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.

Periapical infection may affect birth outcomes via systemic inflammation.

OBJECTIVES: Maternal dental periapical infections are associated with preterm birth and intrauterine growth restriction. This study investigates whether the association is mediated through bacterial spread from periapical lesions to placenta (direct pathway) or systemic inflammatory reaction (indirect pathway). MATERIALS AND METHODS: We compared birth outcomes in Malawian mothers with and without periapical infection. As markers of a direct pathway, we identified placental bacteria using a 16S rDNA approach and assessed histological evidence of inflammation in the placenta and amniotic membranes. We measured C-reactive protein, alpha-1-acid glycoprotein, and salivary cortisol as markers of an indirect pathway. We used regression models to associate the predictor variables with duration of pregnancy and newborn size. RESULTS: Of 1,024 women, 23.5% had periapical infection. There was no association of periapical infection with either bacterial DNA or histological inflammation in placenta or membranes. Periapical infection was associated with C-reactive protein, alpha-1-acid glycoprotein, and cortisol concentrations in a dose-dependent manner at 36 weeks. Addition of alpha-1-acid glycoprotein or cortisol concentration into regression models attenuated the association between periapical infection and pregnancy outcomes. CONCLUSION: There was no evidence of direct spread of periapical bacteria to the placenta. Periapical infections and adverse pregnancy outcomes are in part mediated through systemic inflammation.

Including ethical considerations in models for first-trimester screening for pre-eclampsia.

Recent efforts to develop reliable and efficient early pregnancy screening programmes for pre-eclampsia have focused on combining clinical, biochemical and biophysical markers. The same model has been used for first-trimester screening for fetal aneuploidies i.e. prenatal diagnosis (PD), which is routinely offered to all pregnant women in many developed countries. Some studies suggest combining PD and pre-eclampsia screening, so women can be offered testing for a number of conditions at the same clinical visit. A combination of these tests may be practical in terms of saving time and resources; however, the combination raises ethical issues. First-trimester PD and pre-eclampsia screening entail qualitative differences which alter the requirements for disclosure, non-directedness and consent with regard to the informed consent process. This article explores the differences related to the ethical issues raised by PD and pre-eclampsia in order to elucidate which factors are relevant to deciding the type of information and consent required in each context from the perspective of the ethical principles of beneficence and autonomy. Furthermore, it argues that ensuring respect for patient autonomy is context dependent and, consequently, pre-eclampsia screening and PD should be performed independently of one another.

Epstein-Barr virus early antigen diffuse (EBV-EA/D)-directed immunoglobulin A antibodies in systemic lupus erythematosus patients.

OBJECTIVE: We sought to determine whether the serological response towards lytic cycle antigens of Epstein-Barr virus (EBV) is altered in systemic lupus erythematosus (SLE) patients. METHOD: We used enzyme-linked immunosorbent assay (ELISA) to investigate the prevalence of EBV early antigen diffuse (EBV-EA/D) antibodies in sera from 60 patients with SLE, 40 with scleroderma (SSc), 20 with primary Sjögren's syndrome (pSS), 20 with rheumatoid arthritis (RA), 20 healthy controls, and also subjects with various circulating autoantibodies. Samples from patients were obtained from clinics specialized within the diseases in Denmark and Sweden and samples from healthy controls were obtained from volunteers. RESULTS: A significant elevated titre of immunoglobulin (Ig)A, IgG, and IgM EBV-EA/D antibodies was found in SLE patients compared to healthy controls, a finding not explained by immunosuppressive treatment or disease activity. The largest difference was observed for IgA EBV-EA/D antibodies (p = 0.0013) with a seropositive rate of 58% in SLE patients and 0% in healthy controls. RA and SSc patients and individuals seropositive for anti-Scl-70 were additionally found to have elevated titres of IgA EBV-EA/D antibodies (40%, p = 0.014; 60%, p = 0.015; and 38.5%, p = 0.045, respectively). However, the titres were generally lower than in SLE patients. CONCLUSION: Our findings support an association between EBV and SLE. The elevated titre of EBV-EA/D-directed IgA antibodies found in SLE patients could suggest reactivation of EBV in epithelial cells or reinfection of epithelial cells after reactivation in B cells, indicating lack of control of the latent infection.

Angiogenesis in non-Hodgkin's lymphoma: clinico-pathological correlations and prognostic significance in specific subtypes.

