Purpose: The risk stratification of pediatric anaplastic large cell lymphoma (ALCL) has not been standardized. In this study, new risk factors were included to establish a new risk stratification system for ALCL, and its feasibility in clinical practice was explored. Materials and Methods: On the basis of the non-Hodgkin’s lymphoma Berlin–Frankfurt–Munster 95 (NHL-BFM-95) protocol, patients with minimal disseminated disease (MDD), high-risk tumor site (multiple bone, skin, liver, and lung involvement), and small cell/lymphohistiocytic (SC/LH) pathological subtype were enrolled in risk stratification. Patients were treated with a modified NHL-BFM-95 protocol combined with an anaplastic lymphoma kinase inhibitor or vinblastine (VBL). Results: A total of 136 patients were enrolled in this study. The median age was 8.8 years. The 3-year event-free survival (EFS) and overall survival of the entire cohort were 77.7% (95% confidence interval [CI], 69.0% to 83.9%) and 92.3% (95% CI, 86.1% to 95.8%), respectively. The 3-year EFS rates of low-risk group (R1), intermediate-risk group (R2), and high-risk group (R3) patients were 100%, 89.5% (95% CI, 76.5% to 95.5%), and 67.9% (95% CI, 55.4% to 77.6%), respectively. The prognosis of patients with MDD (+), stage IV cancer, SC/LH lymphoma, and high-risk sites was poor, and the 3-year EFS rates were 45.3% (95% CI, 68.6% to 19.0%), 65.7% (95% CI, 47.6% to 78.9%), 55.7% (95% CI, 26.2% to 77.5%), and 70.7% (95% CI, 48.6% to 84.6%), respectively. At the end of follow-up, one of the five patients who received maintenance therapy with VBL relapsed, and seven patients receiving anaplastic lymphoma kinase inhibitor maintenance therapy did not experience relapse. Conclusion This study has confirmed the poor prognostic of MDD (+), high-risk site and SC/LH, but patients with SC/LH lymphoma and MDD (+) at diagnosis still need to receive better treatment (ClinicalTrials.gov number, NCT03971305).

Objective:To explore the feasibility of smart phone real-time picture exchange-assisted telecytopathology for rapid on-site evaluation (tele-ROSE), and the role of tele-ROSE in improving the diagnostic efficiency of endoscopic physicians.Methods:Data of patients who underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) from April 2020 to May 2021 in Qilu Hospital of Shandong University were retrospectively collected. Patients who didn't receive ROSE from April 2020 to October 2020 were enrolled in the non-ROSE group, and those who underwent ROSE from November 2020 to May 2021 were enrolled in the ROSE group, of which endosonographers used WeChat on the smartphone to send ROSE images to cytopathologists from November 2020 to March 2021 were the mobile phone group, and those whose ROSE results independently diagnosed by trained endosonographers from April 2021 to May 2021 were the self-ROSE group. Basic information, ROSE results, postoperative pathology and follow-up were compared, and the diagnostic effectiveness of tele-ROSE was analyzed.Results:A total of 188 cases were included, of which 179 cases (95.2%) were solid pancreatic lesions and 9 (4.8%) were enterocoelia lesions. There was no significant difference in the puncture time among the non-ROSE, mobile phone and self-ROSE groups [3 (3, 4) VS 3 (3, 4) VS 3 (2, 4), H=1.320, P=0.517]. With the final diagnosis as the golden standard, the sensitivity, the specificity, the accuracy, the positive predictive value, the negative predictive value and Kappa value of the non-ROSE group were 80.6% (58/72), 89.5% (17/19), 82.4% (75/91), 96.7% (58/60), 54.8% (17/31), and 0.6 respectively. The corresponding indices in the ROSE group were 97.4% (74/76), 100.0% (21/21), 97.9% (95/97), 100.0% (74/74), 91.3% (21/23), and 0.9 respectively, those of the mobile phone group were 95.2% (40/42), 100.0% (10/10), 96.2% (50/52), 100.0% (40/40), 83.3% (10/12), and 0.9 respcetively, and those of the self-ROSE group were 100.0% (34/34), 100.0% (11/11), 100.0% (45/45), 100.0% (34/34), 100.0% (11/11), and 1.0 respectively. The sensitivity ( P=0.002), the accuracy ( P=0.001) and the negative predictive value ( P=0.009) of the ROSE group were significantly higher than those of the non-ROSE group, and there was no significant difference in other diagnostic efficacy indices ( P>0.05). There was no significant difference between the mobile phone group and the self-ROSE group in diagnostic efficacy ( P>0.05). Conclusion:Instant smartphone-assisted tele-ROSE through WeChat can well meet the needs of pathologists and endoscopic physicians. After the application of tele-ROSE training, the diagnostic accuracy of endoscopic physicians is equivalent to that of cytopathologist, which helps to obtain more sufficient specimens under endoscopy and improve the diagnostic accuracy of EUS-FNA.

