Leukemia is a common, multiple and dangerous blood disease, whose early diagnosis and treatment are very important. At present, the diagnosis of leukemia heavily relies on morphological examination of blood cell images by pathologists, which is tedious and time-consuming. Meanwhile, the diagnostic results are highly subjective, which may lead to misdiagnosis and missed diagnosis. To address the gap above, we proposed an improved Vision Transformer model for blood cell recognition. First, a faster R-CNN network was used to locate and extract individual blood cell slices from original images. Then, we split the single-cell image into multiple image patches and put them into the encoder layer for feature extraction. Based on the self-attention mechanism of the Transformer, we proposed a sparse attention module which could focus on the discriminative parts of blood cell images and improve the fine-grained feature representation ability of the model. Finally, a contrastive loss function was adopted to further increase the inter-class difference and intra-class consistency of the extracted features. Experimental results showed that the proposed module outperformed the other approaches and significantly improved the accuracy to 91.96% on the Munich single-cell morphological dataset of leukocytes, which is expected to provide a reference for physicians' clinical diagnosis.
Humans ; Blood Cells ; Leukocytes ; Leukemia ; Electric Power Supplies ; Recognition, Psychology

PURPOSE: This study was conducted to examine the late effects, social adjustment, and quality of life in adolescents who had been completely treated for childhood leukemia and their parents. METHODS: Participants consisted of 41 pairs of adolescent survivors (13-18 years) and their parents. Parents checked for their child's physical late effects. The Korean Version of Post-Traumatic Symptoms for psychological late effects, social functioning questionnaire for social adjustment and the PedsQL 4.0 Generic Core Scales for quality of life were completed by adolescents and parents. Data were analyzed using SPSS. RESULTS: Twenty out of 41 adolescents had one or more physical late effects. Adolescents showed more serious psychological late effect than parents. Five children and seven parents had above cut-off scores and they were considered the high risk group for posttraumatic symptoms. Parent-reported scores were significantly higher than child-reported scores in terms of social adjustment and emotional functioning of quality of life. Low school functioning in adolescents was associated with physical late effects. CONCLUSION: The results indicate that long-term and systematic management for childhood leukemia survivors affect positive social adjustment and can further improve quality of life.
Adolescent ; Adult ; Humans ; Leukemia/*psychology ; Parents/psychology ; *Quality of Life ; Questionnaires ; *Social Adjustment ; Stress, Psychological ; Survivors/*psychology ; Time Factors ; Translating

Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; physiopathology ; psychology ; Quality of Life ; psychology ; Survivors ; psychology

BACKGROUND: Acute promyelocytic leukemia (APL) has two subtypes, a typical French-American-British (FAB)-M3 type and an atypical FAB-M3v type described as microgranular variant, and immunophenotyping is a rapid and accurate method for the diagnosis of APL. We tried to define immunological criteria for the diagnosis of APL in each different period from 1987 to 2003. The purpose of this study was to compare the discrimination capacity of several panels with FAB classification. METHODS: We applied immunophenotyping panel I, II, and III for the diagnosis of APL in each of the following three different periods: Panel I [HLA-DR(-), CD15(-)] (1987-1991); Panel II [HLA-DR(-), CD13(+), CD33(+), CD14(-)] (1992-1994); and Panel III [HLA- DR(-), CD34(-), CD13(+), CD33(+), CD14(-)] (1994-2003) with negative lymphoid markers in all panels. Standard FAB classification and direct immunofluorescence method were applied to diagnosis in 570 cases of acute leukemia. RESULTS: The immunophenotyping to identify FAB subtype AML-M3 and M3v was established as the panel of [HLA-DR (-), CD34 (-), CD13 and/or CD33 (+), CD14 (-)] with negative lymphoid markers (CD19, CD10, CD20, CD22, CD3, CD5, and CD7). The sensitivity and specificity of this panel for the diagnosis of APL was 100% and 99%, respectively. CONCLUSIONS: Our study demonstrates the evolution of immunophenotyping panel from a primitive to advanced design. This immunophenotyping panel can be a "quick reference" for the diagnosis of APL without extra effort.
Classification ; Diagnosis* ; Discrimination (Psychology) ; Fluorescent Antibody Technique, Direct ; HLA-DR Antigens ; Immunophenotyping* ; Leukemia ; Leukemia, Promyelocytic, Acute* ; Sensitivity and Specificity