The aim of the study was to evaluate angiogenesis in different subtypes of non-Hodgkin's lymphoma (NHL) and to correlate angiogenic scores to clinical endpoints. Pre-therapeutic lymph node biopsies from 308 patients with NHL [107 follicular B-cell lymphoma (FL), 94 diffuse large B-cell lymphoma (DLBCL), 107 peripheral T-cell lymphoma (PTCL)] were studied. Microvessels were scored according to the Chalkley and microvessel density method (MVD) methods. Vascular endothelial growth factor (VEGF) protein expression was evaluated by immunohistochemistry. Both Chalkley and MVD methods showed, that the lymphoma subtypes differed significantly in angiogenic scores (P < 0.001). Angiogenic scores in tumor area were highest in PTCL, and lowest in FL. However, a remarkable high microvessel density was found in interfollicular areas of FL. In FL, high interfollicular MVD scores predicted progressive disease and poorer overall and event-free survival (P = 0.024 and 0.013). High interfollicular Chalkley scores correlated with transformation to DLBCL (P = 0.01). VEGF expression was detected in all NHL subtype, and the strongest expression was found in PTCL. In FL, patients with diffuse VEGF expression in lymphoma cells had poorer overall survival than those with focal expression.

The inner ear macular sensory epithelia of the Daubenton's bat.

The inner ear macular sensory epithelia of the Daubenton's bat were examined quantitatively to estimate the area and total number of hair cells. Ultrastructural examination of the sensory epithelium reveals two main types of hair cells: the chalice-innervated hair cell and the bouton-innervated hair cell. The existence of an intermediate type, with a nerve ending covering the lateral side of the hair cell, indicates that the chalice-innervated hair cells are derived from bouton-innervated hair cells. Thus, at least a part of the bouton-innervated hair cells forms a transitional stage. A number of immature as well as apoptotic hair cells were observed. It is suggested that a continuous production of new hair cells takes place in mature individuals, probably based on transdifferentiation of supporting cells.

Continuous hair cell turnover in the inner ear vestibular organs of a mammal, the Daubenton's bat (Myotis daubentonii).

In both humans and mice the number of hair cells in the inner ear sensory epithelia declines with age, indicating cell death (Park et al. 1987; Rosenhall 1973). However, recent reports demonstrate the ability of the vestibular sensory epithelia to regenerate after injury (Forge et al. 1993, 1998; Kuntz and Oesterle 1998; Li and Forge 1997; Rubel et al. 1995; Tanyeri et al. 1995). Still, a continuous hair cell turnover in the vestibular epithelia has not previously been demonstrated in mature mammals. Bats are the only flying mammals, and they are known to live to a higher age than animals of equal size. The maximum age of many species is 20 years, with average lifespans of 4-6 years (Schober and Grimmberger 1989). Further, the young are fully developed and able to fly at the age of 2 months, and thus the vestibular organs are thought to be differentiated at that age. Consequently, long-lived mammals such as bats might compensate for the loss of hair cells by producing new hair cells in their postembryonic life. Here we show that the utricular macula of adult Daubenton's bats (more than 6 months old) contains innervated immature hair cells as well as apoptotic hair cells, which strongly indicates a continuous turnover of hair cells, as previously demonstrated in birds.

Synaptic body movements in the sensory cells of lateral line organs in the urodele amphibian Ambystoma mexicanum.

Examination of the neuromasts in the tail of the living juvenile axolotl Ambystoma mexicanum with interference contrast (Nomarski) microscopy shows that their cellular structures can be identified in considerable detail. Microscopy was performed with a 40 x water immersion objective or with a 100 x objective in a tail insertion chamber. Thus the sensory hair bundles can be seen and their orientation can be determined. Large spheres in the basal part of the sensory cells were predicted to be synaptic bodies. Subsequent examination in the transmission electron microscope of the cells observed in the light microscope confirmed this notion. Inspection during periods of several hours reveals definite movements of the synaptic bodies.

The inner ear of the echidna Tachyglossus aculeatus: the vestibular sensory organs.

The monotremes, comprising the echidnas and platypus, have more sensory organs in the inner ear than do other mammals. In addition to the organs usually seen in the mammalian inner ear, they have a lagenar macula, a sense organ found in all non-mammalian vertebrates. In the echidna Tachyglossus aculeatus, this macula consists of a narrow sensory strip at the end of the cochlea. All vestibular sensory organs are populated by two types of sensory cells, cylindrical bouton-innervated hair cells and more or less regular bottle-shaped calyceal-innervated hair cells. The two types are mixed in all vestibular organs, as in placental mammals, and their arrangement in the maculae in particular is very unlike that in reptiles. The sensory epithelia are very large relative to the size of the animals. The utricular macula contains more sensory cells than found in any other amniote so far examined.

Regeneration of lateral line and inner ear vestibular cells.

Labelling experiments with [3H]thymidine demonstrate a continuous production of cells in the mechanoreceptive lateral line organs of the eel (Anguilla anguilla) and butterfly fish (Pantodon buchholzi) as well as in the electroreceptive ampullary organ of the transparent catfish (Kryptopterus bicirrhus). Shortly after [3H]thymidine injection many cells are labelled in the middle and basal parts of the sensory organ and after a few days' survival sensory cells are also labelled. The vestibular sensory organs of selected species of fishes, amphibians, reptiles and birds also show a continuous production of cells. In the budgerigar (Melopsittacus undulatus) labelled cells are found in the basal and middle layer of the sensory epithelium a few hours after injection with [3H]thymidine. A few days after the injection labelled cells are found in non-calyceal hair cells. After one month the calyceal cells are also labelled. Similar experiments with the bat Pipistrellus nathusii and with normal and gentamicin-treated mice (Mus musculus) show no labelled cells in the inner ear sensory epithelia. The lateral line organs and vestibular epithelia of non-mammalian vertebrates all contain a small number of dark cells with the characteristics of apoptotic cells. Macrophages and inclusions in some cells, thought to be remnants of apoptotic cells, are occasionally seen. Fixation at different osmolarities has little effect on the number of dark cells. It is suggested that the continually produced cells replace apoptotic dying cells.

