Robust sustainable canola oil-based biodiesel supply chain network design under supply and demand uncertainty

The excessive consumption of fossil fuels has sparked debates and caused environmental damage, leading the global community to search for a suitable alternative. To achieve sustainable development goals and prevent harmful climate scenarios, the world needs to increase its use of renewable energy. Biodiesel, a clean and eco-friendly fuel with a high flash point and more lubrication than petroleum-based fuels, and without the emission of harmful environmental gases, has emerged as one of the fossil fuel alternatives. To promote the mass-level production of biodiesel, a sustainable supply chain (SC) that does not depend on laboratory production is necessary. For this purpose, this research proposes a multi-objective mixed-integer non-linear mathematical programming (MINLP) model to design a sustainable canola oil-based biodiesel supply chain network (CO-BSCND) under supply and demand uncertainty. This mathematical model aims to minimize the total cost (TC) and total carbon emission while maximizing the total number of job opportunities simultaneously. A scenario-based robust optimization (SBRO) approach is applied to deal with uncertainty. The proposed model is implemented in a real case study in Iran, and numerical experiments and sensitivity analysis are conducted to demonstrate its applicability. The results of this research demonstrate that designing a sustainable supply chain network for the production and distribution of biodiesel fuel is achievable. Moreover, this mathematical modeling makes mass-scale production of biodiesel fuel a possibility. In addition, the SBRO method adopted in this research enables managers and researchers to explore the design conditions of the supply chain network by controlling the uncertainties that affect it. This approach allows the chain's performance to be as close as possible to the actual conditions. As a result, the SBRO method enhances the efficiency of the supply chain network and boosts productivity toward achieving desired goals.

A7 OPPORTUNISTIC PATHOGEN MODULATION OF GLUTEN-REACTIVE CD4+ T CELL ACTIVATION BY DQ2-EXPRESSING ORGANOID MONOLAYERS

Background

Bacteria have recently emerged as additional modulators of inflammation in CeD. We have shown that the elastase-like producing opportunistic pathogen, Pseudomonas (P) aeruginosa, partially metabolizes gluten into peptides that translocate the mucosal barrier and retain their immunogenicity. We previously demonstrated that organoid monolayers derived from DR3-DQ2 mice carrying the CeD risk gene HLA-DQ2 express MHC class II (HLA-DQ2) and co-stimulatory molecules under induced inflammatory conditions, priming the monolayers for gluten antigen presentation. Here we investigate the activation of human (h)CD4⁺ T cell co-cultured with DQ2 monolayers stimulated with gluten pre-digested, or not, by bacterial elastase.

Purpose

To investigate whether organoid monolayers expressing DQ2 activate T cell differentially in the presence of gluten metabolized by elastase-like producing Pseudomonas aeruginosa.

Method

Organoid monolayers were derived from the duodenum and proximal jejunum of gluten-sensitized DR3-DQ2 mice, following the gluten sensitization protocol previously described¹. Monolayers were then stimulated with IFN-γ for 24h to induce MHC-II and co-stimulatory molecules expression. Splenic T-cell expressing hCD4 from gluten-sensitized DR3-DQ2-hCD4 mice were then co-cultured with monolayers in the presence of deamidated pepsin-trypsin-digested (DAPT)-gluten or Pseudomonas aeruginosa PA14 (WT)-digested DAPT-gluten. As a control, DAPT-gluten was incubated with a P. aeruginosa lasB mutant strain that lacks elastase-like activity (lasB^△/△). Co-cultures stimulated with DAPT-gluten alone or WT-media were used as additional controls.

Result(s)

Increased hCD4⁺ T-cell proliferation was observed in co-cultures stimulated with WT-digested gluten compared with lasB^△/△-digested gluten (p<0.0001), gluten alone (p=0.0002) or WT-media (p<0.0001). hCD4⁺ T cell co-cultured with organoid monolayers stimulated with WT-digested gluten, had an activated phenotype with increased expression of CD69, CD44 and CD25 versus those stimulated with gluten, lasB^△/△-digested gluten, or WT-media. Increased levels of pro-inflammatory and T helper type 1 (Th1)-associated cytokines were detected in the supernatant of the co-cultures stimulated with WT-digested gluten, including IL-2, IFN-γ, IL-6, TNF-α, IL-1α, IL-β, and IL-15.

