Machine learning can reliably predict malignancy of breast lesions based on clinical and ultrasonographic features.

PURPOSE: To establish a reliable machine learning model to predict malignancy in breast lesions identified by ultrasound (US) and optimize the negative predictive value to minimize unnecessary biopsies. METHODS: We included clinical and ultrasonographic attributes from 1526 breast lesions classified as BI-RADS 3, 4a, 4b, 4c, 5, and 6 that underwent US-guided breast biopsy in four institutions. We selected the most informative attributes to train nine machine learning models, ensemble models and models with tuned threshold to make inferences about the diagnosis of BI-RADS 4a and 4b lesions (validation dataset). We tested the performance of the final model with 403 new suspicious lesions. RESULTS: The most informative attributes were shape, margin, orientation and size of the lesions, the resistance index of the internal vessel, the age of the patient and the presence of a palpable lump. The highest mean negative predictive value (NPV) was achieved with the K-Nearest Neighbors algorithm (97.9%). Making ensembles did not improve the performance. Tuning the threshold did improve the performance of the models and we chose the algorithm XGBoost with the tuned threshold as the final one. The tested performance of the final model was: NPV 98.1%, false negative 1.9%, positive predictive value 77.1%, false positive 22.9%. Applying this final model, we would have missed 2 of the 231 malignant lesions of the test dataset (0.8%). CONCLUSION: Machine learning can help physicians predict malignancy in suspicious breast lesions identified by the US. Our final model would be able to avoid 60.4% of the biopsies in benign lesions missing less than 1% of the cancer cases.

Long-Term Respiratory Support for Children and Adolescents in Austria: A National Survey.

BACKGROUND: Population-based data on pediatric patients on long-term respiratory support (LTRS) in Austria are lacking. This study aimed to record the pediatric departments active in this field, as well as number and characteristics of patients on LTRS. METHODS: A national cross-sectional study was carried out by means of questionnaires sent to all pediatric departments in Austria. RESULTS: All departments answered to the questionnaires. On June 1st, 2013, the reference day for this study, 12 of the 41 pediatric departments in Austria were active in the field. At this time, these centers were caring for 143 patients, 111 (77.6%) of them under 18 years, which corresponds to a prevalence of 7.4 per 100 000. The patients suffered from neuromuscular disorders (44%), other neurological disorders (18.9%), disorders of respiratory drive (9.1%), obstructive sleep apnea (8.4%), thoracal and spinal diseases (8.4%), pulmonary disorders (4.9%) and other diseases (6.3%). Continuous positive airway pressure was used in 6.3%, non-invasive ventilation in 60.1% and invasive ventilation in 33.6% of the patients, respectively. LTRS was performed at home in 92.3%. CONCLUSION: LTRS represents a common management strategy in children and adolescents with a variety of disorders. Census reports such as this one provide the basis for appropriate planning of resource allocation. The age distribution of our patients shows the need for structured transition into adult care.

Association of symptoms of attention-deficit/hyperactivity disorder with childhood overweight adjusted for confounding parental variables.

OBJECTIVE: There have been numerous reports on association between attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity in children and adolescents; however, most studies adjusted only for a limited number of possible confounders. METHODS: We analyzed the data of 11,159 six through seventeen-year-old participants in the German Health Interview and Examination Survey for Children and Adolescents. We determined weight status based on measured anthropometry and national reference data by International Obesity Task Force criteria. The parent-rated hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire (SDQ-HI) was used as a continuous measure of ADHD symptoms. We examined whether the putative confounders socioeconomic status, migrant status, parental body mass index (BMI) and parental smoking were associated with both SDQ-HI and overweight/obesity. Associations between SDQ-HI and overweight/obesity vs normal weight were analyzed by binary logistic regression analyses. In the first model, we adjusted for age and sex only and in the second model also for the parental confounders. RESULTS: SDQ-HI was associated with an increased risk for overweight/obesity in both sexes adjusting for age and sex. However, after adjusting for all confounders SDQ-HI was associated with an increased risk for overweight/obesity only in adolescent females. Socioeconomic status, parental BMI and parental smoking each were relevant confounders. Migrant status was also significantly associated with both SDQ-HI and overweight/obesity, thus qualifying as a confounder but contributed only weakly to the association. CONCLUSIONS: The association between ADHD symptoms and overweight/obesity is due to confounding by family background variables in all but adolescent girls. Possible reasons for the increased risk for overweight/obesity in this subgroup are discussed. We also propose possible mechanisms for confounding by parental socioeconomic status, BMI and smoking.

