Food allergy: a proposed new tool for educating children and young people and supporting them to self-manage.

Self-managing food allergy in children and young people presents challenges for families as they attempt to find a balance between their child's safety and freedom. Nurses have an important role in providing education that supports children, young people and their parents to self-manage food allergy safely but not at the expense of the child or young person's social development. At Nottingham Children's Hospital, the allergy service and youth service have developed an education and support tool composed of three domains, 'awareness', 'checking' and 'emergency kit', forming the acronym ACE. The authors suggest that the ACE tool could be used by healthcare professionals as a framework for educating children and young people with food allergy and their parents, as well as by children and young people and their parents at home to risk assess and risk manage everyday situations and new scenarios or events.

Assessment of immunological anti-platelet factor 4 antibodies for vaccine-induced thrombotic thrombocytopenia (VITT) in a large Australian cohort: A multicenter study comprising 1284 patients.

BACKGROUND: Vaccine-induced thrombotic thrombocytopenia (VITT) is a rare complication of adenovirus-based vaccines aimed to prevent and minimize COVID-19 and related pathophysiology. OBJECTIVES: To describe patterns of testing for anti-platelet factor 4 (PF4) antibodies using various ELISA assays in a large Australian cohort and comparative functional platelet activation assays in a subset. PATIENTS/METHODS: Asserachrom HPIA IgG ELISA was performed in 1284 patients over a period of 12 months, supplemented in select cohorts by comparative ELISA using three other methods (n = 78-179), three different functional assays (flow cytometry, serotonin release assay, and/or Multiplate; n = 476), and rapid immunological chemiluminescence anti-PF4 assay (n = 460), in a multicenter study. RESULTS: For first episode presentations, 190/1284 (14.8%) ELISA tests were positive. Conversely, most (445/460; 96.7%) chemiluminescence anti-PF4 test results were negative. All functional assays showed associations of higher median ELISA optical density with functional positivity and with high rates of ELISA positivity (64.0% to 85.2%). Data also identified functional positivity in 14.8%-36.0% of ELISA negative samples, suggesting false negative VITT by HPIA IgG ELISA in upward of one third of assessable cases. CONCLUSION: To our knowledge, this is the largest multicenter evaluation of anti-PF4 testing for investigation of VITT. Discrepancies in test results (ELISA vs. ELISA or ELISA vs. functional assay) in some patients highlighted limitations in relying on single methods (ELISA and functional) for PF4 antibody detection in VITT, and also highlights the variability in phenotypic test presentation and pathomechanism of VITT.

A novel flow cytometry procoagulant assay for diagnosis of vaccine-induced immune thrombotic thrombocytopenia.

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe prothrombotic complication of adenoviral vaccines, including the ChAdOx1 nCoV-19 (Vaxzevria) vaccine. The putative mechanism involves formation of pathological anti-platelet factor 4 (PF4) antibodies that activate platelets via the low-affinity immunoglobulin G receptor FcγRIIa to drive thrombosis and thrombocytopenia. Functional assays are important for VITT diagnosis, as not all detectable anti-PF4 antibodies are pathogenic, and immunoassays have varying sensitivity. Combination of ligand binding of G protein-coupled receptors (protease-activated receptor-1) and immunoreceptor tyrosine-based activation motif-linked receptors (FcγRIIa) synergistically induce procoagulant platelet formation, which supports thrombin generation. Here, we describe a flow cytometry-based procoagulant platelet assay using cell death marker GSAO and P-selectin to diagnose VITT by exposing donor whole blood to patient plasma in the presence of a protease-activated receptor-1 agonist. Consecutive patients triaged for confirmatory functional VITT testing after screening using PF4/heparin ELISA were evaluated. In a development cohort of 47 patients with suspected VITT, plasma from ELISA-positive patients (n = 23), but not healthy donors (n = 32) or individuals exposed to the ChAdOx1 nCov-19 vaccine without VITT (n = 24), significantly increased the procoagulant platelet response. In a validation cohort of 99 VITT patients identified according to clinicopathologic adjudication, procoagulant flow cytometry identified 93% of VITT cases, including ELISA-negative and serotonin release assay-negative patients. The in vitro effect of intravenous immunoglobulin (IVIg) and fondaparinux trended with the clinical response seen in patients. Induction of FcγRIIa-dependent procoagulant response by patient plasma, suppressible by heparin and IVIg, is highly indicative of VITT, resulting in a sensitive and specific assay that has been adopted as part of a national diagnostic algorithm to identify vaccinated patients with platelet-activating antibodies.

Elective surgery in patients with inherited bleeding disorders: A retrospective analysis.

