Objective:To preliminarily explore the relationship between intraventricular pressure gradients (IVPG) measured by ultrasound hemodynamic analysis and left ventricular cardiotoxicity after anthracycline chemotherapy.Methods:This was a retrospective cohort study. Patients with diffuse large B-cell lymphoma (DLBCL) who completed 6 cycles of R-CHOP chemotherapy at Fudan University Shanghai Cancer Center from 2014 to 2015 were included. Echocardiography was performed at baseline (T0), after 2 cycles of chemotherapy (T1), after 4 cycles of chemotherapy (T2), and after all chemotherapy cycles (T3). Left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), and left ventricular ejection fraction (LVEF) were analyzed using speckle-tracking imaging technology, and IVPG was measured using hemodynamic analysis technology, including IVPG of long-axis (IVPG-LA) and IVPG of short-axis. The change rate of each index from T0 to T2 was marked as Δ. Left ventricular cardiotoxicity was defined as a decrease in LVEF of ≥10% from the baseline level or LVEF ≤50%. Univariate logistic regression analysis was used to explore the related factors of left ventricular myocardial toxicity, and the receiver operating characteristic curve was drawn to analyze their evaluation efficiency for left ventricular myocardial toxicity.Results:A total of 55 patients were included, including 28 males (51%), aged (46.5±11.7) years. Twelve patients (22%) developed left ventricular cardiotoxicity. Compared with T0, IVPG-LA decreased at T1 ((10.73±2.51)% vs. (11.52±3.62)%, P=0.037); while LVGLS, LVGCS, and LVEF only decreased at T3 (all P<0.05). Univariate logistic regression analysis showed that ΔIVPG-LA and ΔLVGLS were related factors for left ventricular myocardial toxicity in patients with DLBCL receiving chemotherapy (all P<0.05). The receiver operating characteristic curve showed that the area under the curve of ΔLVGLS was 0.702, with an optimal cut-off value of 13.15% (sensitivity 66.7%, specificity 62.8%); the area under the curve of ΔIVPG-LA was 0.812, with an optimal cut-off value of 20.74% (sensitivity 75.0%, specificity 90.7%). Conclusions:Hemodynamic analysis technology shows promise clinical application value in evaluating subclinical changes in left ventricular function in tumor patients after anthracycline chemotherapy; the change rate of IVPG-LA could be used as an early indicator of left ventricular toxicity after anthracycline chemotherapy.

Objective:To preliminarily explore the relationship between intraventricular pressure gradients (IVPG) measured by ultrasound hemodynamic analysis and left ventricular cardiotoxicity after anthracycline chemotherapy.Methods:This was a retrospective cohort study. Patients with diffuse large B-cell lymphoma (DLBCL) who completed 6 cycles of R-CHOP chemotherapy at Fudan University Shanghai Cancer Center from 2014 to 2015 were included. Echocardiography was performed at baseline (T0), after 2 cycles of chemotherapy (T1), after 4 cycles of chemotherapy (T2), and after all chemotherapy cycles (T3). Left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), and left ventricular ejection fraction (LVEF) were analyzed using speckle-tracking imaging technology, and IVPG was measured using hemodynamic analysis technology, including IVPG of long-axis (IVPG-LA) and IVPG of short-axis. The change rate of each index from T0 to T2 was marked as Δ. Left ventricular cardiotoxicity was defined as a decrease in LVEF of ≥10% from the baseline level or LVEF ≤50%. Univariate logistic regression analysis was used to explore the related factors of left ventricular myocardial toxicity, and the receiver operating characteristic curve was drawn to analyze their evaluation efficiency for left ventricular myocardial toxicity.Results:A total of 55 patients were included, including 28 males (51%), aged (46.5±11.7) years. Twelve patients (22%) developed left ventricular cardiotoxicity. Compared with T0, IVPG-LA decreased at T1 ((10.73±2.51)% vs. (11.52±3.62)%, P=0.037); while LVGLS, LVGCS, and LVEF only decreased at T3 (all P<0.05). Univariate logistic regression analysis showed that ΔIVPG-LA and ΔLVGLS were related factors for left ventricular myocardial toxicity in patients with DLBCL receiving chemotherapy (all P<0.05). The receiver operating characteristic curve showed that the area under the curve of ΔLVGLS was 0.702, with an optimal cut-off value of 13.15% (sensitivity 66.7%, specificity 62.8%); the area under the curve of ΔIVPG-LA was 0.812, with an optimal cut-off value of 20.74% (sensitivity 75.0%, specificity 90.7%). Conclusions:Hemodynamic analysis technology shows promise clinical application value in evaluating subclinical changes in left ventricular function in tumor patients after anthracycline chemotherapy; the change rate of IVPG-LA could be used as an early indicator of left ventricular toxicity after anthracycline chemotherapy.