Objective:Based on the artificial intelligence (AI) technology in endoscopy and the internet platform, to explore and construct a safe, standardized, scientific and rigorous database for digestive endoscopy, and to provide reference and evidence for the data quality control of AI in digestive endoscopy in China.Methods:After referring to relevant guidelines and standards, data collection and labelling standards of digestive endoscopy of 12 common gastrointestinal diseases were determined. The software of online collection and labelling of multi-center digestive endoscopy data in Shandong Province was developed. Endoscopic equipment with a domestic market share of >5% was used and dozens of experienced endoscopists from 9 medical centers in Shandong Province were uniformly trained for data labelling. From July 2019 to July 2020, the endoscopic examination data from 9 medical centers including Qilu Hospital of Shandong University, Shandong Provincial Hospital , Liaocheng People′s Hospital, Linyi People′s Hospital, Weihai Municipal Hospital, Taian City Central Hospital, Binzhou Medical University Hospital, Yantai Yuhuangding Hospital and Qilu Hospital of Shandong University (Qingdao) were prospectively and continuously collected and labeled. The optimized, desensitized, and generalized data were uploaded to the server. After the file synchronization, data processing, and expert review, a multi-center digestive endoscopy AI database with standard data collection and labelling in Shandong Province was constructed, namely cloud platform. Descriptive methods were used for statistical analysis.Results:The collection and labelling standards for multi-center digestive endoscopy AI data in Shandong province was established. The software of online collection and labelling of multi-center digestive endoscopy AI data in Shandong province was developed. The database in Shandong province was successfully constructed. In the database, 43 010 lesions, 40 353 images, and 11 289 examinations were labeled. Among them, there were 2 906 cases of early esophageal cancer, 2 912 cases of early gastric cancer, 2 397 cases of early colorectal cancer, and 9 773 cases of colorectal polyps (5 539 cases of adenomatous polyps, 1 161 cases of non-adenomatous polyps and 3 073 case of undetermined polyps).Conclusions:The multi-center AI cloud platform for digestive endoscopy in Shandong Province adopts unified standards and collection and labeling software, which ensures the safety and standardization of endoscopy data. It provides a reference and basis for the construction of a quality control system for standardized data collection and labelling of digestive endoscopy AI data in our country and for the third-party data supervision.

Objective:To observe the effect of combining scalp acupuncture with hyperbaric oxygen on serum homocysteine and highly-sensitive c-reactive protein levels and functional recovery after cerebral infarction.Methods:A total of 101 survivors of cerebral infarction were divided randomly into a scalp acupuncture group ( n=33), a hyperbaric oxygen group ( n=34) and a combined treatment group ( n=34). All received routine treatment plus the appropriate supplementary treatment once a day for 10 days. The subjects were evaluated before the experiment as well as 10 and 90 days afterward. The National Institutes of Health′s stroke scale (NIHSS) was used to quantify neurological deficits and the Barthel Index quantified ability in the activities of daily living. Ninety days after the treatment, modified Rankin scale scores were also assigned. The levels of serum homocysteine (Hcy) and highly-sensitive c-reactive protein (hs-CRP) before and after 10 days of treatment were also compared among the 3 groups. Results:The average NIHSS and Barthel Index scores of all three groups had improved significantly after 10 days of treatment and the improvements persisted at the follow-up 3 months later. Both results were significantly better in the combined treatment group than in the scalp acupuncture group at the 90-day follow-up evaluation. The average Rankin score of the combined treatment group was lower at the last follow-up. Compared with before the intervention, the average Hcy of the scalp acupuncture group, the average hs-CRP of the hyperbaric oxygen group, as well as the average Hcy and hs-CRP of the combined treatment group were significantly lower after 10 days of treatment. Compared with the scalp acupuncture group, the average Hcy [(11.68±2.6) μmol/L] of the combined treatment group was significantly lower after the 10 days of treatment.Conclusions:Supplementing scalp acupuncture with hyperbaric oxygen therapy improves the long-term outcomes of cerebral infarction, reducing the level of serum Hcy.