Conclusion(s)

Using a novel HLA-DQ2-expressing organoid monolayer, we demonstrate elastase-like producing P. aeruginosa, enhanced activation and proliferation of hCD4⁺ T cell through gluten metabolism. This in vitro model constitutes a relevant tool for studying microbial triggers and drivers of intestinal epithelial dysfunction in CeD.

1. Galipeau, H. J. et al. 1. Galipeau, H. J. et al. Sensitization to Gliadin Induces Moderate Enteropathy and Insulitis in Nonobese Diabetic-DQ8 Mice. J. Immunol.187, 4338–4346 (2011).

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CIHR, Other

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Canadian Celiac Disease Association (CCA)

Disclosure of Interest

None Declared

A3 CROHN’S DISEASE PROTEOLYTIC MICROBIOTA ENHANCES INFLAMMATION THROUGH PAR2 PATHWAY IN GNOTOBIOTIC MICE

Background

An imbalance in host proteases has been implicated in inflammatory bowel disease (IBD). Recent evidence implicates microbial proteolytic activity (PA) in ulcerative colitis but whether it also plays a role in Crohn’s disease (CD) remains unclear.

Purpose

We therefore investigated the colitogenic potential and underlying pathways of proteolytic CD microbiota.

Method

Adult germ-free (GF) C57BL/6 mice were colonized with CD microbiota selected based on high (CD-HPA) or low fecal proteolytic activity (CD-LPA), and from healthy controls with LPA (HC-LPA), after which total fecal proteolytic, elastolytic and mucolytic activity were analyzed in the mice. Microbial community was assessed by 16S rRNA gene sequencing. Immune function and colonic injury were investigated by inflammatory gene expression (NanoString) and histology. Colitis severity and underlying pathways were investigated in C57BL/6, Nucleotide-binding Oligomerization Domain-2 knock-out (Nod2^-/-), and Protease-Activated Receptor 2 (PAR2) cleavage resistant mice (R38E-PAR2) subjected to 2% dextran sodium sulfate in drinking water for 5 days followed by 2 days on water.

Result(s)

Colonization with HC-LPA or CD-LPA lowered baseline fecal proteolytic activity compared with GF mice, which was paralleled by lower acute inflammatory cell infiltrate. CD-HPA further increased proteolytic activity compared with GF mice. Fecal supernatants from CD-LPA or HC-LPA colonized mice had lower in vitro PAR2 cleavage compared to supernatants from GF and CD-HPA colonized mice. Several genes, such as Map kinases, Rhoa, Myd88, and Tollip, were increased in GF mice compared to colonized mice. 18 genes related to inflammation and barrier function (e.g., Mapk2k6, Tnf, Claudin1) were differentially expressed between CD-LPA and CD-HPA. CD-HPA mice had lower alpha diversity, distinct microbial profiles, and higher fecal proteolytic activity compared with CD-LPA. Abundance of several beneficial species (e.g., Akkermansia muciniphilia) was decreased while other taxa were increased (e.g., Hungattella hathewayi) in CD-HPA compared to CD-LPA. H. hathewayi as well as the serine protease K04772 were transcriptionally increased in fecal samples from CD-HPA colonized mice. C57BL/6 and Nod2^-/- mice, but not R38E-PAR2 mice, colonized with CD-HPA developed earlier and more severe colitis compared with mice colonized with CD-LPA.

Conclusion(s)

CD proteolytic microbiota is proinflammatory through a PAR2 pathway. H. hathewayi correlates with the proinflammatory phenotype through the serine protease K04772 in this model. The results support a role of microbial PA in CD, which could constitute a biomarker for identifying patients who would benefit from anti-proteolytic therapies.

Disclosure of Interest

None Declared

Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BACKGROUND

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.

METHODS

A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.

RESULTS

Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).

CONCLUSION

The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.

REGISTRATION NUMBER

ISRCTN25616490 (http://www.controlled-trials.com).