Background and purpose:Next generation sequencing-identified genetic alterations of diffuse large B cell lymphoma(DLBCL)and baseline SUVmax detected by 18F-FDG PET/CT were correlated with patients'prognosis.However,their relationship and the associations with R-CHOP response of DLBCL are still unclear.This study aimed to analyze the association bewteen genetic alterations and 18F-FDG PET/CT SUVmax and their correlations with clinicopathological characteristics and R-CHOP response of DLBCL.Methods:A total of 225 cases of primary DLBCL detected by next generation sequencing using 481 lymphoma gene panel and examined by 18F-FDG PET/CT before treatment between 2022 and 2023 were collected.This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center(Ethical No.:050432-4-2307E)and acquired the informed consent of the patients.The translocations of BCL2,BCL6 and MYC were identified by fluorescence in situ hybridization.The clinicopathological characteristics and the PET/CT scan after R-CHOP chemotherapy were collected.Results:Finally,191 patients were enrolled in this study.The frequency of MYD88 mutation,TP53 mutation,copy number variations of CDKN2A/2B,CD79B mutation in the 191 DLBCL patients were 24.6%,27.2%,32.5%and 16.8%,respectively.The range of baseline SUVmax was 5.10-63.10(24.44±10.70,median 22.80).The baseline SUVmax of MYD88L265P DLBCL was significantly higher than that of MYD88 wild type(P=0.039).There were no significant associations of SUVmax with other gene alterations including TP53 mutation,CDKN2A/B loss,CD79B mutation,KMT2D mutation,TNFAIP3 mutation,B2M mutation,EZH2 mutation,BTG1/2 mutation,CREBBP mutation,gene translocations of MYC,BCL2 and BCL6.The higher SUVmax before treatment was correlated with higher serum lactate dehydrogenase(LDH)level(P=0.012)and non-germinal center B-cell-like(non-GCB)DLBCL(P=0.040).However,there was no significant association of SUVmax with R-CHOP response(P=0.714).TP53 mutation was significantly associated with the poor response of R-CHOP(P=0.001)and was an independent predictor of non-complete metabolic response(non-CMR).TP53 mutation combined with Ann Arbor stage,International Prognostic Index(IPI)score and serum LDH level could better predict R-CHOP response than each factor alone.Conclusion:MYD88L265P DLBCL had higher baseline 18F-FDG PET/CT SUVmax.The baseline SUVmax was not associated with R-CHOP response.However,TP53 mutation was significantly correlated with poor response of R-CHOP in DLBCL patients.TP53 mutation combined with clinicopathological characteristics could better predict R-CHOP response.The associations of gene alterations and SUVmax with prognosis of DLBCL patients needed to be explored in the future.

Background and purpose:Next generation sequencing-identified genetic alterations of diffuse large B cell lymphoma(DLBCL)and baseline SUVmax detected by 18F-FDG PET/CT were correlated with patients'prognosis.However,their relationship and the associations with R-CHOP response of DLBCL are still unclear.This study aimed to analyze the association bewteen genetic alterations and 18F-FDG PET/CT SUVmax and their correlations with clinicopathological characteristics and R-CHOP response of DLBCL.Methods:A total of 225 cases of primary DLBCL detected by next generation sequencing using 481 lymphoma gene panel and examined by 18F-FDG PET/CT before treatment between 2022 and 2023 were collected.This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center(Ethical No.:050432-4-2307E)and acquired the informed consent of the patients.The translocations of BCL2,BCL6 and MYC were identified by fluorescence in situ hybridization.The clinicopathological characteristics and the PET/CT scan after R-CHOP chemotherapy were collected.Results:Finally,191 patients were enrolled in this study.The frequency of MYD88 mutation,TP53 mutation,copy number variations of CDKN2A/2B,CD79B mutation in the 191 DLBCL patients were 24.6%,27.2%,32.5%and 16.8%,respectively.The range of baseline SUVmax was 5.10-63.10(24.44±10.70,median 22.80).The baseline SUVmax of MYD88L265P DLBCL was significantly higher than that of MYD88 wild type(P=0.039).There were no significant associations of SUVmax with other gene alterations including TP53 mutation,CDKN2A/B loss,CD79B mutation,KMT2D mutation,TNFAIP3 mutation,B2M mutation,EZH2 mutation,BTG1/2 mutation,CREBBP mutation,gene translocations of MYC,BCL2 and BCL6.The higher SUVmax before treatment was correlated with higher serum lactate dehydrogenase(LDH)level(P=0.012)and non-germinal center B-cell-like(non-GCB)DLBCL(P=0.040).However,there was no significant association of SUVmax with R-CHOP response(P=0.714).TP53 mutation was significantly associated with the poor response of R-CHOP(P=0.001)and was an independent predictor of non-complete metabolic response(non-CMR).TP53 mutation combined with Ann Arbor stage,International Prognostic Index(IPI)score and serum LDH level could better predict R-CHOP response than each factor alone.Conclusion:MYD88L265P DLBCL had higher baseline 18F-FDG PET/CT SUVmax.The baseline SUVmax was not associated with R-CHOP response.However,TP53 mutation was significantly correlated with poor response of R-CHOP in DLBCL patients.TP53 mutation combined with clinicopathological characteristics could better predict R-CHOP response.The associations of gene alterations and SUVmax with prognosis of DLBCL patients needed to be explored in the future.