[Hypertension, dyslipoproteinemia and BMI-category characterise the cardiovascular risk in overweight or obese children and adolescents: data of the BZgA-observational study (EvAKu-J-project) and the KiGGS-study]. / Hypertonie, Dyslipoproteinämie und BMI-Kategorie charakterisieren das kardiovaskuläre Risiko bei übergewichtigen oder adipösen Kindern und Jugendlichen: Daten der BZgA-Beobachtungsstudie (EvAKuJ-Projekt) und der KiGGS-Studie.

BACKGROUND: The considerable increase of obesity in children and adolescents poses a major challenge to the health care system. METHODS: In an observation study of the Bundeszentrale für gesundheitliche Aufklärung (BZgA) somatic data of 1916 overweight and obese children and adolescents aged 8-17 years were compared to data of 7 451 normal weight children and adolescents (KiGGS). Age, sex, body weight, height, BMI-SDS, blood pressure, and lipids were analyzed. Body weight was assessed using the BMI categories of the Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA) guidelines. Blood pressure measurements were given as above 95 (th) percentile and categorized according to the classification of the European Society of Hypertension (ESH). In addition blood pressure in BZgA-patients were estimated as above 95 (th) percentile by age, sex and height in German normal weight children and adolescents. Lipid values were evaluated according to American Heart Association specifications. RESULTS: Out of the participants of BZgA-study 14% were overweight, 48% obese, and 38% extremely obese. Blood pressure values were above the 95 (th) percentile (ESH) in 35%. The blood pressure in normal weight participants of the KiGGS-study were elevated in 5%. Total cholesterol of BZgA-patients was elevated in 13%, LDL-cholesterol was elevated in 13%, HDL-cholesterol was low in 7%, and triglycerides in the fasting state were elevated in 12%. CONCLUSIONS: The rising prevalence of cardiovascular risk factors in children and adolescents with increasing BMI category requires effective strategies for prevention and treatment of obesity.

[Evaluation of obesity treatment in children and adolescents (EvAKuJ Study). Role of therapeutic concept, certification, and quality indicators]. / Evaluation von Therapieangeboten für adipöse Kinder und Jugendliche (EvAKuJ-Projekt). Welche Rolle spielen Behandlungskonzept, AGA-Zertifizierung und initiale Qualitätsangaben?

AIM: Different providers of obesity treatment in children and adolescents in Germany were compared using the following criteria: outpatient/inpatient; with/without AGA certification; good/less good quality. METHODS: A total of 1,916 patients (8-16.9 years) from 48 study centers were examined before (t0), after (t1), and at least 1 year after therapy (t2/3). Body mass index (BMI), blood pressure, blood lipids, and psychosocial data were measured. RESULTS: Patients from inpatient rehabilitation centers were older and more obese. Patients from AGA-certified centers were more obese, and the completeness of comorbidity screening was higher. There were no differences in short- or long-term BMI reduction. "Good" treatment centers (classified after the UKE study 2004) did not differ from those centers not rated as "good" in weight reduction. Patients treated in "good" centers were more obese, and screening for comorbidity was better. No differences in drop out and loss to follow-up were found. CONCLUSION: There were only small differences between the different groups. Pronounced differences were found between the individual treatment centers. In order to improve therapy processes and outcomes, benchmarking and quality management have to be extended.