A5 GLUTEN-SPECIFIC T CELL ACTIVATION BY MHC CLASS II EXPRESSING ORGANOID MONOLAYERS

NOT PUBLISHED AT AUTHOR’S REQUEST

Funding Agencies: CIHR

Quasi-isothermal modulated DSC as a valuable characterisation method for soft tissue biomaterial crosslinking reactions

Glutaraldehyde (Glut) is an extensively used sterilant and fixative for the crosslinking of natural soft tissue biomaterials like bovine pericardium (BP) to provide stability and is required for its application in vivo. There is plenty of debate around the reaction mechanism of Glut with natural biomaterials. Differential scanning calorimetry (DSC) is a commonly used technique that is typically used to measure the thermal profile of polymers. However, a variation known as quasi-isothermal modulated differential scanning calorimetry (QiMDSC) has been utilised for the analysis of polymorphic transformations in both the pharmaceutical and food industries. This communication will address QiMDSC as a method for analysing soft tissue biomaterials and their crosslinking mechanisms and how it can be applied to other biomaterial applications.

A200 HUMANIZED CELIAC-PRONE EPITHELIUM IN VITRO EXPRESS MHC-II AND CO-STIMULATORY MOLECULES NECESSARY FOR GLUTEN PEPTIDE PRESENTATION

Background

The role intestinal epithelial cells (IECs) play in the breakdown of tolerance to gluten at an early stage in celiac disease (CeD) is unclear. Epithelial stress is a feature of CeD, and although the triggers are largely unknown, it is accompanied by expression of several markers that could be involved in initiation of inflammatory responses. IECs have been shown to express MHC class II (MHC-II) molecules and participate in antigen presentation in several models. Whether IECs can participate in gluten peptide presentation, the major environmental trigger in celiac disease, is unknown. To study this, a model expressing human MHC-II, HLA DQ8 or HLA-DQ2, would be required.

Aims

To develop organoid monolayers from transgenic mice expressing human celiac risk genes: HLA-DQ8 and -DQ2. To investigate conditions leading to the induction of epithelial MHC-II and its main co-stimulatory molecules, CD80, CD86 and CD40, that could enable early gluten peptide presentation.

Methods

In order to show pathophysiological significance of the model, we used two approaches, either induction of inflammation in vivo through gluten sensitization, or direct stimulation of the monolayers using pro-inflammatory cytokines relevant in CeD, such as IFNγ. Mice were sensitized with Pepsin-Trypsin digested gliadin and cholera toxin (CT) once a week for 3 weeks, followed by a challenge phase in which they only received gliadin. Control mice received CT only. We then developed organoid monolayers from the duodenum followed by stimulation with 10 ng/ml IFNγ. Finally, markers necessary for gluten peptide presentation, the expression of MHC-II and its co-stimulatory molecules, were evaluated using flow cytometry.

Results

Both in vivo gluten sensitization and in vitro stimulation of the organoid derived monolayer with IFNγ induced a proinflammatory response, that independently primed the epithelium to express MHC-II molecules (p =0.02 and &lt;0.0001, respectively). When in vivo sensitization and in vitro IFNγ stimulation were combined, epithelial MHC-II expression was further upregulated (p &lt;0.0001). Lastly, only the combination of gluten sensitization and in vitro IFNγ induced expression of MHC-II co-stimulatory molecules, which are necessary for antigen presentation.

Conclusions

Our findings support that gluten induced-inflammation in vivo as well as independent stimuli that release IFNγ enhance the capacity of the IECs to express MHC-II molecules. However, co-stimulatory molecules are only expressed by the epithelium when both gluten tolerance is broken by in vivo sensitization and the organoid monolayers is further exposed to IFNγ. The results support the hypothesis that the epithelium participates in gluten peptide presentation and that this pathway is stimulated by both gluten-dependent and independent inflammation.

Funding Agencies

CIHRSupported by CIHR and a Farncombe Family Grant to EFV and TFD.

Cardiovascular response to exercise training in the systemic right ventricle of adults with transposition of the great arteries

KEY POINTS

Patients with transposition of the great arteries (TGA) and systemic right ventricles have premature congestive heart failure; there is also a growing concern that athletes who perform extraordinary endurance exercise may injure the right ventricle. Therefore we felt it essential to determine whether exercise training might injure a systemic right ventricle which is loaded with every heartbeat. Previous studies have shown that short term exercise training is feasible in TGA patients, but its effect on ventricular function is unclear. We demonstrate that systemic right ventricular function is preserved (and may be improved) in TGA patients with exercise training programmes that are typical of recreational and sports participation, with no evidence of injury on biomarker assessment. Stroke volume reserve during exercise correlates with exercise training response in our TGA patients, identifying this as a marker of a systemic right ventricle (SRV) that may most tolerate (and possibly even be improved by) exercise training.