Objective To analyze the changes in left ventricular deformation function in patients with diffuse large B-cell lymphoma(DLBCL)treated with different doses of anthracycline chemotherapy using 3D speckle-tracking imaging(3D-STI).Methods 66 DLBCL patients receiving anthracycline chemotherapy were enrolled.Based on the cumulative dose of anthracycline received,the patients were divided into a high-dose group(＞360 mg/m2,n=39)and a low-dose group(≤360 mg/m2,n=27).Patients underwent transthoracic echocardiography before chemotherapy and within one week after completion of the entire chemotherapy cycle.Left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),and other indices were analyzed using 3D-STI to assess changes in left ventricular deformation indices after chemotherapy and between two groups.Results Compared to baseline,DLBCL patients showed significant reductions in LVGLS,LVGCS and left atrial global longitudinal strain(LAGLS)after treatment completion(P＜0.001).When comparing the high-dose group with the low-dose group,there was a significant increase in relative LVGCS change rate at the end of chemotherapy(21.12[6.52,35.37]vs 5.49[-14.73,27.01];P=0.03).However,there were no statistically significant differences in relative left ventricular ejection fraction(LVEF),LVGLS,LVGCS,LVEF change rate,or LVGLS change rate between the two groups.Conclusions 3D-STI can be a potential method to identify the sub-clinical deterioration of left ventricular systolic function in patients received anthracycline chemotherapy,the difference of change rate of LVGCS may predict the variation of sub-clinical deterioration of left ventricular function between patients received high and low doses of anthracycline chemotherapy.

Background: Immunochemotherapy has demonstrated a promising efficacy for a variety of B-cell lymphoma but has limited efficacy for Epstein–Barr virus-positive (EBV +) diffuse large B-cell lymphoma (DLBCL) that is refractory or relapsed to conventional chemotherapy regimens. Considering higher programmed death-ligand 1 (PD-L1) expres‑ sion in the subset of patients with DLBCL with positive EBV, we speculated that PD-1 inhibitors plus chemotherapy may be an alternative regimen in patients with refractory/relapsed EBV + DLBCL. Methods: This retrospective study included six adult patients diagnosed with refractory EBV + DLBCL resistant to first-line immunochemotherapy regimens (R-CHOP). These patients received PD-1 inhibitors plus chemotherapy as second-line treatment. Results: The final analysis included six patients (four men and two women (median age, 50 years; range, 39–83 years)). Four patients were diagnosed with Epstein–Barr virus (EBV) + DLBCL, and two had DLBCL associated with chronic inflammation. Over a median follow-up of 20 months (range, 2–31 months), the objective response rate was 83% (5/6) and the complete remission rate was 67% (4/6). No severe immune-related adverse reactions occurred, and only a mild rash was reported, which did not necessitate the discontinuation of therapy. Conclusion The combination of PD-1 inhibitors and chemotherapy offers promising results as a second-line treat‑ ment for patients with refractory EBV + DLBCL that is resistant to first-line immunochemotherapy regimens. These preliminary findings warrant further investigation in larger clinical trials to validate the efficacy and safety of this therapeutic approach.

