and welfare.

Twenty Years of Military Prehospital Care in the Eastern Sovereign Base Area, Cyprus

INTRODUCTION

The Medical Reception Station (MRS) in Dhekelia provides a prehospital emergency care (PHEC) service for the Eastern Sovereign Base Area and surrounding Cypriot towns. This service has been evaluated previously but some important aspects of care have not yet been measured. The primary aim of this study was to undertake the most comprehensive service evaluation of the demand for the PHEC service at MRS Dhekelia over a 12-month period. The secondary aim of this study was to compare findings in 2018 to those in 1995-1998 and 2013-2016.

METHODS

All calls to the PHEC team between 01/07/2017 and 30/06/2018 were reviewed and compared with previously reported data from 1995 to 1998 and 2013 to 2016. Data were collected from the occurrence book, the logbook used by the PHEC team to record the details of each call.

RESULTS

There were 164 calls to the PHEC service during the current study period. The number of activations has decreased since the 2013-2016 period but remains greater than 1995-1998. In every month there was a call to a scene where more than one casualty was present, with the highest number being nine patients at one call. More calls were received during the day (55%). There were more calls because of trauma than medical complaints (55% vs 45%). Trauma calls have reduced over 20 years. The frequency of neurological and psychiatric complaints has increased over 20 years.

CONCLUSIONS

The PHEC service at MRS Dhekelia is frequently used. The team consistently face with scenes with more than one casualty. Trauma is becoming less frequent but psychiatric and neurological complaints are increasingly common. These findings are important for training and service provision.

Neurophysiological correlates of stereotypic behaviour in a model carnivore species

Stereotypic behaviour (SB) is common in animals housed in farm, zoo or laboratory conditions, including captive Carnivora (e.g. wild ursids and felids). Neurobiological data on housing-induced SBs come from four species (macaques, two rodent species, and horses), and suggest basal ganglia (BG) dysfunction. We investigated whether similar patterns occur in Carnivora via a model, American mink, because their SB is distinctive in form and timing. We raised 32 males in non-enriched (NE) or enriched (E) cages for 2 years, and assessed two forms of SB: 1) Carnivora-typical locomotor-and-whole-body ('loco') SBs (e.g. pacing, weaving); 2) scrabbling with the forepaws. Neuronal activity was analysed via cytochrome oxidase (CO) staining of the dorsal striatum (caudate; putamen), globus pallidus (externus, GPe; internus, GPi), STN, and nucleus accumbens (NAc); and the GPe:GPi ratio (GPr) calculated to assess relative activation of direct and indirect pathways. NE mink stereotyped more, and had lower GPr CO-staining indicating relatively lower indirect pathway activation. However, no single BG area was affected by housing and nor did GPr values covary with SB. Independent of housing, elevated NAc CO-staining predicted more loco SB, while scrabbling, probably because it negatively correlated with loco SB, negatively covaried with NAc CO-staining in NE subjects. These results thus implicate the NAc in individual differences in mink SB. However, because they cannot explain why NE subjects showed more SB, they provide limited support for the BG dysfunction hypothesis for this species' housing-induced SB. More research is therefore needed to understand how barren housing causes SB in captive Carnivora.

Anatomical subgroup analysis of the MERIDIAN cohort: ventriculomegaly

OBJECTIVE

To assess the contribution of fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort diagnosed with ventriculomegaly (VM) as the only abnormal intracranial finding on antenatal ultrasound.

METHODS

This was a subgroup analysis of the MERIDIAN study of fetuses with only VM diagnosed on ultrasound in women who had a subsequent MRI examination within 2 weeks and for whom outcome reference data were available. The diagnostic accuracy of ultrasound and MRI was reported in relation to the severity of VM. The difference in measurements of trigone size on the two imaging methods and the clinical impact of adding MRI to the diagnostic pathway were also studied.