[Overweight and obesity in childhood and adolescence. Evaluation of inpatient and outpatient care in Germany: the EvAKuJ study]. / Übergewicht und Adipositas in Kindheit und Jugend. Evaluation der ambulanten und stationären Versorgung in Deutschland in der "EvAKuJ-Studie".

Numerous forms of therapy exist for the increasing number of obese children and adolescents in Germany, but these are heterogeneous and have not been evaluated. Access to health care, long- and short-term treatment outcome, as well as factors determining success of therapy were examined for the first time using standardized instruments to measure somatic and psychosocial variables. A total of 1,916 children aged 8-16 years from 48 (5 rehabilitation, 43 outpatient) institutions were examined. Data were collected for height, weight, blood pressure, and lipid status before treatment started (t0), at the end of treatment (t1), and 1 year after completion of treatment (t2). Furthermore, psychosocial variables were documented using questionnaires for parents and children. The mean BMI-SDS (body mass index standard deviation score) reduction at t1 was -0.27 and 1 year later at t2 was -0.23 (per protocol analysis; intention to treat: t1=-0.24; t2=-0.06). Psychological health and quality of life, which were markedly impaired at the beginning, improved. However, physical activity, media consumption, and nutrition remained basically unchanged. A reduction in weight is associated with an improvement in cardiovascular risk profiles, and long-term behavior changes are possible. However, the institutions differed considerably in the percentage of follow-up examinations and in the weight reduction accomplished.

[Treatment of obesity in pediatric patients in Germany: anthropometry, comorbidity and socioeconomic gradients based on the BZgA Observational Study]. / Beobachtungsstudie der BZgA zur Adipositastherapie bei Kindern und Jugendlichen in Deutschland: Anthropometrie, Komorbidität und Sozialstatus.

BACKGROUND: In recent years, the prevalence of overweight and obesity in children and adolescents has markedly increased. Even though numerous treatment options are available for patients, these are heterogeneously structured and insufficiently evaluated. PATIENTS: In this initial report of specific therapy under routine care circumstances, data from 1916 patients aged 8-16.9 years were analyzed. Patients were characterized based on cluster of therapy, sociodemographic, psychosocial and medical features. Furthermore, the quality of care procedures with regard to the diagnosis of comorbidities was analyzed. RESULTS: At initial medical examination mean patient BMI-SDS was +2.43 and mean age was 12.6 years. 43.3% of patients were male. The mean duration of treatment was 6.1 months (55% outpatient, 45% inpatient care setting). 14% of patients were overweight, 48% obese and 37% were extremely obese. In 51% of the patients we could find already comorbidities. Parental BMI was related to patient's BMI. Socioeconomic status was reduced compared to general population. CONCLUSION: In this nationwide, pioneer multicentre observational study initiated by Federal Centre for Health Education (BZgA) in Germany, different therapeutic approaches were compared by examining somatic and psychosocial variables. The short- and long-term effects of different weight reduction programs on BMI-SDS, nutritional- and physical activity habits as well as quality of life and comorbidity will be examined at the end of therapy. Two follow-up assessments are planned for one and two years after the intervention ended.

Efficacy of a commercial inactivated H5 influenza vaccine against highly pathogenic avian influenza H5N1 in waterfowl evaluated under field conditions.