ABSTRACT

We aimed to assess the haemodynamic effects of exercise training in transposition of the great arteries (TGA) patients with systemic right ventricles (SRVs). TGA patients have limited exercise tolerance and early mortality due to systemic (right) ventricular failure. Whether exercise training enhances or injures the SRV is unclear. Fourteen asymptomatic patients (34 ± 10 years) with TGA and SRV were enrolled in a 12 week exercise training programme (moderate and high-intensity workouts). Controls were matched on age, gender, BMI and physical activity. Exercise testing pre- and post- training included: (a) submaximal and peak; (b) prolonged (60 min) submaximal endurance and (c) high-intensity intervals. Oxygen uptake (V̇O2; Douglas bag technique), cardiac output (Q̇c, foreign-gas rebreathing), ventricular function (echocardiography and cardiac MRI) and serum biomarkers were assessed. TGA patients had lower peak V̇O2, Q̇c, and stroke volume (SV), a blunted Q̇c/V̇O2 slope, and diminished SV response to exercise (SV increase from rest: TGA = 15.2%, controls = 68.9%, P < 0.001) compared with controls. After training, TGA patients increased peak V̇O2 by 6 ± 8.5%, similar to controls (interaction P = 0.24). The magnitude of SV reserve on initial testing correlated with Q̇c training response (r = 0.58, P = 0.047), though overall, no change in peak Q̇c was observed. High-sensitivity troponin T (hs-TnT) and N-terminal prohormone of brain naturetic peptide (NT pro-BNP) were low and did not change with acute exercise or after training. Our data show that TGA patients with SRVs in this study safely participated in exercise training and improved peak V̇O2. Neither prolonged submaximal exercise, nor high-intensity intervals, nor short-term exercise training seem to injure the systemic right ventricle.

The effectiveness of mindfulness-based cognitive therapy on quality of life and loneliness of women with HIV

Objective: The present study investigated the performance of Mindfulness according to the Cognitive approach on the Quality of Life and Loneliness of women with HIV. Methods: This research is a semi-experimental with pretest-posttest and check team, which was conducted in winter, 2014. In this research, 24 positive HIV women in Tehran were selected by volunteers sampling method and were stochastically related to either the control team (n = 12) or the MBCT groups (n = 12) and, the World Health Organization quality of life survey and the University of California Los Angeles loneliness scale were administrated as pretest. The MBCT team got eight sessions of mindfulness according to the cognitive theory and the check team got no intervention. At the end, the post-test was administrated to two groups and, covariance method was used for data analysis by SPSS-20 software. Findings: The results of the present study indicated that there were clear variations among the test groups check group and MBCT (p < 0.001). Therefore, Mindfulness-based Cognitive theory increased the mean quality of life and decreased loneliness. Conclusion: The findings indicated that the Mindfulness-based Cognitive therapy increased the quality of life and decreased loneliness in positive HIV women. Therefore, in order to modify the quality of life and loneliness in these cases, attention to these variables during clinical trials with the goal of an appropriate intervention, will be beneficial.

The impact of teaching psychological welfare on marital satisfaction and self-efficacy in nurses

Objective: Proper psychological interventions for enhancing public health and mental welfare in nurses are of great importance. This study intended to explore the influence of the teaching psychological welfare on marital satisfaction and self-efficacy in nurses of Imam Khomeini hospital. Methodology: The method of the present study was semi-experimental with a pre-test post-test design and a control group. Hence, 24 nurses were selected from Imam Khomeini hospital, by using convenience sampling, and they were divided into two groups: experiment and monitoring. By using a 47-questions marital satisfaction questionnaire and a 17-questions general self-efficacy questionnaire, both groups were pre-tested. Then the test group, received lessons on psychological welfare within ten sessions, but the control group received no interventions. Afterwards, both groups were post-tested, and the data collected were analyzed by using descriptive and inferential statistics methods through SPSS software. Findings: Findings showed that teaching psychological welfare significantly increased marital satisfaction and self-efficacy in nurses (p < 0.001). Conclusion: From this research, it was concluded that teaching psychological welfare is an effective strategy for those with risky jobs like nurses, because it is highly efficient, especially when it is performed in groups, because it is cheap, and because it is acceptable by different working people.