RESULTS

In 306 fetuses with VM, ultrasound failed to detect 31 additional brain abnormalities, having an overall diagnostic accuracy of 89.9% for ultrasound, whilst MRI correctly detected 27 of the additional brain abnormalities, having a diagnostic accuracy of 98.7% (P < 0.0001). There were other brain abnormalities in 14/244 fetuses with mild VM on ultrasound (diagnostic accuracy, 94.3%) and MRI correctly diagnosed 12 of these (diagnostic accuracy, 99.2%; P = 0.0005). There was a close agreement between the size of trigones measured on ultrasound and on MRI, with categorical differences in only 16% of cases, showing that MRI did not systematically overestimate or underestimate trigone size. Complete prognostic data were available in 295/306 fetuses and the prognosis category changed after MRI in 69/295 (23.4%) cases. The overall effect of MRI on clinical management was considered to be 'significant', 'major' or 'decisive' in 76/295 (25.8%) cases.

CONCLUSION

Our data suggest that a woman carrying a fetus with VM as the only intracranial finding on ultrasound should be offered an adjuvant investigation by MRI for further evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Anatomical subgroup analysis of the MERIDIAN cohort: posterior fossa abnormalities

OBJECTIVE

To assess the diagnostic and clinical contribution of fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort diagnosed with abnormalities of the posterior fossa as the only intracranial abnormality recognized on antenatal ultrasound.

METHODS

This was a subgroup analysis of the MERIDIAN study of fetuses with abnormalities of the posterior fossa (with or without ventriculomegaly) diagnosed on antenatal ultrasound in women who had MRI within 2 weeks of ultrasound and for whom outcome reference data were available. The diagnostic accuracy of ultrasound and MRI is reported, as well as indicators of diagnostic confidence and effects on prognosis and clinical management. Appropriate diagnostic confidence was assessed by the score-based weighted average method, which combines diagnostic accuracy with diagnostic confidence data.

RESULTS

Abnormalities confined to the posterior fossa according to ultrasound were found in 81 fetuses (67 with parenchymal and 14 with cerebrospinal fluid-containing lesions). The overall diagnostic accuracy for detecting an isolated posterior fossa abnormality was 65.4% for ultrasound and 87.7% for MRI (difference, 22.3% (95% CI, 14.0-30.5%); P < 0.0001). There was an improvement in 'appropriate' diagnostic confidence, as assessed by the score-based weighted average method (P < 0.0001), and a three-fold reduction in 'high confidence but incorrect diagnosis' was achieved using MRI. Prognostic information given to the women changed after MRI in 44% of cases, and the overall effect of MRI on clinical management was considered to be 'significant', 'major' or 'decisive' in 35% of cases.

CONCLUSIONS

Our data suggest that any woman whose fetus has a posterior fossa abnormality as the only intracranial finding on ultrasound should have MRI for further evaluation. This is on the basis of improved diagnostic accuracy and confidence, which impacts substantially on the prognostic information given to women as well as their clinical management. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Anatomical subgroup analysis of the MERIDIAN cohort: failed commissuration

OBJECTIVE

To assess the contribution of fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort diagnosed with either agenesis or hypogenesis of the corpus callosum (referred to collectively as failed commissuration) on antenatal ultrasound.

METHODS

This was a subgroup analysis of the MERIDIAN study of fetuses with failed commissuration (with or without ventriculomegaly) diagnosed on ultrasound in women who had MRI assessment within 2 weeks of ultrasound and for whom outcome reference data were available. The diagnostic accuracy of ultrasound and MRI was studied, as well as indicators of diagnostic confidence and effects on prognosis/clinical management. Appropriate diagnostic confidence was assessed by the score-based weighted average method, which combines diagnostic accuracy with diagnostic confidence data.