BACKGROUND: Bcr/abl translocation is a recurring chromosome aberration in acute leukemia (AL). About half of the translocation in AL occur at minor bcr region (m-bcr) and remaining half at major bcr region (M-bcr). PCR method has been the practical tool for this discrimination. Recently, modified probe of FISH (fluorescence in situ hybridization) for bcr/abl was designed. In this study, we investigated whether FISH analysis with this new probe can discriminate between m-bcr and M-bcr. METHODS: Fourteen cases harboring m-bcr confirmed by qualitative PCR method were enrolled for this study. Except for two cases, all were diagnosed as AL. Cytogenetic results showed Philadelphia chromosome (Ph) in 10 cases all of which the diagnosis was AL. FISH analysis was performed on the archival samples for cytogenetic study in all cases. RESULTS: Eleven out of 14 cases showed bcr/abl translocation signals by FISH. It was of note that all of these translocation signals were different from those seen in M-bcr with thesame probe. The point of breakage onto the hybridized probe for bcr region made the difference. The resultant number of fusion signal is two in m-BCR and one in M-bcr. All Ph- positive cases showed m-bcr FISH signals. One case of Ph-negative AL in remission was m-bcr-positive by FISH. Remaining three cases of Ph-negative were bcr/abl-negative by FISH. CONCLUSION: With recently designed bcr/abl FISH probe, m-bcr was clearly discriminated from M-bcr. In addition, one case of AL in morphological and cytogenetic remission and positive for m-bcr by PCR was revealed to have significant amount of residual leukemic cells by FISH. These results demonstrate that FISH can be a powerful tool for the detection and quantitative analysis of m-bcr both at initial diagnosis and follow-up thereafter.
Chromosome Aberrations ; Cytogenetics ; Diagnosis ; Discrimination (Psychology) ; In Situ Hybridization, Fluorescence ; Leukemia* ; Philadelphia Chromosome ; Polymerase Chain Reaction

BACKGROUND: This retrospective study aimed to characterize and analyze the outcome of therapy-related myeloid neoplasms (t-MNs) in children and adolescents. METHODS: The medical records of 16 patients under 21 years of age at the time of t-MN diagnosis were reviewed. RESULTS: The median patient age was 11.5 years (range, 1.6–20.4 yr). Twelve patients had therapy-related acute myeloid leukemia, 3 patients had myelodysplastic syndrome, and 1 patient had chronic myelomonocytic leukemia. The median latency period was 29 months (range, 11–68 mo). Fourteen patients had cytogenetic aberrations, 8 of whom had an 11q23 abnormality. Of the 13 patients treated with curative intent, 12 patients received myeloid-type induction therapy that led to complete remission (CR) in 8 patients. Nine patients underwent allogeneic transplantation; 4 patients did not undergo transplantation due to chemotherapy-related toxic death (N=3) or parental refusal (N=1). The 5-year overall survival and event-free survival of the 13 patients treated with a curative intent were 46.2% and 30.8%, respectively. For the 9 patients who underwent allogeneic transplantation, the 5-year event-free survival was 66.7%. CONCLUSION: A significant proportion of young patients with t-MNs can experience long-term survival, and allogeneic transplantation plays a key role for attaining cure in these patients.
Adolescent* ; Child* ; Chromosome Aberrations ; Diagnosis ; Disease-Free Survival ; Humans ; Latency Period (Psychology) ; Leukemia, Myeloid, Acute ; Leukemia, Myelomonocytic, Chronic ; Medical Records ; Myelodysplastic Syndromes ; Parents ; Retrospective Studies ; Transplantation, Homologous

This study was conducted to investigate long-term neurocognitive outcomes and to determine associated risk factors in a cohort of Korean survivors of childhood acute lymphoblastic leukemia (ALL). Forty-two survivors of ALL were compared with 42 healthy controls on measures of a neurocognitive test battery. We analysed potential risk factors (cranial irradiation, sex, age at diagnosis, elapsed time from diagnosis, and ALL risk group) on neurocognitive outcomes. ALL patients had lower, but non-significant full-scale intelligence quotient (FSIQ, 107.2 +/- 12.2 vs. 111.7 +/- 10.2), verbal intelligence quotient (VIQ, 107.7 +/- 13.6 vs. 112.2 +/- 11.4), and performance intelligence quotient (PIQ, 106.3 +/- 14.2 vs. 110.1 +/- 10.7) scores than healthy controls. However, patients treated with cranial irradiation performed significantly lower on FSIQ (102.2 +/- 8.1), VIQ (103.3 +/- 11.7), and PIQ (101.4 +/- 13.2) compared to non-irradiated patients and healthy controls. ALL patients also had poor attention, concentration, and executive functions. Among ALL survivors, cranial irradiation was a risk factor for poor FSIQ, being male was a risk factor for poor PIQ, and younger age was a risk factor for poor attention. Therefore, the delayed cognitive effects of ALL treatment and its impact on quality of life require continuing monitoring and management.
Adolescent ; Age Factors ; Child ; *Cognition ; Female ; Humans ; Intelligence ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality/*psychology ; *Survivors ; Tertiary Healthcare

