Un pas en avant : la Stratégie de développement durable

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A Path Forward: The Strategy Towards Sustainability

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Le vent du changement souffle toujours

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The Winds of Change Continue

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La crise des opioïdes au Canada : l’engagement de la SCPH

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The Canadian Opioid Crisis: CSHP’s Commitment

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The Value of Vision

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La valeur d’une vision

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An increased CD25-positive intestinal regulatory T lymphocyte population is dependent upon Cox-2 activity in the Apcmin/+ model

Only mismatch repair (MMR)-deficient colorectal cancer (CRC) appears to respond well to programmed death (PD)-1 inhibition at the present time. Emerging evidence suggests a role for micro-environmental factors such as CD25⁺ cells modulating response to PD-1 inhibition. In the Apc^Min/+ model of familial adenomatous polyposis (MMR-proficient CRC), increased Cyclooxygenase-2 (Cox-2) expression by cells which include alternatively activated mononuclear phagocytes promotes intestinal tumorigenesis by mechanisms which may include immune suppression. To gain insight into this, we compared regulatory T cell (T_reg ) populations between Apc^Min/+ and wild-type mice prior to and after the phase of increased intestinal Cox-2-dependent prostaglandin E₂ (PGE₂ ) production. There was no difference in systemic T_reg function or numbers between Apc^Min/+ and wild-type mice. However, increased numbers of small intestinal CD25⁺ T_regs were observed with increased Cox-2 activity in the absence of any difference in the expression of Tgf-β or Tslp between Apc^Min/+ and wild-type mice. Cox-2 inhibitor therapy (Celecoxib) reversed the increase in Apc^Min/+ intestinal CD25⁺ T_reg numbers, without decreasing numbers of CD25⁺ systemic T_regs . Forkhead box protein 3 (FoxP3⁺ ) and Cox-2⁺ cells were co-localized to the interstitium of adenomas of Apc^min/+ mice. These results suggest selective dependence of an 'activated T_reg ' phenotype on paracrine Cox-2 activity in Apc^Min/+ small intestine. For therapeutic potential, further studies are required to evaluate the relevance of these findings to human cancer as well as the functional significance of CD25⁺ intestinal T_regs in cancer.

We All Have a Story

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Winds of Change

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Un vent de changement

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Retrospective audit of medication order turnaround time after implementation of standardized definitions

BACKGROUND

Standardizing the interpretation of "stat", "emergent", "urgent", and "now" medication orders can improve patient safety. However, the effect of implementing standardized definitions on the turnaround time for medication orders in hospital pharmacy dispensaries has not been studied.

OBJECTIVES

To examine the effects of using formal definitions for "stat", "emergent", "urgent", and "now" on turnaround time for medication orders within a pharmacy dispensary.

METHODS

Definitions for "stat", "emergent", "urgent", and "now" orders, as well as for "turnaround time", were developed from the formal literature and the grey literature. The definitions were implemented by educating all pharmacy staff. Retrospective audits of turnaround time were conducted at baseline (for all orders over a 1-month period) and after implementation of the definitions (for a total of 28 days over a 3-month period). Health records and medication orders were used to calculate time from prescribing to administration (total turnaround time) and time from prescribing to departure from the dispensary (dispensary turnaround time). Differences between total and dispensary turnaround times were compared with nonparametric statistics.

RESULTS

During the baseline audit period, 84 (1.1%) of 7787 orders were identified as "stat", "emergent", "urgent", or "now". After implementation of the formal definitions, 142 (2.6%) of 5365 orders were identified by one of these terms. The percentage of orders meeting the target dispensary turnaround time of less than 15 min was at least 90% both at baseline (76/84 [90%]) and after implementation (129/142 [91%]) (p = 0.80). Median dispensary turnaround time for stat and emergent medication orders combined (10 versus 9 min, p = 0.27) and for urgent and now medication orders combined (10 versus 12 min, p = 0.09) did not change after implementation of formal definitions. Similarly, median total turnaround time did not change for stat and emergent medication orders combined (30 versus 45 min, p = 0.32), but it increased for urgent and now orders combined (35 versus 45 min, p = 0.041).