cloud point extraction, hydrophilic interaction chromatography, anti-AIDS drugs, serum 【Objective】 Cloud point extraction （CPE） combined with hydrophilic interaction （HILIC） was employed to simultaneously determine the anti-AIDS drugs in the serum of rats. 【Methods】Triton X-114 was used as extraction medium to extract four nucleoside antiviral drugs from rat serum. Response surface methodology was employed to further optimize CPE parameters. The content of four anti-AIDS drugs in rat serum was simultaneously determined by HILIC method.【Results】 The optimized conditions were as follows：5%（w/v）Triton X- 114，0.3 mol/L NaCl，PH 5.0， the water- bath equilibrium 20 min at 40 ℃ . Under optimized extraction conditions，the extraction rates of the four anti- AIDS drugs were all over 85.0%，which was pretty close to the predicted result. The extracted samples were analyzed under the optimal chromatographic conditions. The recovery rate was over 75.0% and RSD was less than 5.0%. The optimized chromatographic conditions were as follows：Ze month- CN（250 × 4.6 mm，5 micron）as stationary phase，mobile phase （methanol：acetonitrile：ammonium acetate buffer）（5∶5∶90），column temperature 35 ℃，detection wavelength 275 nm，flow rate 0.5 mL/min.【Conclusion】The developed method of CPE combined with HILIC can enrich four anti-AIDS drugs in rat serum ，which is simple，environment- friendly and can be used to accurately determine the blood concentration of four anti-AIDS drugs in rat serum，providing a new method for clinical blood concentration monitoring.

Objective:To develop intelligent quality-control system (IQCS) based on deep convolutional neural networks (DCNN), and to prospectively evaluate the clinical feasibility of this system.Methods:Aimed at quality control objectives during gastroscopy such as the observation integrity of gastric mucosal, gastric mucosa visibility, time spent on gastroendoscopy and suspicious gastric cancer detection, four DCNN models including gastroscopic scanning location recognition model, gastric mucosa visibility recognition model, in vivo and in vitro identification model and gastric cancer detection model were designed. A total of 98 385 white light gastroscopy images were retrospectively collected from multiple centers for training and testing the DCNN models. The accuracy, sensitivity and specificity of each model were calculated and the receiver operating characteristic (ROC) curve was drawn. The models were integrated and formed the multi-function integrated IQCS. At the center of gastroendoscopy, Qilu Hospital of Shandong University, 100 consecutive patients who underwent routine gastroscopy were prospectively enrolled. The feasibility of IQCS in real clinical practice was evaluated. The condition of each quality control function of the system (average error point out or correct rate) and the detection of lesions after the examination were recorded. Results:The accuracy, sensitivity and specificity of the model of gastroscopic scanning location recognition to identify each site were 98.40% to 99.85%, 61.95% to 100.00% and 98.65% to 100.00%, respectively; the area under curve (AUC) of ROC curve ranged from 0.997 6 to 1.000 0. The accuracy, sensitivity and specificity of the model of gastric mucosa visibility recognition to identity the mucosal visibility were 97.02% to 98.27%, 85.14% to 99.28% and 93.72% to 100.00%, respectively. The accuracy, sensitivity and specificity of the model of in vivo and in vitro identification were 97.27%, 99.85% and 94.50%, respectively; the AUC of ROC was 0.961 5. The accuracy, sensitivity and specificity of the model of gastric cancer detection were 95.92%, 95.64% and 96.05%, respectively; the AUC of ROC was 0.975 9. The results of feasibility evaluation of IQCS indicated that in the quality control of gastric mucosa observation integrity, the system average error was 0.32 time/case; in the quality control of mucosal visibility, the system average error was 0.47 time/case; the correct rate of intelligent timing during gastroscopy was 96.00%, in the quality control of suspicious gastric cancer detection, the system average error was 0.36 time/case. A total of 3 cases of gastric cancer and 1 case of high grade gastric intraepithelial neoplasia were detected. The system could accurately identify the location. Conclusions:Gastroscopy IQCS can accurately achieve quality control in the observation integrity of gastric mucosa, gastric mucosa visibility, time spent on gastroendoscopy and suspicious gastric cancer detection in actual examination, which makes accurate and efficient gastroscopy quality control possible.

Objective: To evaluate the effectiveness of deep learning model trained on routine CT scans when identity the malignant and benign lung nodule on target CT scans dataset. Methods: This retrospective study enrolled 923 patients with lung nodules found by chest CT scan in Shanghai Chest Hospital from January 2016 to December 2018. A total of 969 nodules with pathological report were analyzed. The deep learning based pulmonary malignant prediction method in a fine-grained classification manner was used to make the prediction, and the AUC (the area under the curve), accuracy, sensitivity and specificity of routine CT scans and target CT scans were compared, and Delong test and IDI (Integrated Discrimination Improvement) were employed to provide statistical results. Furthermore, statistical methods were used to investigate the differences between the benign and malignant classification of nodules on routine CT and on target CT. Results: In the benign and malignant discrimination task, AUC, accuracy, sensitivity and specificity on the routine scans were 0.81, 82.0%, 86.0% and 56.6% respectively, while the AUC, accuracy, sensitivity and specificity on the target scans were 0.84, 85.0%, 88.8% and 60.5% respectively. The IDI was 0.056 (Z test, P<0.05), and there was statistically significant difference in ROC (Delong test, P=0.01). Conclusions The deep learning model trained on the data set of routine CT scans can achieve better diagnostic efficiency in target CT scans data.