Highly pathogenic avian influenza virus (HPAIV) can cause devastating losses in the poultry industry. In addition, several HPAIV exhibit a zooanthroponotic potential and can cause fatal infections in humans. These attributes particularly apply to HPAIV H5N1 of Asian origin. Due to the absence of overt clinical symptoms, introduction and subsequent spread of HPAIV H5N1 in domestic waterfowl (especially ducks) may occur undetected, which increases the risk of transspecies transmissions to highly vulnerable gallinaceous poultry and mammals, including humans. Humans may also become infected with HPAIV H5N1 by food products from slaughtered, silently infected ducks. Vaccination against HPAIV can raise a protective barrier against an incursion of HPAIV since, at least under experimental conditions, the reproduction factor R0 lowered to <1, which ensures eradication of the virus. The objective of this study was to analyse whether these results can also be obtained under free-ranging field conditions in commercially reared flocks of goose parents and fattening ducks injected with a licensed, adjuvanted inactivated H5N2 vaccine. The time and labour required for the vaccination of these geese and duck flocks exceeded expected values, mainly due to animal sorting according to foot ring labels. No adverse effects directly associated with vaccination were observed. Serologically, a homogenous H5-specific antibody response was induced. Titres varied with temporal distance from the last application of vaccine. Geese parents were clinically protected against challenge with HPAIV A/Cygnus cygnus/Germany/R65/06 (H5N1), but still could be infected and spread HPAIV H5N1, albeit at lower levels and for shorter periods compared to unvaccinated controls. Fattening Pekin ducks proved to be clinically resistant against challenge virus infection and shed very little virus.

EU demonstration project for separate discharge and treatment of urine, faeces and greywater--part I: results.

The main aim of this EU demonstration project was to test two new sanitation concepts to determine if these concepts are more sustainable, compared with the conventional sanitation system, particularly with regard to nutrient recycling. Two different sanitation concepts were tested. One concept comprised the use of gravity separation toilets, the other used vacuum separation toilets. Results from a life-cycle-assessment investigation show that the new sanitation concepts are more sustainable. A cost analysis for an existing residential area did not prove lower costs for the new sanitation concepts in this special case. The experience from this demonstration project shows that prior to a widespread use of the new sanitation concepts, several improvements have to be made. One important issue is the improvement of separation toilets. Since nutrient recycling, water saving and reuse as well energy reduction become more and more important, further research should be undertaken in this field.

EU demonstration project for separate discharge and treatment of urine, faeces and greywater--part II: cost comparison of different sanitation systems.

The experience from the EU demonstration project was used for a cost analysis of different sanitation systems with regard to nutrient recycling. The analysis was made for an existing residential area, for which the different sanitation systems have been applied. The cost calculations were made for a lifetime of 50 years. The multiple sewer systems cause higher investment costs, mainly for the installation of the additional facilities; the investment costs for the treatment are lower. The cost analysis did not prove lower costs for the new sanitation concepts in this special case in comparison with the conventional system. Economic benefits are demonstrated for the operation costs. The result will be reinforced by the consideration of an increase of the energy costs. The revenues for the nutrient related products have only a very small impact on the result.

Acute myeloid leukemia: analysis of ras gene mutations and clonality defined by polymorphic X-linked loci.

In vitro DNA amplification and synthetic oligonucleotide hybridization was used to analyze 57 acute myelocytic leukemias (AML) for the presence of ras gene mutations. We demonstrated mutated alleles in 19% of primary AMLs (10/51) as well as in five of six secondary leukemias. Mutations occurred predominantly at N-ras codons 12, 13, or 61 (13 cases) and twice at Ki-ras codons 12 and 13. Ras gene mutations were preferentially associated with an M4 morphology according to the FAB (French-American-British) classification, but no particular correlation was observed with respect to clinical parameter (sex, age, course of disease) or immunophenotype and karyotype. Mutated ras alleles were absent in nine mutation-positive cases analyzed during remission. However, a more complex pattern emerged from the five patients analyzed in relapse exhibiting identical ras mutations in three cases, absence of a mutated allele in one patient, and acquisition of a N-ras mutation in yet another case, in which no mutation had been detected initially. Moreover, restriction fragment length polymorphisms (RFLP) of the X-chromosome genes hypoxanthine phosphoribosyl transferase (HPRT) and phosphoglycerate kinase (PGK) were studied in 19 of the AML patients. Nine cases (47%) were heterozygous for BglI or BamHI RFLPs at the PGK or HPRT loci, respectively, and therefore suitable for clonal analysis investigating X-chromosome inactivation. All of the patients exhibited a monoclonal leukemic cell population at presentation. In addition, five of seven cases studied in remission showed reemergence of a polyclonal pattern. However, two children exhibited persistence of monoclonal hematopoiesis despite complete clinical/hematological remission and a corresponding loss of a mutated ras allele in one of the patients. These data indicate the value of molecular genetic approaches for evaluation of the heterogeneous nature of remission and relapse in AML.