PURPOSE: The purpose of this study was to identify the factors relating to resilience for adolescents with leukemia and examine the relationship between these factors. METHODS: From June to September in 2014, 199 adolescents aged 11 to 21 participated in the study as they visited the out-patient clinic at C university hospital for follow-up care. To verify the predictors and the effects of resilience, uncertainty, symptom distress, perceived social support, spiritual perspective, defensive coping, courageous coping, hope, and self-transcendence were measured. Collected data were analyzed using hierarchical regression analysis with the SAS statistics program. RESULTS: The final regression model showed that courageous coping, hope, and self-transcendence were significant predictors related to resilience in adolescents with leukemia and explained for 63% of the variance in resilience. CONCLUSION: The findings indicate that adolescent-oriented intervention programs enhancing courageous coping, hope, and self-transcendence should be provide for adolescents with leukemia in order to overcome illness-related stress and support physical, psychological and social adjustment.
Adaptation, Psychological ; Adolescent ; Antineoplastic Agents/therapeutic use ; Female ; Hope ; Humans ; Leukemia/drug therapy/*psychology/radiotherapy ; Male ; Psychology, Adolescent ; *Resilience, Psychological ; Self Concept ; Social Support ; Stem Cell Transplantation ; Surveys and Questionnaires ; Uncertainty ; Young Adult

BACKGROUND: Sometimes myelodysplastic syndrome (MDS) is especially difficult to distinguish from acquired aplastic anemia (AA) because of the clinical, cytologic, and histologic similarities of these two disorders. The proliferative activity of the hematopoietic cells is very different in various hematologic disorders and Ki-67 expression in the bone marrow cells is an useful cell proliferation marker. We tried to evaluate the significance of Ki-67/MIB-1 immunoreactivity in the discrimination of MDS and AA. METHODS: Bone marrow biopsy specimens from 56 individuals, 7 controls, 21 with MDS, 16 with AA and 12 with acute leukemia were obtained in Pusan Paik Hospital. Immunohistochemial staining for Ki-67 antigen was assessed by the MIB-1 monoclonal antibody using a microwave oven-based antigen retrieval technique. RESULTS: The mean values (+/-SD) of Ki-67 positive cells was as follows: control group, 16.8+/-3.6%; MDS, 25.3+/-10.1%; AA, 5.1+/-2.9%; acute leukemia, 30.5+/-10.4%. MDS cases showed statistically higher values of Ki-67 than did those of AA cases and control group (P<0.001) but no significance in Ki-67 frequencies was observed between the cases of MDS and acute leukemia. CONCLUSIONS: In the bone marrows of MDS cases the Ki-67 positive cells were frequently observed, suggesting high proliferative activity even in the nonleukemic state, while most of the bone marrows in AA showed very low proliferative activity. Thus immunohistochemical staining with Ki-67/MIB-1 would be useful in the discrimination of AA and MDS by the difference of Ki-67 positive cell percentage in the bone marrow.
Anemia, Aplastic* ; Biopsy* ; Bone Marrow Cells ; Bone Marrow* ; Busan ; Cell Proliferation ; Discrimination (Psychology) ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; Leukemia ; Microwaves ; Myelodysplastic Syndromes*

PURPOSE: The purpose of this study was to identify the level of distress and posttraumatic growth in fathers of chronically ill children and also, to identify the relation between characteristics of the fathers and children and their posttraumatic growth and to investigate factors that influence posttraumatic growth. METHODS: In this study, 48 fathers who visited a university hospital in Seoul, Korea and who gave written consent completed the questionnaire between September 23 and November 19, 2013. Data were analyzed using Mann-Whitney U test, Kruskal-Wallis test, Pearson correlation coefficient and stepwise multiple regression. RESULTS: The level of distress in fathers of chronically ill children was relatively high and the majority of them were experiencing posttraumatic growth. Models including the variable (deliberate rumination, religiousness, optimism) explained 64.3% (F=26.38, p <.001) of the variance for posttraumatic growth. Deliberate rumination (beta=.59, p <.001) was the most influential factor. CONCLUSION: The findings demonstrate that it is essential for nurses to intervene and facilitate continuously so as to promote posttraumatic growth and relieve distress in fathers of chronically ill children. Furthermore, it is also necessary for nurses to find ways to develop ideal interventions to activate deliberate rumination and offer spiritual care and help maintain optimism in these individuals.
*Adaptation, Psychological ; Adult ; Child ; Chronic Disease ; Fathers/*psychology ; Female ; Hospitals, University ; Humans ; Leukemia/pathology ; Male ; Neoplasms/pathology ; Optimism ; Regression Analysis ; Social Support ; Surveys and Questionnaires