Objective To study the changes of serum brain natriuretic peptide(BNP),uric acid(UA)and procalcitonin(PCT)levels in children patients with dilated cardiomyopathy(DCM).Methods 24 children pa-tients with DCM and 24 children undergoing healthy physical examination from March 2015 to September 2016 were selected as the observation group and control group.The observation group was divided into differ-ent Ross grade groups according to the improved Ross heart failure grade scoring.The levels of serum BNP, UA and PCT in each group were detected and their correlation with the main echocardiographic indicators was analyzed.Results The levels of BNP,UA and PCT had statistical difference between the observation group and control group(P<0.05);the BNP and UA levels had statistical difference among different Ross grades (P<0.05),moreover which were increased along with the severity increase,but the PCT level had no statisti-cally significant(P> 0.05);the BNP level was positively correlated with the DCM severity(r= 0.713,P=0.000),the UA level was positively correlated with the DCM severity(r=0.489,P=0.002),while the corre-lation between the PCT level and DCM severity had no statistical significance(r=0.288,P=0.076);the BNP had obvious correlation with main echocardiographic indicators(P<0.05).Conclusion The levels of serum BNP,UA and PCT in children patients with DCM are changed significantly,in which BNP and UA may be the good markers for reflecting the disease severity and progression or prognosis.

Objective To evaluate the feasibility of needle-based confocal laser endomicroscopy (nCLE) for imaging of intra-abdominal tissues and organs in rabbit models in vivo. Methods The nCLE miniprobe was inserted through the 19-gauge needle into various intra-abdominal tissues and organs[omentum majus, liver, pancreas and psoas major (skeletal muscle)]. The nCLE images were acquired and real-time sequences of respective locations were recorded. Finally, nCLE image characteristics were compared with histopathologic findings. Results nCLE was successfully performed in intra-abdominal tissues and organs of five rabbit models. The microscopic structures of cells, glands and microvessels in the omentum majus, liver, pancreas and psoas major ( skeletal muscle) were visualized clearly, respectively. Characteristics of various intra-abdominal tissues and organs were displayed on nCLE images, which were correlated well with histological findings. Conclusion Imaging of intra-abdominal tissues and organs with nCLE in vivo is feasible in future clinical practice.

Objective: To determine the prevalence and antimicrobial susceptibility of Salmonella isolated from broiler production process in 4 provinces of China. Methods: Using convenience sampling method, 238 sample sites from broiler whole production process were chosen in Henan, Jiangsu, Heilongjiang and Shandong provinces in 2012. A total of 11 592 samples were collected and detected to analyze prevalence baseline, including 2 090 samples from breeding chicken farms and hatcheries, 1 421 samples from broiler farms, 5 610 samples from slaughterhouses and 2 471 samples from distribution and retail stores. All Salmonella strains were isolated through selective enrichment, and were serotyped according to Kauffmann-White scheme. The antimicrobial susceptibilities of selected Salmonella strains were determined by the broth microdilution method and fourteen antimicrobial agents were examined. Results: During incubation course, the average prevalence of Salmonella was 5.5% in feces of breeding hens, feces of chicks, and hatching eggs, 123 Salmonella strains were isolated. During cultivation course, the prevalence of Salmonella was 8.0% in feces from broiler farms, soil, feed, and workers, 114 Salmonella strains were isolated. During slaughter course, the prevalence of Salmonella was 24.9% in swabs pre-slaughter, dressed broiler carcasses, pre-cooled broiler carcasses, water from precooling pool, cutter and chipping boards, frozen chicken portions, and workers, 1 438 Salmonella strains were isolated. During distribution and sale course, the prevalence of Salmonella was 20.9% in transport carts, frozen chicken portions, retail chicken portions and workers, 551 Salmonella strains were isolated. The dominant Salmonella serotypes were Salmonella Enteritidis (n=1 229) and Salmonella Indiana (n=621). Among 1 231 examined strains, 97.2% Salmonella isolates were resistant to at least one antimicrobial, 69.9% Salmonella strains were multi-drug resistant isolates. Conclusion Our findings indicated that Salmonella contamination was common and serious in commercial broiler whole production process in China, especially in the course of defeathering, precooling and selling. The environment of broiler farm is the important source of Salmonella contamination. Additionally, antibiotic resistance of Salmonella was serious for common antimicrobials and multi-drug resistant strains existed widespread, which can pose potential risk on public health and clinical therapy.