The inner ear of the common rhea (Rhea americana L.).

The morphology of the inner ear in rheas was examined by light and electron microscopy. The shape is typically bird-like with very long semicircular canals. The anterior and posterior cristae have small septa cruciata. The vestibular sensory epithelia contain two main types of hair cell innervation; bouton-innervated hair cells and calyceal hair cells characterized by a surrounding nerve calyx. The utricular macula has a single zone of calyceal hair cells, while all other previously examined birds, except the mute swan, have 2 zones. The height of the tallest sensory hairs of the cristae is 20-30 microns. In the utricular and lagenar macula, the hairs are 5-7 microns in the striola and 10-20 microns in the main parts of the sense organs. Along the edges of the maculae the longest hairs may reach 20-30 microns. The number of stereovilli on mature vestibular hair cells is 40-60. The sensory hairs of the hearing organ, the basilar papilla, are generally shorter but more numerous than the vestibular sensory hairs. In the proximal end, the tallest of the 175-200 stereovilli are 2.8-3.7 microns; in the distal end of the papilla, the number of stereovilli decrease to 65-100, and their height increases gradually to 7.3-8.7 microns. The neural sensory hairs are generally taller than those of the abneural side.

Organization of the ampullary organs of the African knife fish Xenomystus nigri (Teleostei: Notopteridae).

Ampullary organs are found on the head and body of the African knife fish Xenomystus nigri. Each organ consists of a duct connecting the basally located sensory cells with the surrounding water. The sensory epithelium is found in a chamber situated in the basal part of the epidermis, which most often is somewhat depressed into the dermis. Each organ contains four to eight sensory cells separated from each other by supporting cells. Both sensory and supporting cells are surrounded by mantle cells. Apically, the pear-shaped sensory cells have a tuft of 40 to 60 microvilli and between these a short cilium; basally they are innervated by one large afferent nerve ending. No efferent endings have been observed.

The lateral line mechanoreceptive mesencephalic, diencephalic, and telencephalic regions in the thornback ray, Platyrhinoidis triseriata (Elasmobranchii).

Central lateral line pathways were mapped in the thronback ray, Platyrhinoidis triseriata, by analyzing depth profiles of averaged evoked potentials (AEPs), multiunit activity (MUA), and single unit recordings. Neural activity evoked by contra- or ipsilateral posterior lateral line nerve (pLLN) shock is restricted to the tectum mesencephali, the dorsomedial nucleus (DMN) and anterior nucleus (AN) of the mesencephalic nuclear complex, the posterior central thalamic nucleus (PCT), the lateral tuberal nucleus of the hypothalamus, and the deep medial pallium of the telencephalon (Figs. 2, 3, 4, 6, 7). Neural responses (AEPs and MUA) recorded in different lateral line areas differ with respect to shape, dynamic response properties, and/or latencies (Figs. 9, 10 and Table 1). Ipsilaterally recorded mesencephalic and diencephalic AEPs are less pronounced and of longer latency than their contralateral counterpart (Fig. 9 and Table 1). In contrast, AEP recorded in the telencephalon show a weak ipsilateral preference. If stimulated with a low amplitude water wave most DMN, AN, and tectal lateral line units respond in the frequency range 6.5 Hz to 200 Hz. Best frequencies (in terms of least displacement) are 75-150 Hz with a peak-to-peak water displacement of 0.04 micron sufficient to evoke a response in the most sensitive units (Fig. 11A, B, C). DMN and AN lateral line units have small excitatory receptive fields (RFs). Anterior, middle, and posterior body surfaces map onto the rostral, middle, and posterior brain surfaces of the contralateral DMN (Fig. 12). Some units recorded in the PCT are bimodal; they respond to a hydrodynamic flow field--generated with a ruler approaching the fish--only if the light is on and the eye facing the ruler is left uncovered (Fig. 13).

Non-innervated sense organs of the lateral line: development in the regenerating tail of the salamander Ambystoma mexicanum.

New lateral organs (neuromasts) are formed in regenerating tails of the larvae of a urodele, the axolotl (Ambystoma mexicanum), even in the absence of the lateral line nerve, as confirmed by electron microscopic examination. The non-innervated organs are similar to normal innervated organs. The hair cells are polarized in opposite directions, and despite the lack of nerve endings, contain synaptic bodies, which in normal innervated organs are found in relation to afferent boutons.