CONCLUSIONS

Implementing standardized definitions for "stat", "emergent", "urgent", and "now" had no significant effect on dispensary turnaround time. However, the majority of orders with these designations met the expected target for dispensary turnaround time. Further interventions aimed at other health care professionals may be needed to reduce total turnaround time. This research supports the concept of interdisciplinary interventions for reducing total turnaround time.

Lymphoid and myeloid cell populations in the non-pregnant human Fallopian tube and in ectopic pregnancy

Lymphoid and myeloid cell populations in human endometrium are well-documented and are known to play important roles in providing immune tolerance, controlling trophoblast invasion, and mediating vascular remodeling. Immune cell populations in the Fallopian tube have not been comprehensively studied. The aim of this study was to characterize lymphoid and myeloid cell populations in non-pregnant Fallopian tube and determine whether they are altered in Fallopian tube from women with ectopic pregnancy. Fallopian tube was analyzed by flow cytometry and immunohistochemistry. Populations of CD3+ (CD4+ and CD8+) lymphocytes, LIN1-HLADR+ (CD123+ and CD11c+) dendritic cells, monocytes, neutrophils, and CD56(dim)CD16- natural killer (NK) cells were demonstrated to be present in non-pregnant Fallopian tube. CD123+ dendritic cells were predominant over CD11c+ dendritic cells. Numbers of CD11c+ cells were significantly higher in the progesterone-dominant mid-luteal phase of the menstrual cycle compared with the follicular phase. Numbers of CD45+ leukocytes, CD68+ cells, and CD11c+ cells were higher in Fallopian tube from women with ectopic pregnancy compared with mid-luteal phase Fallopian tube. These data will advance our understanding of normal human Fallopian tube physiology and disorders of Fallopian tube function, such as ectopic pregnancy.

Five cases of sarcoidosis in one family: a new immunological link?

We report a family in which five members have been affected with sarcoidosis. The radiological findings of all cases are presented, together with HLA typing, T cell subset and cytokine analysis in four cases. A new HLA association in the presentation of sarcoidosis is suggested.

Distribution of plasminogen activator inhibitor in normal liver, cirrhotic liver, and liver with metastases

AIMS

To examine the distribution of PAI-1 antigen in normal and cirrhotic liver and liver with metastases.

METHODS

Sections of normal and cirrhotic liver and liver with metastases were stained using the alkaline phosphatase antialkaline phosphatase (APAAP) technique and monoclonal antibody specific for plasminogen activator inhibitor (PAI-1).

RESULTS

PAI-1 antigen was identified as discrete granules in the cytoplasm of hepatocytes in normal liver, particularly around portal tracts and central veins of the liver lobule. In cirrhotic liver a striking reduction of PAI-1 antigen was noted. In liver with metastases increased amounts of PAI-1 antigen were concentrated in hepatocytes around the margins of malignant deposits.

CONCLUSIONS

Cirrhotic liver contains considerably less PAI-1 antigen than does normal liver, despite raised plasma concentrations of PAI-1. This may reflect release of hepatic PAI-1 into the circulation or decreased clearance of PAI-1 from the plasma. Secondary malignant deposits in the liver seem to stimulate production of PAI-1 in adjacent hepatocytes. This may influence the invasive process and may contribute to the thrombotic tendency associated with malignancy.

High-speed automatic analysis of eeg spike and wave activity using an analogue detection and microcomputer plotting system

Spike and wave activity is detected by analogue circuitry which separately filters the spike and the slow wave components from the EEG. The filter outputs are converted to DC voltages, which are then compared with individually adjusted threshold voltages. A detector output pulse is produced when both the spike and the wave threshold levels are exceeded. A graph of the incidence of spike and wave activity per 15 min intervals over 24 h is plotted by a microcomputer and modified impact printer. The analysis is carried out at 60 times real time on EEG recordings obtained from unrestrained patients using a portable cassette-tape recorder.