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The English pronoun system is undergoing a change in progress as singular they is used more frequently to refer to specific individuals, especially those who identify as nonbinary. How does this change affect the language production system? Research has shown that the production of he/she pronouns is supported by salient discourse status and inhibited in contexts where the pronoun would be ambiguous. In an analysis of naturally-occurring written texts, we test whether they production patterns with he/she production, controlling for discourse context. Results show that the overall rate of pronoun use is lower for references to nonbinary individuals than for references to binary individuals. This difference is not explained by the potential ambiguity of a referent in context. We speculate that relative unfamiliarity with nonbinary they and nonbinary gender may inhibit the activation of they during production, or may lead writers to avoid using a form that may not be familiar to their addressees.

The current most powerful prognostic model in Multiple Myeloma (MM) combines beta-2 microglobulin (b2m) with albumin, corresponding to the International Staging System (ISS). However, the prognosis of patients within the ISS stage I (high albumin and low b2m) may vary. Ki-67 is a nuclear protein associated with cell proliferation. We retrospectively evaluated the percentage of bone marrow plasma cells expressing Ki-67 antigen (Ki-67 index) in a series of 174 untreated MM patients at diagnosis. Median survival was 51, 41 and 20 months respectively, and median Ki-67 index was 3.0%, 6.1% and 6.5% in ISS stages I, II, and III respectively. Independently of ISS, Ki-67 indexor =4% was highly predictive of adverse prognosis. Ki-67 index correlated with markers of intrinsic malignancy and with markers of tumour burden. Within ISS stage I, median survival was of 31 months (RR of death 2.65) in patients with Ki-67 indexor =4%. Eventually, the combination of Ki-67 with b2m produced an efficient prognostic model, which appeared most effective in our series when compared with b2m and KI-67 with chromosome 13 deletion models. In this series, we demonstrated that a proliferation marker provides clear-cut additional survival prognostic information to b2m into the ISS model.