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Zhou H, Yao C, Dong Y, Alhaskawi A, Wang Z, Lai J, Ezzi SHA, Kota VG, Abdulla MHAH, Lu H. Clinical characteristics and management experience of schwannoma in extremities: Lessons learned from a 10-year retrospective study. Front Neurol 2022; 13:1083896. [PMID: 36588891 PMCID: PMC9797853 DOI: 10.3389/fneur.2022.1083896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Schwannomas are the most common neoplastic lesions of the peripheral nerves when growing on the extremities, they usually have adverse effects on patients due to the exposed and functional nature of the region. Methods In the present single-center retrospective study, we included all patients with pathologically confirmed schwannoma located in extremities between 2011 and 2021 totaling 183 patients. Data on gender, age, duration history, clinical presentation, occurrence region, nerve affiliation, imaging data, modus operation, mass volume, immunohistochemistry, postoperative neurological function, and recurrence were collected. Results As in previous studies, patients were predominantly middle-aged with a mean age of 49.5, without gender preference and a male-to-female ratio of 1.2:1. Most patients are first seen for this disease, and only five of them are recurrent. The majority presented with an isolated (91.26%), asymptomatic (37.7%) mass, with tenderness (34.97%) being the second frequent complaint. 60% of lesions occurred in the upper extremity, more commonly on the left side (55.26%) than the right. The average duration of onset was 47.50 months. MRI is more sensitive for neurogenic tumors than ultrasound, as it owns 78.93% correct. In immunohistochemistry, the top three markers for positive labeling schwannoma are S-100 (98.95%), Ki67 (98.68%) and β-Catenin. 98.36% of patients underwent complete resection of the lesion, of which 14.44% required partial sacrifice of the nerve fibers. Thanks to the application of intraoperative peripheral nerve microscopic operation, only 6 patients showed symptoms of postoperative nerve injury, and 3 of them received second surgery. Intraoperative microscopic manipulation, preservation of the main nerve, and the need for reconstruction of the affected nerve fibers are some of the points worth noting. Discussion In summary, the possibility of schwannoma should not be overlooked in the identification of masses that occur in the upper extremities of the middle-aged population. Preoperative ultrasound and MR are useful for determining the nature of the mass, and S100, Ki67, and β-Catenin are sensitive to it. Surgical resection can achieve satisfying functional results and a low risk of nerve injury.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengjun Yao
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zewei Wang
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingtian Lai
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Vishnu Goutham Kota
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou, China,*Correspondence: Hui Lu
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Zhou H, Bai Q, Hu X, Alhaskawi A, Dong Y, Wang Z, Qi B, Fang J, Kota VG, Abdulla MHAH, Ezzi SHA, Lu H. Deep CTS: a Deep Neural Network for Identification MRI of Carpal Tunnel Syndrome. J Digit Imaging 2022; 35:1433-1444. [PMID: 35661280 PMCID: PMC9712834 DOI: 10.1007/s10278-022-00661-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is a common peripheral nerve disease in adults; it can cause pain, numbness, and even muscle atrophy and will adversely affect patients' daily life and work. There are no standard diagnostic criteria that go against the early diagnosis and treatment of patients. MRI as a novel imaging technique can show the patient's condition more objectively, and several characteristics of carpal tunnel syndrome have been found. However, various image sequences, heavy artifacts, small lesion characteristics, high volume of imagine reading, and high difficulty in MRI interpretation limit its application in clinical practice. With the development of automatic image segmentation technology, the algorithm has great potential in medical imaging. The challenge is that the segmentation target is too small, and there are two categories of images with the proximal border of the carpal tunnel as the boundary. To meet the challenge, we propose an end-to-end deep learning framework called Deep CTS to segment the carpal tunnel from the MR image. The Deep CTS consists of the shape classifier with a simple convolutional neural network and the carpal tunnel region segmentation with simplified U-Net. With the specialized structure for the carpal tunnel, Deep CTS can segment the carpal tunnel region efficiently and improve the intersection over union of results. The experimental results demonstrated that the performance of the proposed deep learning framework is better than other segmentation networks for small objects. We trained the model with 333 images, tested it with 82 images, and achieved 0.63 accuracy of intersection over union and 0.17 s segmentation efficiency, which indicate great promise for the clinical application of this algorithm.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, College of Medicine, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province People’s Republic of China 310003
| | - Qi Bai
- School of Mathematical Sciences, Zhejiang University, #38 Zheda Road, Hangzhou, Zhejiang Province People’s Republic of China 310027
| | - Xianliang Hu
- School of Mathematical Sciences, Zhejiang University, #38 Zheda Road, Hangzhou, Zhejiang Province People’s Republic of China 310027
| | - Ahmad Alhaskawi
- Department of Orthopedics, College of Medicine, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province People’s Republic of China 310003
| | - Yanzhao Dong