Laparoscopic donor nephrectomy: an increasingly common cause for testicular pain and swelling

INTRODUCTION

Laparoscopic donor nephrectomy (LDN) is now a well established method for kidney procurement from living donors. In our centre, LDN is currently offered only to donors suitable for a left nephrectomy. The aim of this study was to investigate the incidence of testicular pain and swelling following LDN.

METHODS

A total of 25 left-sided LDN male patients were assessed in a prospective structured interview together with a control cohort of 25 male patients who had undergone left-sided open donor nephrectomy (ODN).

RESULTS

Data were collected on testicular pain, swelling, numbness, urinary symptoms and sexual dysfunction from all 50 patients (100% response rate). Of the 25 LDN patients, 11 (44%) experienced ipsilateral testicular pain and/or swelling. In most instances, pain was of immediate onset, mild to moderate in severity, lasted for a few days to several weeks and was associated with testicular swelling (10 of 11 cases). However, testicular pain and/or swelling were not apparent in ODN patients, with only 2 of 25 (8%) experiencing mild testicular pain, 1 of whom also had swelling.

CONCLUSIONS

Testicular pain and swelling following LDN is a common problem. It is underreported in the literature and should be included in the differential diagnoses of testicular pain and swelling. Further investigation is required to confirm our findings.

Contact lens disinfecting solutions antibacterial efficacy: comparison between clinical isolates and the standard ISO ATCC strains of Pseudomonas aeruginosa and Staphylococcus aureus

PURPOSE

To evaluate the disinfectant properties of the three multipurpose contact lens disinfecting solutions available in Iran, against clinical isolates and the standard ISO ATCC strains of Pseudomonas aeruginosa and Staphylococcus aureus, based on the international organization for standardization (ISO) 14729 guidelines.

METHODS

Three multipurpose solutions that were tested were ReNu Multiplus, Solo Care Aqua and All-Clean Soft. The test solutions were challenged with clinical isolates and the standard strains of P. aeruginosa(ATCC 9027) and S. aureus(ATCC 6538), based on the ISO Stand-alone procedure for disinfecting products. Solutions were sampled for surviving microorganisms at manufacturer's minimum recommended disinfection time. The number of viable organisms was determined and log reductions calculated.

RESULTS

All of the three test solutions in this study provided a reduction greater than the required mean 3.0 logarithmic reduction against the recommended standard ATCC strains of P. aeruginosa and S. aureus. Antibacterial effectiveness of Solo Care Aqua and All-Clean Soft against clinical isolates of P. aeruginosa and S. aureus were acceptable based on ISO 14729 Stand-alone test. ReNu MultiPlus showed a minimum acceptable efficacy against the clinical isolate of S. aureus, but did not reduce the clinical isolate by the same amount.

CONCLUSIONS

Although the contact lens disinfecting solutions meet/exceed the ISO 14729 Stand-alone primary acceptance criteria for standard strains of P. aeruginosa and S. aureus, their efficacy may be insufficient against clinical isolates of these organisms.

[Attitudes of general practitioners to pharmaceutical sales representatives in Sousse]

The therapeutic knowledge of physicians is the corner stone to the rational use of medicines; however information about medicines is generally obtained from the pharmaceutical industry via their sales representatives (reps). We aimed to identify general practitioners' (GPs) attitudes to pharmaceutical reps and the information they provide. We surveyed 140 GPs using a self-administered questionnaire. The response rate was 78% (72 GPs from the public sector and 68 from the private sector). About 10% of the GPs said they received daily visits from pharmaceutical reps; 84% of GPs considered them an efficient source of information and 31% said they might change their therapeutic prescribing following visits from these reps. Because of their positive perception of pharmaceutical reps, GPs are susceptible to the information they provide. Controlling the validity of the therapeutic information imparted by the pharmaceutical industry is thus a fundamental component of the programme for the rational use of medicines.