Freeze-fracture study of an invertebrate multiple-contact synapse: the fly photoreceptor tetrad.

Bow-shaped particle arrays on the P-faces of the photoreceptor terminals R1-R6 in the lamina ganglionaris of the house fly represent the presynaptic sites of chemically mediated multiple-contact synapses (Shaw and Stowe, '82, Saint Marie and Carlson, '82). A particle array consists of two polar patches of regularly arranged particles and a central patch of irregularly arranged ones. Corresponding to these P-face arrays, the receptor E-faces have lattices of pits opposite the polar patches, and pits and some particles at the center. The presynaptic particle array corresponds in its dimensions to the electron-dense bar found in thin sections. The center-to-center spacing of the regularly arranged particles agrees with the spacing of striations found in the bar overlying the two polar elements of the postsynaptic tetrad. The elements in the two medial postsynaptic positions are hyperpolarizing monopolar cells L1 and L2, which show a strip of P-face particles within an otherwise bare postsynaptic membrane enclosed by a ridge, and a bare E-face. Comparison with other invertebrate synapses reveals two types of organization of postsynaptic membranes. IMPs fracture with the postsynaptic P-face in GABAergic and/or inhibitory synapses and with the E-face in glutaminergic and/or excitatory synapses; the fly photoreceptor synapse thus fits in the former category.

Activity of NK 611, a new epipodophyllotoxin derivative, against colony forming units from freshly explanted human tumours in vitro.

NK 611 is a new semisynthetic analogue of etoposide, which presumably also acts through inhibition of topoisomerase II, and has been found to be more potent against several cancer cell lines in vitro than etoposide. The objectives of our study were to determine the activity of NK 611 against freshly explanted clonogenic cells from human tumours and compare this agent with etoposide and other clinically useful agents. After exposure for 1 h in 45 evaluable tumour specimens, NK 611 showed clear concentration-dependent antitumour activity. At 51 microM, 49% of specimens were markedly inhibited. Using a long-term (21-28 day) exposure at 6.8 microM, 58% of 50 evaluable specimens were profoundly inhibited. At equimolar concentrations, NK 611 was as active as etoposide. Across all tumour types studied, NK 611 was as active as vinblastine, bleomycin, doxorubicin, 5-fluorouracil, mitomycin-C and cisplatin. Our results showed cross resistance to etoposide in the majority of specimens. Activity of NK 611 was greater with long-term exposure than with short-term exposure indicating schedule dependency. We conclude that NK 611 has a wide spectrum of in vitro antitumour activity. Since preliminary clinical information suggests that this drug is well tolerated at high doses, further development of this agent in Phase II trials with multiple dosing schedules is warranted.

Detection of liver metastases from pancreatic cancer using FDG PET.

UNLABELLED: We evaluated the potential of the glucose analog [18F]fluorodeoxyglucose (FDG) as a PET tracer for the hepatic staging in 168 patients designated for resective pancreatic surgery. METHODS: Metastatic liver disease was confirmed or excluded during surgery or with CT follow-up for at least 6 mo. Proven metastases were then retrospectively identified on preoperative CT (gold standard). Hepatic PET scans of all patients were interpreted blindly. Any focal FDG uptake was considered malignant. Both proven hepatic metastases and suspicious hepatic PET lesions were then compared, lesion by lesion, with CT. Standardized uptake values (SUV) and tumor-to-liver ratios (T/L) were determined for the most intense lesion of each patient. RESULTS: Sensitivity of FDG PET was 68% (15 of 22 patients). The lesion detection rate was 97% (28 of 29 metastases) for lesions >1 cm and 43% (16 of 37 metastases) for lesions < or = 1 cm. Specificity was 95% (138 of 146 patients). Six of eight patients with false-positive results had marked intrahepatic cholestasis (versus 3 of 15 patients with true-positive lesions), one had an infrahepatic abscess and one had a right basal pulmonary metastasis. The SUV and T/L were 4.6+/-1.4 and 2.3+/-1.1, respectively, for malignant lesions and 4.1+/-1.5 and 1.9+/-0.3, respectively, for false-positive lesions and therefore are of limited value. CONCLUSION: FDG PET provides reliable hepatic staging for lesions >1 cm. False-positive results are associated with the presence of marked intrahepatic cholestasis. For lesions < or = 1 cm, FDG PET can define malignancy in 43% of suspicious CT lesions in the absence of dilated bile ducts.

