Quantiferon Monitor Testing Sheds Light on Immune System Disparities between Multiple Sclerosis Patients and Healthy Individuals.

The aim of this study was to conduct QuantiFERON Monitor (QFM) testing in patients with multiple sclerosis (MS), which is used to monitor the state of the immune system through the non-specific stimulation of leukocytes followed by determining the level of interferon-gamma (IFN-γ) released from activated cells. Additionally, we tested the level of selected cytokines (IFN-α, IFN-γ, IL-1α, IL-1ß, IL-1ra, IL-2, IL-3, IL-4, IL-6, IL-7, IL-10, IL-15, IL-33, VEGF) from stimulated blood samples to further understand the immune response. This study builds upon a previously published study, utilizing activated serum samples that were initially used for IFN-γ determination. However, our current focus shifts from IFN-γ to exploring other cytokines that could provide further insights into the immune response. A screening was conducted using Luminex technology, which yielded promising results. These results were then further elaborated upon using ELISA to provide a more detailed understanding of the cytokine profiles involved. This study, conducted from August 2019 to June 2023, included 280 participants: 98 RRMS patients treated with fingolimod (fMS), 96 untreated patients with progressive MS (pMS), and 86 healthy controls (HC). Our results include Violin plots showing elevated IL-1α in pMS and fMS. Statistical analysis indicated significant differences in the interleukin levels between groups, with IL-1ra and age as key predictors in differentiating HC from pMS and IL-1ra, IL-1α, age, and EDSS in distinguishing pMS from fMS. These findings suggest cytokines' potential as biomarkers in MS progression and treatment response.

Imagining Resilient Courts: from COVID-19 to the Future of Canada's Court System.

The coronavirus disease 2019 (COVID-19) pandemic has challenged an array of democratic institutions in complex and unprecedented ways. Little academic work, however, has considered the pandemic's impact on Canada's courts. This article aims to partially fill that gap by exploring the Canadian court system's response to COVID-19 and the prospects for administering justice amid disasters, all through the lens of resilience. After taking a forensic look at how the court system has managed the challenges brought on by COVID-19, we argue that features of resilience such as self-organization, flexibility, learning, and reflexive planning can contribute to the administration of justice during future shocks. We propose that the business of judging during shocks can become more integral to the business as usual of court systems. Imagining such a resilient court can be a way to step from COVID-19 to the future of Canada's court system.

La pandémie de la maladie à coronavirus 2019 (COVID-19) a mis au défi un grand nombre d'institutions démocratiques, de manière complexe et inédite. Or, très peu de recherches universitaires se sont intéressées à l'impact de la pandémie sur les tribunaux canadiens. Cet article vise à combler partiellement cette lacune en explorant la réponse du système judiciaire canadien à la COVID-19 et l'administration de la justice pendant les moments de crise, dans l'optique de la résilience. Un regard attentif à la manière dont le système judiciaire a géré les défis occasionnés par la COVID-19 nous permet de voir que les aspects de résilience tels que l'auto-organisation, la flexibilité, l'apprentissage et la planification réflexive peuvent contribuer à l'administration de la justice lors de futurs chocs. Nous proposons donc que les procédures adoptées pendant les temps de crise deviennent une pratique plus courante. Un tel tribunal résilient serait une façon de passer au travers de la COVID-19 et d'aider le système judiciaire canadien à se propulser dans l'avenir.

Towards a legal toolkit for disaster resilience and transformation.

Law is acknowledged as playing an important role in the growing field of disaster resilience. Still, a detailed inquiry into the possible relationships between law and disaster resilience remains largely absent from the discourse. This paper explores how legal thinking, approaches, and instruments can act as 'tools' in altering the nature and conditions of disaster risks. It looks at how state institutions can wield them and non-state actors employ them to participate in processes of change. Moving beyond a resilience literature that has tended to focus on law in terms of statutes, regulations, and human rights, this paper examines the ways in which legal reasoning, procedure, and substantive law can be instrumentalised to resist shocks, provoke incremental adjustments, or even foment transformational shifts in underlying risk conditions. It concludes by suggesting that law can offer both a breadth of insights for reconceptualising how power influences resilience and a number of instruments for challenging these power structures.

Positioning resilience for 2015: the role of resistance, incremental adjustment and transformation in disaster risk management policy.

Resilience is a ubiquitous term in disaster risk management and is an increasingly prominent concept in early discussions focused on elaborating the post-2015 international policy landscape. Riddled with competing meanings and diverse policy implications, however, it is a concept caught between the abstract and operational. This paper provides a review of the rise to prominence of the concept of resilience and advances an elaboration of the related concepts of resistance, incremental adjustment and transformation. We argue that these concepts can contribute to decision-making by offering three distinct options for risk management policy. In order to deliberately and effectively choose among these options, we suggest that critical reflexivity is a prerequisite, necessitating improved decision-making capacity if varied perspectives (including those of the most vulnerable) are to be involved in the selection of the best approach to risk management.

Real-world effectiveness of cladribine as an escalation strategy for MS: Insights from the Czech nationwide ReMuS registry.

Background: Cladribine, a selective immune reconstitution therapy, is approved for the treatment of adult patients with highly active multiple sclerosis (MS). Objectives: Provide experience with cladribine therapy in a real-world setting. Methods: This is a registry-based retrospective observational cohort study. First, using data from the Czech nationwide registry ReMuS, we analysed patients who initiated cladribine from September 1, 2018 to December 31, 2021. Second, we analysed a subgroup of patients who initiated cladribine between September 1, 2018 to June 30, 2020, thus possessing a follow-up period of at least 2 years. We evaluated demographic and MS characteristics including disease-modifying therapies (DMTs) before and after cladribine administration, relapses, Expanded Disability Status Scale (EDSS), and adherence. Results: In total, 617 patients (335 with follow-up of at least 2 years) started cladribine therapy in the study period (mean age 37.0, mean disease duration 8.4 years, 74.1% females). In most cases, cladribine was administered as a second-line drug, a total of 80.7% had been escalated from a platform DMT. During 2 years before cladribine initiation, the average annualised relapse rate (ARR) was .67. Following cladribine initiation, the ARR decreased to .28 in the first year and .22 in the second year. Overall, across the entire two-year treatment period, 69.0% of patients were relapse-free and the average ARR was .25. As for EDSS development, the median baseline EDSS was 2.5 and remained stable even after 24 months. The adherence to treatment ranged of around 90%. Conclusion: This nationwide study confirms the efficacy of cladribine in real-world settings, especially in patients who are not treatment-naïve. In addition, the study shows an exceptionally high adherence rate, a finding that underscores the invaluable role of cladribine, but also the value of registry-based studies in capturing real-world clinical practice.