Up-front rituximab maintenance improves outcome in patients with follicular lymphoma: a collaborative Nordic study.

The introduction of the anti-CD20 antibody rituximab in combination with chemotherapy (R-chemo) has improved the prognosis of patients with follicular lymphoma (FL). During the last decade, the addition of a maintenance treatment with rituximab (MR) after R-chemo has been tested with the hope of further improving the outcome of these patients. Using 2 independent population-based cohorts, we investigated the effect of up-front MR on time related end points as well as the risk of histological transformation (HT). FL patients were included if they: (1) completed first-line induction treatment with R-chemo, (2) were alive after induction treatment and eligible for MR, and (3) had no evidence of HT at this time point. The training cohort consisted of 733 Danish patients of whom 364 were consolidated with MR; 369 were not. Patients receiving MR more often had advanced clinical stage (90% vs 78%), high Follicular Lymphoma International Prognostic Index (FLIPI) score (64% vs 55%), and bone marrow infiltration (49% vs 40%). Those consolidated with MR had an improved 5-year overall survival (OS; 89% vs 81%; P = .001) and progression-free survival (PFS; 72% vs 60%; P < .001). In the training cohort, MR was associated with a reduction of HT risk (P = .049). Analyses of an independent validation cohort of 190 Finnish patients confirmed the favorable impact of MR on 5-year OS (89% vs 81%; P = .046) and PFS (70% vs 57%; P = .005) but did not find a reduced risk of HT. The present population-based data suggest that the outcome of patients with FL has improved after consolidation of R-chemo with MR.

Clinical utility of the Revised International Staging System in unselected patients with newly diagnosed and relapsed multiple myeloma.

We analyzed the utility of Revised International staging system (RISS) in an unselected cohort of newly diagnosed multiple myeloma (NDMM; cohort 1), and relapsed/refractory multiple myeloma (RRMM; cohort 2) patients. Cohort 1 included 1900 patients seen within 90 days of diagnosis, from 2005 to 2015, while cohort 2 had 887 patients enrolled in 23 clinical trials at Mayo Clinic. The overall survival (OS) and progression-free survival (PFS) was calculated from the time since diagnosis or trial registration. The median estimated follow up was 5 and 2.3 years for Cohorts 1 and 2, respectively. Among 1067 patients evaluable in Cohort 1, the median OS and PFS was 10 and 2.8 years for RISS stage I, 6 and 2.7 years for RISS stage II and 2.6 and 1.3 years for RISS stage III (P<0.0001). Among 456 patients evaluable in Cohort 2, the median OS and PFS was 4.3 and 1.1 years for RISS stage I, 2 and 0.5 years for RISS stage II and 0.8 and 0.2 years for RISS stage III (P<0.0001). In conclusions, RISS gives a better differentiation of NDMM as well as RRMM patients into three survival subgroups and should be used to stratify patients in future clinical trials.

Give 'til it hurts: trade-offs between immunity and male reproductive effort in the decorated cricket, Gryllodes sigillatus.

Trade-offs between life-history variables can be manifested at either the phenotypic or genetic level, with vastly different evolutionary consequences. Here, we examined whether male decorated crickets (Gryllodes sigillatus) from eight inbred lines and the outbred founder population from which they were derived, trade-off immune effort [lytic activity, phenoloxidase (PO) activity or encapsulation] to produce spermatophylaxes: costly nuptial food gifts essential for successful sperm transfer. Canonical correlation analysis of the outbred population revealed a trade-off between spermatophylax mass and lytic activity. Analysis of our inbred lines, however, revealed that although PO activity, encapsulation, body mass, spermatophylax mass and ampulla (sperm capsule) mass were all highly heritable, lytic activity was not, and there was, therefore, no negative genetic correlation between lytic activity and spermatophylax mass. Thus, males showed a phenotypic but not a genetic trade-off between spermatophylax mass and lytic activity, suggesting that this trade-off is mediated largely by environmental factors.

