Evert-Jan Boerma

BACKGROUND: The distinction between Burkitt's lymphoma and diffuse large-B-cell lymphoma is crucial because these two types of lymphoma require different treatments. We examined whether gene-expression profiling could reliably distinguish Burkitt's lymphoma from diffuse large-B-cell lymphoma. METHODS: Tumor-biopsy specimens from 303 patients with aggressive lymphomas were profiled for gene expression and were also classified according to morphology, immunohistochemistry, and detection of the t(8;14) c-myc translocation. RESULTS: A classifier based on gene expression correctly identified all 25 pathologically verified cases of classic Burkitt's lymphoma. Burkitt's lymphoma was readily distinguished from diffuse large-B-cell lymphoma by the high level of expression of c-myc target genes, the expression of a subgroup of germinal-center B-cell genes, and the low level of expression of major-histocompatibility-complex class I genes and nuclear factor-kappaB target genes. Eight specimens with a pathological diagnosis of diffuse large-B-cell lymphoma had the typical gene-expression profile of Burkitt's lymphoma, suggesting they represent cases of Burkitt's lymphoma that are difficult to diagnose by current methods. Among 28 of the patients with a molecular diagnosis of Burkitt's lymphoma, the overall survival was superior among those who had received intensive chemotherapy regimens instead of lower-dose regimens. CONCLUSIONS: Gene-expression profiling is an accurate, quantitative method for distinguishing Burkitt's lymphoma from diffuse large-B-cell lymphoma.

Background: Perioperative music can positively affect postoperative pain, opioid requirement, and anxiety. These effects are even present when music is played solely during general anesthesia. This study assesses the effect of implementing perioperative music as standard patient care in elective bariatric metabolic surgery (BMS). Methods: This prospective study compared the preimplementation (control) and postimplementation (intervention) groups between March and October 2023. The control group did not receive music, while the intervention group received patient-selected music using headphones and a tablet. Music was provided as standard during anesthesia. Only patients undergoing elective BMS (primary ring augmented Roux-en-Y gastric bypass) were included. The primary outcome was postoperative pain on a 10-point scale (numeric rating scale, NRS) on the first postoperative day. The secondary outcomes included postoperative nausea, patient satisfaction, and opioid and antiemetic requirements. Results: In the control group, 66 patients were included, while 65 were included in the intervention group. Median NRS scores were 5 in both groups, showing no significant difference (p = 0.325). Medication use (analgesics and antiemetics) was similar in both groups. Patient satisfaction scores were high at 8 (8-9) and 9 (8-10), respectively, with no significant difference (p = 0.137). In the intervention group, most patients (86%) want to listen to music during subsequent surgical procedures. Conclusion: Implementing perioperative music in BMS did not significantly reduce postoperative pain or postoperative medication use. As the bariatric perioperative tract is already well-received without music, it poses a challenge for detecting notable improvements. However, the strong patient preference for music during future surgeries emphasizes the positive perception of music in perioperative care.