Specific learning disorder (SLD) is a common neurodevelopmental disorder in children that significantly affects academic performance and quality of life. At present, diagnosis mainly relies on standardized tests and professional evaluations, a process that is complex and time-consuming. Multiple studies have shown that machine learning can analyze diverse data, including test scores, handwriting samples, eye movement data, neuroimaging data, and genetic data, to automatically learn the relationships between input features and output labels and achieve efficient prediction. It shows great potential for early screening, auxiliary diagnosis, and research on underlying mechanisms in SLD. This article reviews the applications of machine learning in the auxiliary diagnosis of SLD and discusses its performance when handling different data types.
Humans ; Machine Learning ; Specific Learning Disorder/diagnosis* ; Child

OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

BACKGROUND:The development and evolution of atlas are complex,and there are a few research reports. CT imaging can show the normal development process,anatomical structure,developmental variation and deformity of the axis. It has important clinical value to clarify the time of occurrence of ossification center of axis and closure of epiphyseal plate and its evolution process and law.OBJECTIVE:To present the anatomical structure of the normal development and variation of children's axis based on CT images.METHODS:CT images obtained from 732 children aged 0 to 15 years who underwent neck scans between June 2016 and November 2019 were retrospectively analyzed. The observation indicators encompassed the axis odontoid,bilateral pedicle,vertebral ossification center,secondary ossification center at the tip of odontoid,pedicle,base of odontoid,and posterior median epiphyseal plate,as well as any variations or deformities in axis development. The changes in these indicators were analyzed and compared across different age groups. SPSS 17.0 statistical software package was utilized for data classification and statistical analysis. RESULTS AND CONCLUSION:(1) A total of 732 subjects were examined,comprising 718 cases (98.1％) with normal development of the axis and 14 cases (1.9％) exhibiting deformity or dysplasia. (2) The axis demonstrated the presence of five ossification centers,including those of the bilateral pedicles,odontoid process,and vertebral body,which were observed at birth. The median age for the secondary ossification center located at the tip of the odontoid process was determined to be 5.7 years,with an interquartile range of 4.1 to 7 years. The earliest recorded occurrence was observed at 8 months and 22 days,while the latest occurrence was noted at 12 years and 10 months. (3) The median age at which fusion took place was 6 years,with an interquartile range of 5-8 years. The maximum age at which non-fusion was observed was 8 years and 9 months,while the minimum age at which fusion occurred was 4 years and 3 months. (4) The median age at which bilateral epiphyseal plate closure occurred was approximately 3.8 years,with an interquartile range of about 2.9-4.6years. The earliest observed closure was at 2 years and 3 months,while the latest observed unclosure was at 6 years old. (5) The median age at which odontoid base epiphyseal plate closure occurred was 5.2 years,with an interquartile range of 3.5-6.8 years. The minimum age for closure was 2 years and 6 months,and the latest age for non-closure was 9 years and 6 months. (6) The posterior median epiphyseal plate typically closed at a median age of 1.5 years,with an interquartile range of 1.0-2.1 years. However,two cases exhibited delayed closure,occurring at ages 2 years and 5 months,and 14 years,respectively. Theearliest closure observed was at 6 months and 20 days. (7) Axis malformation or developmental abnormalities,including 7 cases of accessory ossification center and accessory epiphyseal plate,3 cases of free ossified small bones in the axis,2 cases of posterior median epiphyseal plate failure,2 cases of secondary ossification centers in the absence of the apex of odontosis,and 1 case of absence at ossification center in the odontoid of the armature vertebrae. (8) It is concluded that the utilization of multi-slice spiral CT scanning in conjunction with the multi-plane reconstruction technique enables comprehensive visualization of the anatomical structure of the axis,facilitating precise assessment of both its typical developmental variations and deformities.

Calcitonin-negative medullary thyroid carcinoma(CNMTC)is a rare subtype of medullary thyroid carcinoma,characterized by normal serum calcitonin levels,which often leads to misdiagnosis or missed diagnosis.The pathogenesis of CNMTC remains unclear and may involve impaired secretion mechanisms or assay-related false negatives.Diagnostic approaches include ultrasound-guided fine needle aspiration cytology,serum CEA and ProGRP measurements,and RET gene testing.Surgical resection remains the mainstay of treatment,while neoadjuvant therapy may be considered in selected cases.This review summarizes recent advances in the understanding,diagnosis,treatment,and prognosis of CNMTC,aiming to provide clinical guidance for better management of this challenging condition.