INTRODUCTION: Published guidelines are available to assist in the management of patients with inherited bleeding disorders in the elective surgical setting however good quality outcome data is lacking. AIM: - Evaluate the outcomes of adult patients with inherited bleeding disorders, who received factor replacement for elective surgery in NSW/ACT, Australia. - Assess adherence to relevant guidelines including Haemophilia Treatment Centre (HTC) utilisation and appropriate factor replacement. METHOD: A retrospective analysis was performed between 2000 and 2018 to describe patient characteristics, surgical details, factor provision and outcomes. Univariate analysis was used to determine variables associated with guideline adherence. Covariates with p < 0.1 were included in the multivariate analysis. RESULTS: A total of 1065 surgeries were performed on 571 patients. Diagnoses included Haemophilia A (43.5%), Haemophilia B (9.7%), von Willebrand disease (VWD) (45.3%) and rare bleeding disorders (RBDs) (1.6%). Bleeding complications were reported in 14 surgeries and 19 patients received factor replacement beyond standard duration of prophylaxis. Approximately 50% of all surgeries were performed in a HTC. Multivariate analysis demonstrated that diagnosis, surgical specialty, sex and year (p < 0.001) were associated with non-compliance with variable pattern within each category. Factor replacement was as expected except for plasma-derived Factor VIII/VWF usage in patients with VWD undergoing major bleeding risk surgery. VWD classification (p < 0.001) was associated with this deviation. CONCLUSION: Low complication rates demonstrate that elective surgery in Australia is being safely performed in patients with inherited bleeding disorders however non-compliance with published guidelines exists highlighting areas of practice and policy discrepancies that warrant further exploration.

PCP-B class pollen coat proteins are key regulators of the hydration checkpoint in Arabidopsis thaliana pollen-stigma interactions.

The establishment of pollen-pistil compatibility is strictly regulated by factors derived from both male and female reproductive structures. Highly diverse small cysteine-rich proteins (CRPs) have been found to play multiple roles in plant reproduction, including the earliest stages of the pollen-stigma interaction. Secreted CRPs found in the pollen coat of members of the Brassicaceae, the pollen coat proteins (PCPs), are emerging as important signalling molecules that regulate the pollen-stigma interaction. Using a combination of protein characterization, expression and phylogenetic analyses we identified a novel class of Arabidopsis thaliana pollen-borne CRPs, the PCP-Bs (for pollen coat protein B-class) that are related to embryo surrounding factor (ESF1) developmental regulators. Single and multiple PCP-B mutant lines were utilized in bioassays to assess effects on pollen hydration, adhesion and pollen tube growth. Our results revealed that pollen hydration is severely impaired when multiple PCP-Bs are lost from the pollen coat. The hydration defect also resulted in reduced pollen adhesion and delayed pollen tube growth in all mutants studied. These results demonstrate that AtPCP-Bs are key regulators of the hydration 'checkpoint' in establishment of pollen-stigma compatibility. In addition, we propose that interspecies diversity of PCP-Bs may contribute to reproductive barriers in the Brassicaceae.

Validity of Race, Ethnicity, and National Origin in Population-based Cancer Registries and Rapid Case Ascertainment Enhanced With a Spanish Surname List.

BACKGROUND: Accurate information regarding race, ethnicity, and national origins is critical for identifying disparities in the cancer burden. OBJECTIVES: To examine the use of a Spanish surname list to improve the quality of race-related information obtained from rapid case ascertainment (RCA) and to estimate the accuracy of race-related information obtained from cancer registry records collected by routine reporting. SUBJECTS: Self-reported survey responses of 3954 participants from California enrolled in the Cancer Care Outcomes Research and Surveillance Consortium. MEASURES: Sensitivity, specificity, positive predictive value, and percent agreement. We used logistic regression to identify predictors of underreporting and overreporting of a race/ethnicity. RESULTS: Use of the Spanish surname list increased the sensitivity of RCA for Latino ethnicity from 37% to 83%. Sensitivity for cancer registry records collected by routine reporting was ≥95% for whites, blacks, and Asians, and specificity was high for all groups (86%-100%). However, patterns of misclassification by race/ethnicity were found that could lead to biased cancer statistics for specific race/ethnicities. Discordance between self-reported and registry-reported race/ethnicity was more likely for women, Latinos, and Asians. CONCLUSIONS: Methods to improve race and ethnicity data, such as using Spanish surnames in RCA and instituting data collection guidelines for hospitals, are needed to ensure minorities are accurately represented in clinical and epidemiological research.

Medicaid status and stage at diagnosis of cervical cancer.