Clinical and pharmacokinetic study of oral NK611, a new podophyllotoxin derivative.

NK611 is a novel water-soluble podophyllotoxin derivative that has comparable antitumour activity but higher potency and better bioavailability in animals as compared with etoposide. The primary objectives of this study were to determine, after both oral and intravenous administration in the same patient, the bioavailability and the pharmacokinetic profile of NK611. Secondary objectives involved evaluation of the toxicity and the antitumor activity. Patients were randomly assigned to receive oral or intravenous (30-min infusion) doses of 5, 10, and 20 mg/m2 on day 1, when pharmacokinetic studies were performed. A daily oral dose of 20 mg/m2 was then given from day 4 through day 7 for respective total doses of 85, 90, and 100 mg/m2. NK611 and its metabolites were determined in plasma and urine by two different high-performance liquid chromatography (HPLC) methods with UV detection. A total of 21 adult patients entered the study and received the complete first cycle and at least the 1st day of cycle 2; 17 of them received at least 2 complete cycles of treatment. After intravenous administration, the plasma decay curve of NK611 followed a two-exponential model, and after oral administration it declined monoexponentially in most cases. At all dose levels, bioavailability values were around 100%. At concentrations between 10 and 20 mg/m2 after both routes of administration, the pharmacokinetics were nonlinear; the terminal half-life, plasma clearance, and volume of distribution were significantly different; and the area under the plasma concentration-time curve was not correlated to the dose. The urinary excretion of NK611 corresponded to 10-15% of the dose after administration by both routes, whereas that of N-demethyl NK611 and its picroform was highly variable. The features of neutropenia were comparable with those noted for etoposide involving a high degree of interpatient variability and recovery within 1 month after treatment. A daily dose of 20 mg/m2 for 5 consecutive days every 4 weeks is the recommended regimen for phase II studies in patients who have never been treated or have undergone previous chemotherapy only once.

In vitro inhibition of adhesion of enterotoxigenic Escherichia coli K88 to piglet intestinal mucus by egg-yolk antibodies.

The objective of the study was to determine if the adhesion of E. coli K88 to piglet intestinal mucus could be inhibited in vitro by spray-dried egg-yolk anti-K88 antibodies. Binding of E. coli was monitored using a radioactive assay. Four 14+/-2-day-old healthy piglets were used for the preparation of mucus from the small intestine. Competition and displacement phenomena were investigated by incubating (a) egg-yolk antibodies and E. coli together prior to adding to the mucus and (b) E. coli and mucus, followed by egg-yolk antibodies. The results demonstrated that egg-yolk antibodies inhibited the adhesion of 3H-labeled local strain of hemolytic E. coli K88+ (E. coli K88+ MB) to piglet small intestinal mucus by 84.6-97.0% when the egg-yolk antibodies were diluted 10, 20, 40 or 100 times. The adhesion inhibiting effects of egg-yolk antibodies declined dramatically when the antibody dilution was more than 250-fold. A similar adhesion inhibiting effect was observed when egg-yolk antibodies were incubated with E. coli K88+ MB for 15, 30 and 60 min prior to the adhesion test. Egg-yolk antibodies when diluted 50- and 100-fold had a very strong inhibiting ability against E. coli K88+ MB at a concentration of 10(9) colony forming units (cfu) ml(-1) (adhesion was < 6%). However, dilution of 100 times for egg yolk antibodies was insufficient to inhibit the adhesion of E. coli K88+ MB to intestinal mucus when the concentration of E. coli K88+ MB was 10(10) cfu ml(-1). The displacement test indicated that there was no significant reduction in the adhesion of E. coli K88+ MB to the small intestinal mucus when egg-yolk antibodies were added after adhesion of the organism to the mucus. These studies demonstrate that anti-K88+ MB fimbriae antibodies from chicken egg-yolk when added to E. coli K88+ MB prevented their binding to receptors in the mucus isolated from the intestine of piglets.

