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

OBJECTIVETo investigate the neurocognitive function of children with acute lymphoblastic leukemia (ALL) and long-term disease-free survival and related influencing factors.

METHODSA total of 40 ALL children with long-term disease-free survival were enrolled as study group, and 40 healthy children were enrolled as control group. The Chinese Wechsler Intelligence Scale for Children (C-WISC), continuous performance test (CPT), and Stroop test software were used for the evaluation of all children. Neurocognitive function was compared between groups and influencing factors were analyzed.

RESULTSCompared with the control group, the study group had significantly lower full intelligence quotient, verbal intelligence quotient, and performance intelligence quotient in C-WICS (P<0.05) and significantly higher numbers of mistakes and misses in CPT (P<0.05). There were no significant differences in the numbers of correct answers, mistakes, and misses of word-color consistency between the study group and the control group (P>0.05), while the study group had significantly higher numbers of mistakes and misses of word-color contradiction and irrelevance (P<0.05). The total dose of high-dose methotrexate and ALL risk classification were associated with the reduction in intelligence quotient, and children's younger age at diagnosis of ALL was associated with the higher numbers of misses and mistakes. Girls tended to have a significantly lower performance intelligence quotient than boys (P<0.05).

CONCLUSIONSALL children with long-term disease-free survival have neurocognitive impairment, which may be associated with the dose of chemotherapeutic drugs, age at diagnosis, and sex.

Adolescent ; Child ; Child, Preschool ; Cognition ; drug effects ; Disease-Free Survival ; Female ; Humans ; Infant ; Intelligence Tests ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; mortality ; psychology

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

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

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

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: 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

Cases of clonal cytogenetic abnormalities in Philadelphia-negative cells during the treatment of Philadelphia-positive CML have been previously reported. However, clonal abnormalities unrelated to the original t(8;21) or t(15;17) karyotype are not common. Deletion of 20q (del(20q)) is one of the most common recurrent cytogenetic abnormalities in myeloid neoplasms. Here we describe 3 patients with t(8;21), t(15;17), or t(9;22) who developed unrelated del(20q) after successful treatment of leukemia. We retrospectively reviewed the cytogenetic results of 23 AML patients with t(8;21)(q22;q22), 28 AML patients with t(15;17)(q22;q12), and 47 CML patients with t(9;22)(q34;q11.2). We identified 3 patients with del(20q) as the only clonal aberration unrelated to the primary karyotype when they achieved complete morphologic and cytogenetic remission. The latency period between diagnosis and emergence of del(20q) was 1, 114, and 35 months for the 3 patients, respectively. There was no evidence of therapy-related MDS/AML during the follow-up period. In 1 AML patient with t(8;21), relapse occurred in a t(8;21)(q22;q22) clone and the del(20q) clones were lost. The clinical significance of del(20q) as an unrelated clonal aberration is unknown, but our study suggests that del(20q) does not cause therapy-related MDS/AML or indicate disease progression.
Chromosome Aberrations ; Chromosome Deletion ; Chromosomes, Human, Pair 20 ; Clone Cells ; Cytogenetics ; Disease Progression ; Follow-Up Studies ; Humans ; Karyotype ; Latency Period (Psychology) ; Leukemia ; Recurrence ; Retrospective Studies

Acute promyelocytic leukemia (APL) is considered as a curative disease after combined chemotherapy based on all-trans retinoic acid (ATRA) and anthracycline. However, as long-term survivors continue to increase, reports on sporadic cases of therapy-related myeloid neoplasm (t-MN) after successful APL treatment are also increasing. Recently, we have experienced one patient who developed t-MN 7 yr after APL diagnosis. Even though he had not been exposed to alkylating agents at all, he showed alkylating agents-associated features such as long latency period (>5 yr), first presentation as myelodysplatic phase (multilineage dysplasia with increased blasts), and complex karyotype including monosomy 5 and 7. He received only supportive care and expired 3 months after the diagnosis of t-MN (6 months of survival after the onset of cytopenias). t-MN after complete remission of APL is a rare but fatal complication, and patients with complex karyotypes show ominous prognosis in particular. For the early diagnosis of t-MN, long-term and close monitoring of the patient is needed. One should suspect this late complication whenever any unknown cytopenia develops, and should perform bone marrow biopsy and cytogenetic analysis.
Alkylating Agents ; Biopsy ; Bone Marrow ; Cytogenetic Analysis ; Early Diagnosis ; Humans ; Karyotype ; Latency Period (Psychology) ; Leukemia, Promyelocytic, Acute ; Monosomy ; Prognosis ; Survivors ; Tretinoin

Agriculture in every industrialized country is one of the most hazardous occupations, based on occupational fatality rates, nonfatal occupational injury rates, and occupational illness rates. The fatality rate and nonfatal injury rate for agricultural workers are twice to five times higher than all occupations. Low back pain and osteoarthritis of the hip and knee are the most important occupational illness of occupational workers. these conditions are worsened by poor ergonomic working conditions, long working days, and heavy work loads. Respiratory illnesses are common problems among the agricultural work force. The most frequent cause of respiratory illness is organic dust from livestock production and handling grain or hay that may produce bronchitis, asthma-like condition, irritation of the mucosa of the upper airways and eyes, and organic dust toxic syndrome. Skin conditions may be one of the most frequently reported type of agricultural illness. The most common category of skin condition is contact dermatitis, which may occur as irritant or allergic contact dermatitis. Sunburn and miliarial rubra by Sun and heat exposure are the second most common causes of skin conditions. Overall cancer seems to be lower. However, there are several cancers for which the farming population may be at increased risk, including non-Hodgkin's lymphoma, leukemia, multiple myeloma, brain, prostate, and skin. The issue of pesticide exposure is often a dominant concern among the farming population and also noise-induced hearing loss, vibration-related injuries including Raynaud's phenomenon, and zoonotic infectious diseases.
Brain ; Bronchitis ; Communicable Diseases ; Dermatitis, Allergic Contact ; Dermatitis, Contact ; Developed Countries ; Dust ; Eye ; Handling (Psychology) ; Hearing Loss, Noise-Induced ; Hip ; Hot Temperature ; Knee ; Leukemia ; Livestock ; Low Back Pain ; Lymphoma, Non-Hodgkin ; Mucous Membrane ; Multiple Myeloma ; Occupational Diseases ; Occupational Injuries ; Occupations ; Osteoarthritis ; Prostate ; Skin ; Solar System ; Sunburn ; Edible Grain ; Farmers