RESULTS

In the MERIDIAN cohort, 79 fetuses were diagnosed with failed commissuration on ultrasound (55 with agenesis and 24 with hypogenesis of the corpus callosum). The diagnostic accuracy for detecting failed commissuration was 34.2% for ultrasound and 94.9% for MRI (difference, 60.7% (95% CI, 47.6-73.9%), P < 0.0001). The diagnostic accuracy for detecting hypogenesis of the corpus callosum as a discrete entity was 8.3% for ultrasound and 87.5% for MRI, and for detecting agenesis of the corpus callosum as a distinct entity was 40.0% for ultrasound and 92.7% for MRI. There was a statistically significant improvement in 'appropriate' diagnostic confidence when using MRI as assessed by the score-based weighted average method (P < 0.0001). Prognostic information given to the women changed in 36/79 (45.6%) cases after MRI and its overall effect on clinical management was 'significant', 'major' or 'decisive' in 35/79 cases (44.3%).

CONCLUSIONS

Our data suggest that any woman whose fetus has failed commissuration as the only intracranial finding detected on ultrasound should have MRI examination for further evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Abstract P5-08-27: Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry

Introduction In 2010, the cutoff for HR positivity in breast cancer was established as ≥1% of cells staining HR+, previously having varied from 1% to 10%. The impact of this change on treatment patterns and outcomes is poorly understood. SystHERs is a prospective, observational cohort registry of patients (pts) with HER2+ metastatic breast cancer (MBC) that commenced enrollment in 2012. To our knowledge, SystHERs is the largest registry to collect and analyze data for the HER2+ subgroup. We report baseline characteristics, treatment patterns, and early outcomes by %HR+ (1–9% vs 10–100%).

Methods SystHERs enrolled pts aged ≥18 years and within 6 months of HER2+ MBC diagnosis. For pts with locally-determined HR+ disease, defined as HR+ in primary or metastatic tissue, %HR+ is the highest percentage of ER+ or PR+ tissue in early breast cancer or MBC. The percentage of ER+ or PR+ cells was not reported for pts considered HR– by the investigator. Median overall survival (OS; Kaplan–Meier) and hazard ratios (Cox regression) were estimated.

Results As of Feb 1, 2016, data were available for 872 eligible pts with known HR status, of whom 608 (70%) had HR+ disease. Of the 608 pts, 53 (9%) had 1–9%HR+ and 496 (82%) had 10–100%HR+; %HR+ was not reported for 59 pts. Baseline characteristics were similar between %HR+ subgroups (Table 1).

As shown in Table 2, the 1–9%HR+ subgroup was less likely to receive first-line hormonal therapy (26%) than the 10–100%HR+ subgroup (56%). 87% and 79% of pts received chemotherapy, respectively.

Median time from MBC diagnosis was 16.5 months (range, 0.4–49.4 months). Median OS was not reached at the data cutoff. The number of deaths was 13 (25%) in the 1–9%HR+ subgroup, and 68 (14%) in the 10–100%HR+ subgroup (log-rank P=0.025). The OS hazard ratio (0.514, 95% CI 0.283–0.931) favored the 10–100%HR+ subgroup. OS did not differ significantly between pts with 1–9%HR+ vs HR– disease (log-rank P=0.582, hazard ratio 1.185, 95% CI 0.647–2.169).

Table 1. Baseline characteristics 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)Age at MBC diagnosis, median yrs (range)54 (30–86)57 (21–86)55 (28–88)Race, %   White838372Black151320Premenopausal, %282522ECOG performance status, %   04654441463942≥2878MBC diagnosis type, %   De novo404958Recurrent605142Visceral, %*686275*Non-hepatic abdominal, ascites, CNS, liver, lung, or pleural effusion sites of metastasis

Table 2. First-line treatment 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)HER2-targeted therapy, %969391Chemotherapy, %877989Hormonal therapy, %26564

Conclusions These preliminary observational data suggest potential differences in treatment patterns and survival outcomes in low vs moderate/high HR+ expressers, with the former being less likely to receive hormonal therapy (26% vs 56%). Furthermore, low HR positivity was associated with poorer OS and was similar to OS observed in pts with HR– disease.

Citation Format: Jahanzeb M, Tripathy D, Rugo H, Swain S, Kaufman PA, Mayer M, Hurvitz S, O'Shaughnessy J, Mason G, Yardley DA, Brufsky A, Chu L, Antao V, Beattie M, Yoo B, Cobleigh M. Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-27.

Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

Background

Clinical studies suggest that hemodiafiltration (HDF) may lead to better clinical outcomes than high-flux hemodialysis (HF-HD), but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD.

Methods

The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1) estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3) application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different risk profiles, for example, by age (patients aged 40, 50, and 60 years), sex, and diabetic status. Scatter plots of simulations in the cost-effectiveness plane were produced, incremental cost-effectiveness ratios were estimated, and cost-effectiveness acceptability curves were computed.

Results

An incremental cost-effectiveness ratio of €6,982/quality-adjusted life years (QALY) was estimated for the baseline cohort of 50-year-old male patients. Given the commonly accepted threshold of €40,000/QALY, HDF is cost-effective. The probabilistic sensitivity analysis showed that HDF is cost-effective with a probability of ~81% at a threshold of €40,000/QALY. It is fundamental to measure the outcome also in terms of quality of life. HDF is more cost-effective for younger patients.

Conclusion

HDF can be considered cost-effective compared to HF-HD.

Diagnosis of fetal submicroscopic chromosomal abnormalities in failed array CGH samples: copy number by sequencing as an alternative to microarrays for invasive fetal testing

OBJECTIVES

Array comparative genomic hybridization (CGH) has become the technology of choice for high-resolution prenatal whole genome analysis. Limitations of microarrays are mainly related to the analog nature of the analysis, and poor-quality DNA can result in failed quality metrics with these platforms. We examined a cohort of abnormal fetuses with failed array CGH results using a next-generation sequencing algorithm, CNV-Seq. We assessed the ability of the platform to handle suboptimal prenatal samples and generate interpretable molecular karyotypes.

METHODS

Nine samples obtained from abnormal fetuses and one from a normal control fetus were sequenced using an Illumina GAIIx. A segmentation algorithm for sequencing data was used to determine regional copy number data on the sequencing datasets.

RESULTS

Phred quality scores were satisfactory for analysis of all samples. CNV-Seq identified both large- and small-scale abnormalities in the cohort, and normal results were obtained for fetuses for which microarray data were previously uninterpretable. No variants of uncertain significance were detected. Analysis of the digital sequencing datasets offered some advantages over array CGH output.

CONCLUSIONS

Using next-generation sequencing for the detection of genomic copy number variants may be advantageous for poor-quality, invasively-acquired prenatal samples. CNV-Seq could become a potential alternative to array CGH in this setting.

Home visit program improves technique survival in peritoneal dialysis

BACKGROUND

Peritoneal dialysis (PD) is a home therapy, and technique survival is related to the adherence to PD prescription at home. The presence of a home visit program could improve PD outcomes. We evaluated its effects on clinical outcome during 1 year of follow-up.

METHODS

This was a case-control study. The case group included all 96 patients who performed PD in our center on January 1, 2013, and who attended a home visit program; the control group included all 92 patients who performed PD on January 1, 2008. The home visit program consisted of several additional visits to reinforce patients' confidence in PD management in their own environment. Outcomes were defined as technique failure, peritonitis episode, and hospitalization. Clinical and dialysis features were evaluated for each patient.

RESULTS

The case group was significantly older (p = 0.048), with a lower grade of autonomy (p = 0.033), but a better hemoglobin level (p = 0.02) than the control group. During the observational period, we had 11 episodes of technique failure. We found a significant reduction in the rate of technique failure in the case group (p = 0.004). Furthermore, survival analysis showed a significant extension of PD treatment in the patients supported by the home visit program (52 vs. 48.8 weeks, p = 0.018). We did not find any difference between the two groups in terms of peritonitis and hospitalization rate; however, trends toward a reduction of Gram-positive peritonitis rates as well as prevalence and duration of hospitalization related to PD problems were identified in the case group. The retrospective nature of the analysis was a limitation of this study.

CONCLUSION

The home visit program improves the survival of PD patients and could reduce the rate of Gram-positive peritonitis and hospitalization. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=365168.