OBJECTIVES: We examined whether Medicaid beneficiaries are more likely to be diagnosed with late-stage cervical cancer than women not enrolled in Medicaid. METHODS: Using the California Cancer Registry-Medicaid linked file, we identified 4682 women diagnosed during 1996-1999 with invasive cervical cancer. Multivariate logistic regression was used to evaluate the association between late-stage diagnosis and prediagnosis Medicaid status. RESULTS: Late-stage disease was diagnosed in 51% of Medicaid and 42% of non-Medicaid women. Relative to women without Medicaid coverage, adjusted odds ratios for late-stage diagnosis were 2.8 times higher among women enrolled in Medicaid at the time of their diagnosis and 1.3 times higher among those intermittently enrolled before being diagnosed. Vietnamese women were less likely than White women to have advanced disease; the adjusted odds for women in other racial/ethnic groups did not differ from those among Whites. Women of low socioeconomic status and older women were at increased risk. CONCLUSIONS: Women intermittently enrolled in Medicaid or not enrolled until their diagnosis were at greatest risk of a late-stage diagnosis, suggesting that more outreach to at-risk women is needed to ensure access to screening services.

Survival among patients with adenocarcinoma of the pancreas: a population-based study (United States).

OBJECTIVE: The purpose of the current study was to evaluate survival of patients diagnosed in California with adenocarcinoma of the pancreas by demographic and tumor-related factors. METHODS: Through the California Cancer Registry (CCR) we identified all California residents diagnosed with invasive pancreatic adenocarcinoma between 1994 and 2000. Demographic, tumor and treatment information was extracted from the CCR, and socioeconomic status (SES) was assigned based on census block group of residence. RESULTS: A total of 10,612 eligible patients were identified of whom 1674 (15.8%) underwent surgical resection. Patients of lower SES were less likely to undergo resection and somewhat less likely to survive. Median survival was 3.5 months for patients who were not resected and 13.3 months for those who underwent resection. Adjuvant therapy was associated with a decreased risk of death among patients who underwent resection. CONCLUSIONS: This study is the largest population-based study to date to explore survival from pancreatic cancer among all age groups in a racially diverse population. Median survival was shorter than that reported from other series. Race/ethnicity did not have a significant effect on survival. However patients residing in poor neighborhoods were less likely to undergo resection and somewhat less likely to survive this disease.

Acoustic streaming in ovarian cysts.

OBJECTIVE: The purpose of this study was to investigate the hypothesis that endometriomas do not show acoustic streaming and then to quantify the streaming velocity of the particles within ovarian cysts that do show acoustic streaming. METHODS: Ovarian cysts greater than 2 cm in diameter, with internal echoes seen on B-mode sonography, were prospectively evaluated for the presence of acoustic streaming. If acoustic streaming was present, a 2-mm pulsed Doppler sample volume was then placed within the distal portion of the cyst, and the streaming velocity was recorded. Follow-up included review of subsequent sonographic examinations, surgical notes, and histopathologic reports, with the latter being considered the final results if available. RESULTS: Acoustic streaming was detected in 10 (38%) of 26 ovarian cysts, but of the 10 endometriomas, none (0%) showed acoustic streaming (P = .002). Acoustic streaming was detected in 86% (n = 6) of cystadenomas. Four of these were serous cystadenomas, which all showed acoustic streaming, with a velocity range of 1.5 to 3.6 cm/s. Two mucinous cystadenomas showed acoustic streaming with velocities of 0.8 and 2.0 cm/s. CONCLUSIONS: Endometriomas appear as cysts containing homogeneous, low-level, "ground glass" echoes on gray scale sonography. Other types of ovarian cysts can also have these appearances. Endometriomas do not show acoustic streaming. Cystadenomas may have streaming velocities within a defined range. Acoustic streaming assessment may therefore prove to be an additional useful tool in assessing ovarian cysts and in completely excluding endometrioma as a diagnosis if a cyst shows acoustic streaming.

Acoustic streaming: an in vitro study.

The aims of this study were, first, to determine if cyst size and cyst-to-transducer distance have an impact upon acoustic streaming and, second, to investigate the effect of cyst content viscosity on acoustic streaming using an artificial ovarian cyst model. Artificial ovarian cysts were constructed and suspended in a tissue-mimicking bath. Although there was no subjective difference in acoustic streaming velocity between cyst sizes during B-mode insonation, with colour Doppler and pulsed Doppler examination, higher acoustic streaming scores were recorded for larger cysts. When the cyst-to-transducer distance was increased, the acoustic streaming velocity was noted to decrease in all scanning modalities. The second stage of the study demonstrated decreasing acoustic streaming velocity as the viscosity of the cyst content was increased. The finding of a clear association between cyst content viscosity and acoustic streaming velocity raises the exciting possibility that we may be able to make estimations of the viscosity of ovarian cyst contents, in the clinical setting, by sonographic means.