Inbred decorated crickets exhibit higher measures of macroparasitic immunity than outbred individuals.

Inbreeding is assumed to have negative effects on fitness, including the reduced ability to withstand immune challenges. We examined the immunological consequences of inbreeding in decorated crickets, Gryllodes sigillatus, by comparing lytic activity, phenoloxidase (PO) activity, and encapsulation ability of crickets from eight inbred lines with that of crickets from the outbred founder population. Surprisingly, crickets from inbred lines had a greater encapsulation ability compared with crickets from the outbred population. We suggest that because inbred crickets have reduced reproductive effort, they may, therefore, have the option of devoting more resources to this form of immunity than outbred individuals. We also found that both inbred and outbred females had higher immunity than males in PO activity and implant darkness. This result supports the hypothesis that females should devote more effort to somatic maintenance and immunity than males. PO activity and implant darkness were heritable in both males and females, but lytic activity was only heritable in females. Males and females differed in the heritability of, and genetic correlations among, immune traits, suggesting that differences in selective pressures on males and females may have resulted in a sexual conflict over optimal immune trait values.

Pediatric critical care nurses' knowledge of cardiac dysrhythmias.

OBJECTIVE: To describe pediatric critical care nurses' knowledge of dysrhythmias in critically ill pediatric patients and relate this knowledge level to certain demographic variables (education, nursing experience, certification, supplemental training, area of employment and geographic region of residence). DESIGN: A descriptive survey. SETTING: American Association of Critical-Care Nurses' 19 geographic regions of the United States. PARTICIPANTS: Of 1000 questionnaires mailed to pediatric critical care nurses who were members of the American Association of Critical-Care Nurses in 1991, 356 responses were received (a response rate of 36%). INTERVENTION: A criterion-referenced, self-administered test regarding pediatric dysrhythmias and a demographic sheet randomly mailed to 1000 pediatric critical care nurses. Test results were analyzed and compared with demographic variables. RESULTS: The mean total test score was 66%. Significantly higher total test scores and selected subtest scores were demonstrated in relationship to the following variables: increased age; certification in pediatric advanced life support, advanced cardiac life support or adult critical care; increased years of adult critical care experience; advanced dysrhythmia courses and dysrhythmia self-study; and perceived knowledge level above that of the advanced beginner. CONCLUSIONS: Pediatric critical care nurses' overall knowledge of dysrhythmias was low. Knowledge strengths included recognition of basic and life-threatening dysrhythmias and calculation of basic ECG measurements. Knowledge deficits included importance of sinus bradycardia in the neonate, appropriate intervention for life-threatening dysrhythmias and calculation of an irregular heart rate. These deficits should be considered when planning continuing education programs for pediatric critical care nurses.

Epidemiology of isolation precautions.

OBJECTIVE: To investigate compliance with isolation precautions. DESIGN: A prospective observational study carried out during ten weeks of 1989. Participants were unaware of the study. SETTING: The isolation bay of a 24-bed surgical intensive care unit in a 900-bed university tertiary care facility. PARTICIPANTS: Study participants included any healthcare worker or visitor entering the patient room during designated 15-minute intervals. RESULTS: We observed 467 subjects entering patient rooms. Compliance with strict isolation (65%) was better than with wound/skin (40%) or excretion/secretion (36%) isolation (p less than .01). Visitors were more compliant than healthcare workers (88% versus 41%; p less than .01). Spending more time in the room was associated with improved compliance (p less than .01). Compliance was higher for subjects entering with a group compared with those entering alone (51% versus 41%; p less than .05). The compliance rate for nurses improved as the nurse/patient ratio improved (p = .14). Compliance was independent of severity of illness. Multivariate analysis revealed that the amount of time spent in the room, being a visitor, and use of strict isolation were independent predictors of compliance. CONCLUSIONS: Noncompliance was widespread. When increased demands are placed on the time of physicians and nurses in the name of cost containment, unperceived consequences, such as those resulting from decreased compliance, must be considered.