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Objective:To investigate the clinical manifestations, pathological features, treatment and prognosis of primary bone lymphoma in children.Methods:The clinical data of children who were initially diagnosed as primary bone lymphoma and treated in Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to January 2020 were retrospectively analyzed, including gender, onset age, primary involvement site, clinical stage, pathological type, fracture, and clinical outcome. The related literature was reviewed.Results:All 11 children were initially diagnosed as primary bone lymphoma, with a median age of onset of 8.6 years old (2.7-12.3 years old), including 7 males and 4 females. There were 7 cases of diffuse large B-cell lymphoma (DLBCL), 3 cases of B lymphoblastic lymphoma (BLL), and 1 case of anaplastic large cell lymphoma (ALCL). The initial symptoms were bone pain in 8 cases, local swelling in 1 case, limp in 1 case, and fever in 1 case. One case was in stage Ⅰ, 7 cases were in stageⅡ, and 3 cases were in stage Ⅳ, and the most common sites of involvement were femur and tibia. All 11 cases were treated with chemotherapy according to different pathological types, with a median follow-up time of 45 months (7-80 months). Ten cases got complete remission, 1 case of BLL died of bone marrow recurrence after chemotherapy remission.Conclusions:The clinical manifestations of primary bone lymphoma in children are insidious, DLBCL is the most common pathological type, and the prognosis is good after standardized treatment.
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Objective To study the efficiency and accuracy of artificial intelligence (AI) system based on fundus photograph in diabetic retinopathy(DR)screening,and evaluate the clinical application value of AI system. Methods A diagnostic trial was adopted. Total of 13683 color fundus photos were collected in Zhaoqing Gaoyao People's Hospital from March,2017 to November,2018. The AI system for DR (ZOC-DR-V1) was established,based on transfer learning + NASNet algorithm,by training 4465 precisely labeled fundus images (2510 normal,and 1955 with any stage of DR). One thousand confirmed fundus images (300 normal and 700 with any stage of DR),diagnosed by AI ( AI group ) and doctors ( 3 ophthalmologist doctors and 3 endocrinologist doctors ) ( doctor group ) , respectively. Ophthalmologist group and endocrinologist group were both composed of primary,intermediate and senior physicians. The mean reading time of each image and the total time of 1000 images were recorded. The accuracy and efficiency of AI system and doctor groups were compared. The reading process was divided into two stages. The diagnostic coincidence rate and the average reading time of each group between the two parts were calculated and compared. This study protocol was approved by Ethic Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No. 2017KYPJ104). Results After training,the diagnostic coincidence rate of AI system (ZOC-DR-V1) in test set was 94. 7％,AUC was 0. 994. In this "man-machine to war",the diagnostic coincidence rate of primary,intermediate and senior endocrinologist was 94. 0％,91. 4％ and 93. 4％;the diagnostic coincidence rate of primary,intermediate and senior ophthalmologist was 92. 7％,94. 4％ and 95. 6％;the diagnostic coincidence rate of AI system was 95. 2％. There was no difference in the diagnostic coincidence rate between AI system and senior ophthalmologist ( P = 0. 749 ) . The mean reading time of each image of primary, intermediate and senior endocrinologists was (4. 63±1. 87),(3. 74±3. 47) and (5. 71±3. 47) seconds,and the total time of 1000 images of primary,intermediate and senior endocrinologists was 1. 29,1. 04 and 1. 58 hours;the mean reading time of each image of primary,intermediate and senior ophthalmologists was ( 7. 25 ± 6. 58 ) , ( 5. 18 ± 5. 01 ) and ( 5. 18 ± 3. 47 ) seconds,and the total time of 1000 images of primary,intermediate and senior endocrinologists was 2. 02,1. 44 and 1. 44 hours;the mean and total time of AI system was (1. 62±0. 67) seconds and 0. 45 hours,and the reading time of AI system was significantly shorter than that of the doctor groups (all at P=0. 000). The diagnostic coincidence rates between previous and posterior part of primary endocrinologist, primary and intermediate ophthalmologist were significantly different (χ2=11. 986,6. 517,10. 896;all at P<0. 05),and the mean reading time in the posterior part was significantly shorter than that in the previous part of intermediate and senior endocrinologist and primary ophthalmologist (t=4. 175,8. 189,5. 160;all at P<0. 01). While the reading time of AI system remained stable throughout the process(χ2=3. 151,P=0. 103;t=0. 038,P=0. 970). Conclusions The ophthalmic AI system based on fundus images has a good diagnostic efficiency,and its diagnostic coincidence rate can compare with senior ophthalmologist,providing a new method and platform for large-scale DR screening.