- Department of Orthopedics, College of Medicine, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province People’s Republic of China 310003
| | - Zewei Wang
- Zhejiang University School of Medicine, #866 Yuhangtang Road, Hangzhou, Zhejiang Province People’s Republic of China 3100058
| | - Binjie Qi
- Department of Rehabilitation Medicine, College of Medicine, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province People’s Republic of China 310003
| | - Jianyong Fang
- Suzhou Warrior Pioneer Software Co., Ltd, Room 26, Building 17, No. 6, Trade City, Wuzhong Economic Development Zone, Suzhou, Jiangsu Province People’s Republic of China 215000
| | - Vishnu Goutham Kota
- Zhejiang University School of Medicine, #866 Yuhangtang Road, Hangzhou, Zhejiang Province People’s Republic of China 3100058
| | | | - Sohaib Hasan Abdullah Ezzi
- Zhejiang University School of Medicine, #866 Yuhangtang Road, Hangzhou, Zhejiang Province People’s Republic of China 3100058
| | - Hui Lu
- Department of Orthopedics, College of Medicine, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province People’s Republic of China 310003
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, #866 Yuhangtang Road, Hangzhou, Zhejiang Province People’s Republic of China 310058
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Zhou H, Yu X, Alhaskawi A, Dong Y, Wang Z, Jin Q, Hu X, Liu Z, Kota VG, Abdulla MHAH, Ezzi SHA, Qi B, Li J, Wang B, Fang J, Lu H. A deep learning approach for medical waste classification. Sci Rep 2022; 12:2159. [PMID: 35140263 PMCID: PMC8828884 DOI: 10.1038/s41598-022-06146-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Abstract
As the demand for health grows, the increase in medical waste generation is gradually outstripping the load. In this paper, we propose a deep learning approach for identification and classification of medical waste. Deep learning is currently the most popular technique in image classification, but its need for large amounts of data limits its usage. In this scenario, we propose a deep learning-based classification method, in which ResNeXt is a suitable deep neural network for practical implementation, followed by transfer learning methods to improve classification results. We pay special attention to the problem of medical waste classification, which needs to be solved urgently in the current environmental protection context. We applied the technique to 3480 images and succeeded in correctly identifying 8 kinds of medical waste with an accuracy of 97.2%; the average F1-score of five-fold cross-validation was 97.2%. This study provided a deep learning-based method for automatic detection and classification of 8 kinds of medical waste with high accuracy and average precision. We believe that the power of artificial intelligence could be harnessed in products that would facilitate medical waste classification and could become widely available throughout China.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Xiangyu Yu
- UniDT Technology (Shanghai) Co., Ltd, Shanghai, 200436, People's Republic of China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Zewei Wang
- Zhejiang University School of Medicine, #866 Yuhangtang Road, Hangzhou, 310058, Zhejiang Province, People's Republic of China
| | - Qianjun Jin
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Xianliang Hu
- School of Mathematical Sciences, Zhejiang Univeristy, #38 Zheda Road, Hangzhou, 310027, Zhejiang Province, People's Republic of China
| | - Zongyu Liu
- School of Mathematical Sciences, Zhejiang Univeristy, #38 Zheda Road, Hangzhou, 310027, Zhejiang Province, People's Republic of China
| | - Vishnu Goutham Kota
- Zhejiang University School of Medicine, #866 Yuhangtang Road, Hangzhou, 310058, Zhejiang Province, People's Republic of China
| | | | - Sohaib Hasan Abdullah Ezzi
- Zhejiang University School of Medicine, #866 Yuhangtang Road, Hangzhou, 310058, Zhejiang Province, People's Republic of China
| | - Binjie Qi
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Juan Li
- Department of Infrastructure and General Affairs, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Bixian Wang
- Department of Infrastructure and General Affairs, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Jianyong Fang
- Suzhou Warrior Pioneer Software Co., Ltd. (Room 26, Building 17, No. 6, Trade City, Wuzhong Economic Development Zone), Suzhou, 215000, Jiangsu Province, People's Republic of China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China. .,Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, #866 Yuhangtang Road, Hangzhou, 310058, Zhejiang Province, People's Republic of China.
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Abstract
Neurofibroma is a rare nerve sheath tumor of neuroectodermal origin, especially the huge and isolated neurofibroma located in the inguinal region. To our knowledge, no such case has previously been reported. We report a case of 34-year-old male patient with a 4-year history of progressive enlargement of the medial root mass in his left thigh with sitting and standing disorders along with pain. The tumor was completely removed by operation, and pathological diagnosis showed neurofibroma. There was no obvious neurologic defect after surgery, and no recurrence tendency was found in the follow-up of 2 years. For a large solitary mass with slow growth and no malignant clinical manifestations for a long time, clinicians cannot rule out the hypothetical diagnosis of neurofibroma, even though its growth site is very rare, such as this case of a huge tumor located in the groin. For neurogenic tumors, early operation should be performed, and the prognosis of patients after tumor resection is excellent.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
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