Characterization and purification of porcine small intestinal mucus receptor for Escherichia coli K88ac fimbrial adhesin.

The objectives of this study were to investigate the nature of, and to purify K88ac fimbrial adhesin-specific receptors in the mucus from the small intestine of piglet. Adhesion was studied by incubating (3)H-labeled Escherichia coli with mucus that were treated with or without pronase, proteinase, trypsin or sodium metaperiodate. The results indicated that treatment with either proteolytic enzymes or sodium metaperiodate (to oxidize sugars) significantly reduced E. coli K88ac or K88+MB adhesion to the mucus, suggesting that the K88ac and K88+MB specific receptors in this preparation were, at least in part, glycoprotein in nature. The K88+MB fimbriae specific receptor was purified using affinity chromatography. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of the purified K88+MB specific receptor together with the above data suggested that the receptor from the mucus of the small intestine of the pig was a 80-kDa glycoprotein.

Passive protective effect of egg-yolk antibodies against enterotoxigenic Escherichia coli K88+ infection in neonatal and early-weaned piglets.

The protective effects of egg-yolk antibodies obtained from hens immunized with fimbrial antigens from a local strain (Escherichia coli K88+ MB, Manitoba, Canada) of K88+ piliated enterotoxigenic E. coli (ETEC) were evaluated in 3- and 21-day-old piglets in which ETEC diarrhea was induced and also in early-weaned piglets in a commercial farm. The results demonstrated that the E. coli K88+ MB-induced diarrhea in 3-day-old piglets was cured 24 h after treating with egg-yolk antibodies while those treated with egg-yolk powder from conventional hens continued to have diarrhea and 62.5% of them died of severe diarrhea. For 21-day-old weaned piglets, those fed egg-yolk antibodies had transient diarrhea, positive body weight gains and 100% survival during the period of the experiment, whereas control piglets that were treated with placebo had severe diarrhea and dehydration and some died within 48 h after infection. In the field trial, the incidence and severity of diarrhea of 14-18-day-old weaned piglets fed egg-yolk antibodies were much lower than in those fed a commercial diet containing an antibiotic. These results indicate that the neonatal and early-weaned piglets that received the egg-yolk antibodies were protected against ETEC infection.

Familial dysautonomia: a diagnostic dilemma. chronic lung disease with signs of an autoimmune disease.

We present an 11-year-old girl with sensory and autonomic neurological dysfunction, and respiratory insufficiency caused by recurrent aspiration. The diagnosis of familial dysautonomia (FD) was confirmed by a missing axonal flare to histamine, miosis in response to conjunctival methacholine and homozygous polymorphic linked markers DS58(18) and DS159(7) on chromosome 9. Ashkenazi Jewish descent could not be ascertained by history. A variety of positive tests for autoantibodies were initially interpreted as evidence for systemic lupus erythematosus vs. overlap syndrome with pulmonary, cerebral, skin, and ocular involvement. The diagnosis of FD was delayed because of the rarity of this disorder in Germany (second case reported). We discuss possible explanations for the misleading immunological findings, including interference by antibodies binding to milk proteins used as blocking reagents in enzyme-linked immunoassays and circulating immune-complexes due to chronic aspiration pneumonitis.