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Objective To analyze the clinical characteristics of children with neuroblastoma (NB) complicated with lung or pleural metastasis,further to explore the correlation between characteristics and short-term outcome of NB,so as to provide a basis for clinical diagnosis and treatment.Methods A retrospective analysis was performed concerning the age of onset,clinical features,treatment and outcome of 36 patients with NB who were admitted at Blood Tumor Center,Beijing Children's Hospital of Capital Medical University from December 2007 to December 2017.The diagnostic criteria,therapeutic regimen and therapeutic efficacy criteria of the enrolled children were all based on the NB protocol of Beijing Children's Hospital of Capital Medical University (BCH-NB-2007),the clinical stage was based on international clinical stage of neuroblastoma (INSS stage),and stratified treatment was conducted according to the BCH-NB risk grouping standard.The follow-up period lasted till October 31,2018.Results (1) The common clinical features of grouped children:36 patients were selected into the group,accounted for 5.99％ (36/601 cases) in total hospitalized NB children,they were less than 10 years old,10 cases under 18 months,and the median age was 29.5 months (9-105 months);20 cases were male,and 16 cases were female;the primary tumor was located in the retroperitoneal site in 19 cases,accounting for 52.78％,9 cases in adrenal site,accounting for 25.00％,and 8 cases in mediastinal site,accounting for 22.22％.Risk groups:29 cases were in high-risk group,6 cases were in medium-risk group and 1 case was in low-risk group.The main symptoms were of pain onset in 8 cases,fever in 6 cases,local mass in 6 cases,abdominal mass in 4 cases,mediastinal mass in 3 cases,paleness in 3 cases,subcutaneous nodules in 2 cases,abdominal distension in 2 cases,lower limb swelling in 1 case,and diarrhea in 1 case.Among them,16 cases had respiratory system symptoms first,accounting for 44.4％.(2) Laboratory examination:there were 35 patients of neuron-specific enolase (NSE) ≥25 μg/L on the initial diagnosis,of which 11 cases were more than 370 μg/L,the value of serum lactate dehydrogenase (LDH) ≥ 717.5 U/L in 25 patients,accounting for 69.44％,and 10 cases were accompanied by N-myc gene amplification.(3) Imaging examination:on the first diagnosis,chest/abdomen CT showed 75.75％ (24/33 cases) of pleural or lung involvement,PET-CT showed 81.8％ (27/33 cases) of pleural or lung involvement,B-ultrasound showed 41.67 ％ (5/12 cases) of pleural or lung involvement;3 imaging examinations showed:1 positive in 16 cases,2 positive in 16 cases,and 3 positive in 4 cases.(4)Comparison of clinical features of pleural and pulmonary involvement:among the 30 children with pleural involvement,6 cases had respiratory symptoms,3 cases had respiratory symptoms on the 6 cases with pulmonary involvement only,and 4 cases with pleural and pulmonary involvement had no respiratory symptoms at first diagnosis.(5)Treatment and outcome:2 cases died because of critical condition after diagnosis,5 cases didn't receive the law treatment,29 cases accepted law stratification treatment,among them,1 case in low risk group,INSS-Ⅳ,alleviate current (CR);4 cases in the moderate group,INSS-Ⅳ,CR in 2 cases,partial response (PR) in 1 case,progress in 1 case,new tumor foci occurring after chemotherapy discontinuation for 13 months.Twenty-four cases were in the high-risk group,event occurred in 7 cases (29.17％) of them,1 case had progression by postoperative evaluation,4 cases of progression at 1.5,2.0,3.0 and 6.0 months after cessation of chemotherapy,and 2 cases had recurrence at 11 and 17 months after cessation of chemotherapy.Overall survival rate (OS) was 41.4％ for all children analyzed by Kaplan-Merier,and 32.9％ of them were predicted to have 3-year event-free survival.Conclusions Children with pulmonary or pleural metastasis of neuroblastoma have no specific respiratory symptoms.CT scan might be a useful method for diagnosing the group Ⅳ children with pulmonary or pleural metastasis of neuroblastoma.Moreover,there seemed to be no significant correlation between the N-myc gene expression and survival prognosis of these children.