[Attitudes of general practitioners to pharmaceutical sales representatives in Sousse]

The therapeutic knowledge of physicians is the corner stone to the rational use of medicines; however information about medicines is generally obtained from the pharmaceutical industry via their sales representatives [reps]. We aimed to identify general practitioners’ [GPs] attitudes to pharmaceutical reps and the information they provide. We surveyed 140 GPs using a self-administered questionnaire. The response rate was 78% [72 GPs from the public sector and 68 from the private sector]. About 10% of the GPs said they received daily visits from pharmaceutical reps; 84% of GPs considered them an efficient source of information and 31% said they might change their therapeutic prescribing following visits from these reps. Because of their positive perception of pharmaceutical reps, GPs are susceptible to the information they provide. Controlling the validity of the therapeutic information imparted by the pharmaceutical industry is thus a fundamental component of the programme for the rational use of medicines

[Circulation of pharmaceutical information among general practitioners in the region of Sousse (Tunisia)]

The general practitioner plays an essential role in the rational strategy of drug-use by the quality of his prescription which translates the validity and the relevance of his pharmaceutical information. The objective of this work is to study the different means of pharmaceutical information used by general practitioners in the region of Sousse (Tunisia). We conducted a transversal, descriptive, exhaustive survey of 140 general practitioners in private (68) and public (72) practice during 1999. Data were collected through a questionnaire. This study, with a participation rate of 78%, showed that pharmaceutical dictionaries are the major source of information for 86% of general practitioners, that medical delegates have a positive image for 84% of them and that 36% of general practitioners do not subscribe to any medical journal. Thus, general practitioners are exposed to relatively unreliable pharmaceutical information coming generally from the pharmaceutical industry.

Food allergy is a matter of geography after all: sesame as a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel

OBJECTIVE

To determine the prevalence, importance, and the order of frequency of IgE-mediated food allergens among infants and young children in Israel.

STUDY DESIGN AND PATIENTS

In a cross-sectional study, the prevalence of IgE-mediated food allergy was investigated in 9070 infants and young children (0-2 years) who were followed-up at 23 Family Health Centers (FHCs) in central Israel. Patients with suspected IgE-mediated food allergic reactions, were recruited for further evaluation (detailed questionnaire and skin-prick test (SPT)).

RESULTS

We identified 150 out of 9070 (1.7%) patients with suspected IgE-mediated food allergy. Among them, 102/150 (67%) [59 males, 43 females; mean age 10.3 months] completed a detailed questionnaire and underwent SPT. Evaluation revealed 131 positive SPTs in 78/102 (76.5%) patients. Twenty-seven positive SPTs in 18 patients were considered clinically irrelevant based on previous consumption of the relevant foods without clinical symptoms. Thus, there were 104 relevant positive SPTs in 78 patients. The overall prevalence of clinically relevant IgE-mediated food allergic reactions among these patients is estimated to be 1.2% (104/9070). The most common food allergens were egg, cow's milk, and sesame. Anaphylaxis was the presenting symptom in 14/78 (18%) including six sesame-induced cases. A history of other atopic diseases was reported in 27 (35%) patients. In addition, 22 (28%) had a history of atopy in first-degree family members.

CONCLUSIONS

We found sesame to be a major cause of IgE-mediated food allergy in Israel. In fact, it is second only to cow's milk as a cause of anaphylaxis. We recommend that testing for food allergens be tailored to each community based on local experience and should include sesame in appropriate populations.

[Subretinal neovascularization in angioid streaks]

Angoid streaks are linear crack-line dehiscences of Bruch's membrane. Choroidal neovascularization is the most serious complication of angioid streaks. The authors try to determine the incidence of neovascular macular degeneration in angioid streaks, their detection and treatment. A retrospective study of 26 eyes of 13 patients with angioid streaks was performed, 6 of whom had macular complications and 3 had subretinal neovascular membranes. Indocyanine green angiography is an adjunctive diagnostic tool in the detection of subretinal neovascular membranes in angioid streaks. Laser photocoagulation of choroidal neovascularization in angioid streaks may end the choroidal neovascularization and help stabilize visual acuity.