Objective:To investigate the clinical predictive value of Ki67 proliferation index combined with preoperative serum Ctn for postoperative biochemical cure of medullary thyroid carcinoma (MTC) .Methods:Clinical data were collected from Dec. 2008 to Dec. 2024 from 90 patients with surgically confirmed MTC at China-Japan Union Hospital of Jilin University. The optimal cut-off value for preoperative Ctn prediction of biochemical cure (171.18pg/mL) was determined by the ROC curve; the Ki67 proliferation index cut-off value was adopted from the international MTC grading system standard (5%). Patients were divided into three groups based on the above cutoff values: double-low group (Ki67 <5% and Ctn <171.18pg/mL, n=23), single-high group (Ki67 ≥5% and Ctn <171.18pg/mL or Ki67 <5% and Ctn ≥171.18pg/mL, n=49), and double-high group (Ki67 ≥5% and Ctn ≥171.18pg/mL, n=18). The Kaplan-Meier method (Log-Rank and Trend test) was used to compare the differences in biochemical cure rates between groups, and the Cox proportional risk model was used to analyze the risk factors affecting biochemical cure. Results:The correlation between preoperative Ctn and Ki67 proliferation index was not significant. The three groups differed significantly in gender, tumor distribution, tumor size, vascular invasion, N stage, TNM stage, and biochemical cure ( P<0.05), with the double-high group being significantly associated with larger tumors, later N stage and TNM stage, and lower biochemical cure ( P<0.001). Kaplan-Meier analysis showed that the biochemical cure rate in the double-high, single-high, and double-low groups showed a stepwise improvement.Cox univariate analysis showed that tumor size, N stage, TNM stage, preoperative Ctn, and Ki67 combined with Ctn were risk factors for failure to biochemically cure; multivariate analysis confirmed that the double-high group was an independent risk factor ( P<0.05). In the single-high group, the biochemical cure rate of patients in the low Ki67-high Ctn group was lower than that of the high Ki67-low Ctn group and more malignant. Ki67 had less effect on biochemical cure and disease-free survival at the low Ctn level, and Ki67 was an independent risk factor for failure to biochemically cure at the high Ctn level ( P=0.023) and was significantly associated with disease-free survival ( P=0.004) . Conclusions:Serum Ctn is more sensitive than Ki67 index in predicting biochemical cure after MTC, and the correlation between the two was weak. Ki67 proliferation index alone has limited prognostic value, but combines with preoperative Ctn significantly optimize the prognostic assessment of patients.The role of Ki67 index varied at different Ctn levels.

Objective:To investigate the clinical predictive value of Ki67 proliferation index combined with preoperative serum Ctn for postoperative biochemical cure of medullary thyroid carcinoma (MTC) .Methods:Clinical data were collected from Dec. 2008 to Dec. 2024 from 90 patients with surgically confirmed MTC at China-Japan Union Hospital of Jilin University. The optimal cut-off value for preoperative Ctn prediction of biochemical cure (171.18pg/mL) was determined by the ROC curve; the Ki67 proliferation index cut-off value was adopted from the international MTC grading system standard (5%). Patients were divided into three groups based on the above cutoff values: double-low group (Ki67 <5% and Ctn <171.18pg/mL, n=23), single-high group (Ki67 ≥5% and Ctn <171.18pg/mL or Ki67 <5% and Ctn ≥171.18pg/mL, n=49), and double-high group (Ki67 ≥5% and Ctn ≥171.18pg/mL, n=18). The Kaplan-Meier method (Log-Rank and Trend test) was used to compare the differences in biochemical cure rates between groups, and the Cox proportional risk model was used to analyze the risk factors affecting biochemical cure. Results:The correlation between preoperative Ctn and Ki67 proliferation index was not significant. The three groups differed significantly in gender, tumor distribution, tumor size, vascular invasion, N stage, TNM stage, and biochemical cure ( P<0.05), with the double-high group being significantly associated with larger tumors, later N stage and TNM stage, and lower biochemical cure ( P<0.001). Kaplan-Meier analysis showed that the biochemical cure rate in the double-high, single-high, and double-low groups showed a stepwise improvement.Cox univariate analysis showed that tumor size, N stage, TNM stage, preoperative Ctn, and Ki67 combined with Ctn were risk factors for failure to biochemically cure; multivariate analysis confirmed that the double-high group was an independent risk factor ( P<0.05). In the single-high group, the biochemical cure rate of patients in the low Ki67-high Ctn group was lower than that of the high Ki67-low Ctn group and more malignant. Ki67 had less effect on biochemical cure and disease-free survival at the low Ctn level, and Ki67 was an independent risk factor for failure to biochemically cure at the high Ctn level ( P=0.023) and was significantly associated with disease-free survival ( P=0.004) . Conclusions:Serum Ctn is more sensitive than Ki67 index in predicting biochemical cure after MTC, and the correlation between the two was weak. Ki67 proliferation index alone has limited prognostic value, but combines with preoperative Ctn significantly optimize the prognostic assessment of patients.The role of Ki67 index varied at different Ctn levels.