Background: Immunochemotherapy has demonstrated a promising efficacy for a variety of B-cell lymphoma but has limited efficacy for Epstein–Barr virus-positive (EBV +) diffuse large B-cell lymphoma (DLBCL) that is refractory or relapsed to conventional chemotherapy regimens. Considering higher programmed death-ligand 1 (PD-L1) expres‑ sion in the subset of patients with DLBCL with positive EBV, we speculated that PD-1 inhibitors plus chemotherapy may be an alternative regimen in patients with refractory/relapsed EBV + DLBCL. Methods: This retrospective study included six adult patients diagnosed with refractory EBV + DLBCL resistant to first-line immunochemotherapy regimens (R-CHOP). These patients received PD-1 inhibitors plus chemotherapy as second-line treatment. Results: The final analysis included six patients (four men and two women (median age, 50 years; range, 39–83 years)). Four patients were diagnosed with Epstein–Barr virus (EBV) + DLBCL, and two had DLBCL associated with chronic inflammation. Over a median follow-up of 20 months (range, 2–31 months), the objective response rate was 83% (5/6) and the complete remission rate was 67% (4/6). No severe immune-related adverse reactions occurred, and only a mild rash was reported, which did not necessitate the discontinuation of therapy. Conclusion The combination of PD-1 inhibitors and chemotherapy offers promising results as a second-line treat‑ ment for patients with refractory EBV + DLBCL that is resistant to first-line immunochemotherapy regimens. These preliminary findings warrant further investigation in larger clinical trials to validate the efficacy and safety of this therapeutic approach.

Background: Immunochemotherapy has demonstrated a promising efficacy for a variety of B-cell lymphoma but has limited efficacy for Epstein–Barr virus-positive (EBV +) diffuse large B-cell lymphoma (DLBCL) that is refractory or relapsed to conventional chemotherapy regimens. Considering higher programmed death-ligand 1 (PD-L1) expres‑ sion in the subset of patients with DLBCL with positive EBV, we speculated that PD-1 inhibitors plus chemotherapy may be an alternative regimen in patients with refractory/relapsed EBV + DLBCL. Methods: This retrospective study included six adult patients diagnosed with refractory EBV + DLBCL resistant to first-line immunochemotherapy regimens (R-CHOP). These patients received PD-1 inhibitors plus chemotherapy as second-line treatment. Results: The final analysis included six patients (four men and two women (median age, 50 years; range, 39–83 years)). Four patients were diagnosed with Epstein–Barr virus (EBV) + DLBCL, and two had DLBCL associated with chronic inflammation. Over a median follow-up of 20 months (range, 2–31 months), the objective response rate was 83% (5/6) and the complete remission rate was 67% (4/6). No severe immune-related adverse reactions occurred, and only a mild rash was reported, which did not necessitate the discontinuation of therapy. Conclusion The combination of PD-1 inhibitors and chemotherapy offers promising results as a second-line treat‑ ment for patients with refractory EBV + DLBCL that is resistant to first-line immunochemotherapy regimens. These preliminary findings warrant further investigation in larger clinical trials to validate the efficacy and safety of this therapeutic approach.

Objective: To detect the changes of systolic function of left ventricle in patients with lymphoma receiving anthracycline by three dimensional speckle tracking imaging(3D-STI). Methods: Thirty patients with newly diagnosed diffused large B-cell lymphoma who had received R-CHOP chemotherapy were enrolled. Left ventricular global longitudinal strain (GLS), global circumferential strain(GCS) and longitudinal strain(LS) on different left ventricular segments were measured by 3D-STI at baseline, after the completion of 2 cycles and 4 cycles of the regimen respectively. Results: Compared with baseline, GLS reduced significantly after four cycles of anthracycline chemotherapy(P=0.002). Analysis of LS on different segments of the left ventricle shows: after 2 cycles of anthracycline chemotherapy, LS only on apical septum was significantly decreased(P=0.019). After 4 cycles of treatment, LS on mid anterior, mid anteroseptal, mid inferoseptal, mid anterolateral, apical anterior, apical septal walls and apex worsened (t=3.321, P=0.002; t=2.497, P=0.018; t=2.387, P=0.024; t=2.096, P=0.045; t=4.015, P=0.000; t=4.064, P=0.000; t=3.370, P=0.002, respectively). Conclusions LS deterioration emerges on some left ventricular walls in patients with lymphma underwent chemotheapy based on anthracycline in early stage of the remedy, especially on apex and mid segments. LS on apical septum manifests firstly. The segmental LS index maybe expected to be valuable for monitoring of early cardiotoxicity of antharcycline.

Objective To investigate the effect of long cotton branch instead of cotton ball in postoperative oral nursing of patients in the department of neurosurgery. Methods All 72 cases of coma from January 2013 to January 2014 were used long cotton branches in postoperative oral nursing (observation group),72 cases of coma from December 2011 to December 2011 were used cotton ball in postoperative oral nursing (control group), the effect of nursing care, oral cavity cleaning degree,nurse fatigue degree score and complication were compared. Results The nursing efficient,oral cavity cleaning degree and nurse fatigue degree score of the observation group was significantly better than the control group(P<0.05);the complication rates of the observation group was significantly lower than the control group(P<0.05). Conclusion Use long cotton branch instead of cotton ball in postoperative oral nursing of patients in the department of neurosurgery,could get more significant clinical effect and lower complication rates.