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Objective@#To analyze the clinical characteristics of children with neuroblastoma (NB) complica-ted with lung or pleural metastasis, further to explore the correlation between characteristics and short-term outcome of NB, so as to provide a basis for clinical diagnosis and treatment.@*Methods@#A retrospective analysis was performed concerning the age of onset, clinical features, treatment and outcome of 36 patients with NB who were admitted at Blood Tumor Center, Beijing Children′s Hospital of Capital Medical University from December 2007 to December 2017.The diagnostic criteria, therapeutic regimen and therapeutic efficacy criteria of the enrolled children were all based on the NB protocol of Beijing Children′s Hospital of Capital Medical University (BCH-NB-2007), the clinical stage was based on international clinical stage of neuroblastoma (INSS stage), and stratified treatment was conducted according to the BCH-NB risk grouping standard.The follow-up period lasted till October 31, 2018.@*Results@#(1)The common clinical features of grouped children: 36 patients were selected into the group, accounted for 5.99% (36/601 cases) in total hospitalized NB children, they were less than 10 years old, 10 cases under 18 months, and the median age was 29.5 months (9-105 months); 20 cases were male, and 16 cases were female; the primary tumor was located in the retroperitoneal site in 19 cases, accounting for 52.78%, 9 cases in adrenal site, accounting for 25.00%, and 8 cases in mediastinal site, accounting for 22.22%.Risk groups: 29 cases were in high-risk group, 6 cases were in medium-risk group and 1 case was in low-risk group.The main symptoms were of pain onset in 8 cases, fever in 6 cases, local mass in 6 cases, abdominal mass in 4 cases, mediastinal mass in 3 cases, paleness in 3 cases, subcutaneous nodules in 2 cases, abdominal distension in 2 cases, lower limb swelling in 1 case, and diarrhea in 1 case. Among them, 16 cases had respiratory system symptoms first, accounting for 44.4%.(2)Laboratory examination: there were 35 patients of neuron-specific enolase (NSE) ≥25 μg/L on the initial diagnosis, of which 11 cases were more than 370 μg/L, the value of serum lactate dehydrogenase (LDH) ≥717.5 U/L in 25 patients, accounting for 69.44%, and 10 cases were accompanied by N-myc gene amplification.(3)Imaging examination: on the first diagnosis, chest/abdomen CT showed 75.75%(24/33 cases) of pleural or lung involvement, PET-CT showed 81.8% (27/33 cases) of pleural or lung involvement, B-ultrasound showed 41.67%(5/12 cases) of pleural or lung involvement; 3 imaging examinations showed: 1 positive in 16 cases, 2 positive in 16 cases, and 3 positive in 4 cases.(4)Comparison of clinical features of pleural and pulmonary involvement: among the 30 children with pleural involvement, 6 cases had respiratory symptoms, 3 cases had respiratory symptoms on the 6 cases with pulmonary involvement only, and 4 cases with pleural and pulmonary involvement had no respiratory symptoms at first diagnosis.(5)Treatment and outcome: 2 cases died because of critical condition after diagnosis, 5 cases didn′t receive the law treatment, 29 cases accepted law stratification treatment, among them, 1 case in low risk group, INSS-Ⅳ, alleviate current (CR); 4 cases in the moderate group, INSS-Ⅳ, CR in 2 cases, partial response (PR) in 1 case, progress in 1 case, new tumor foci occurring after chemotherapy discontinuation for 13 months. Twenty-four cases were in the high-risk group, event occurred in 7 cases (29.17%) of them, 1 case had progression by postoperative evaluation, 4 cases of progression at 1.5, 2.0, 3.0 and 6.0 months after cessation of chemotherapy, and 2 cases had recurrence at 11 and 17 months after cessation of chemotherapy.Overall survival rate (OS) was 41.4% for all children analyzed by Kaplan-Merier, and 32.9% of them were predicted to have 3-year event-free survival.@*Conclusions@#Children with pulmonary or pleural metastasis of neuroblastoma have no specific respiratory symptoms.CT scan might be a useful method for diagnosing the group Ⅳ children with pulmonary or pleural metastasis of neuroblastoma.Moreover, there seemed to be no significant correlation between the N-myc gene expression and survival prognosis of these children.