BACKGROUND:The development and evolution of atlas are complex,and there are a few research reports. CT imaging can show the normal development process,anatomical structure,developmental variation and deformity of the axis. It has important clinical value to clarify the time of occurrence of ossification center of axis and closure of epiphyseal plate and its evolution process and law.OBJECTIVE:To present the anatomical structure of the normal development and variation of children's axis based on CT images.METHODS:CT images obtained from 732 children aged 0 to 15 years who underwent neck scans between June 2016 and November 2019 were retrospectively analyzed. The observation indicators encompassed the axis odontoid,bilateral pedicle,vertebral ossification center,secondary ossification center at the tip of odontoid,pedicle,base of odontoid,and posterior median epiphyseal plate,as well as any variations or deformities in axis development. The changes in these indicators were analyzed and compared across different age groups. SPSS 17.0 statistical software package was utilized for data classification and statistical analysis. RESULTS AND CONCLUSION:(1) A total of 732 subjects were examined,comprising 718 cases (98.1％) with normal development of the axis and 14 cases (1.9％) exhibiting deformity or dysplasia. (2) The axis demonstrated the presence of five ossification centers,including those of the bilateral pedicles,odontoid process,and vertebral body,which were observed at birth. The median age for the secondary ossification center located at the tip of the odontoid process was determined to be 5.7 years,with an interquartile range of 4.1 to 7 years. The earliest recorded occurrence was observed at 8 months and 22 days,while the latest occurrence was noted at 12 years and 10 months. (3) The median age at which fusion took place was 6 years,with an interquartile range of 5-8 years. The maximum age at which non-fusion was observed was 8 years and 9 months,while the minimum age at which fusion occurred was 4 years and 3 months. (4) The median age at which bilateral epiphyseal plate closure occurred was approximately 3.8 years,with an interquartile range of about 2.9-4.6years. The earliest observed closure was at 2 years and 3 months,while the latest observed unclosure was at 6 years old. (5) The median age at which odontoid base epiphyseal plate closure occurred was 5.2 years,with an interquartile range of 3.5-6.8 years. The minimum age for closure was 2 years and 6 months,and the latest age for non-closure was 9 years and 6 months. (6) The posterior median epiphyseal plate typically closed at a median age of 1.5 years,with an interquartile range of 1.0-2.1 years. However,two cases exhibited delayed closure,occurring at ages 2 years and 5 months,and 14 years,respectively. Theearliest closure observed was at 6 months and 20 days. (7) Axis malformation or developmental abnormalities,including 7 cases of accessory ossification center and accessory epiphyseal plate,3 cases of free ossified small bones in the axis,2 cases of posterior median epiphyseal plate failure,2 cases of secondary ossification centers in the absence of the apex of odontosis,and 1 case of absence at ossification center in the odontoid of the armature vertebrae. (8) It is concluded that the utilization of multi-slice spiral CT scanning in conjunction with the multi-plane reconstruction technique enables comprehensive visualization of the anatomical structure of the axis,facilitating precise assessment of both its typical developmental variations and deformities.

Calcitonin-negative medullary thyroid carcinoma(CNMTC)is a rare subtype of medullary thyroid carcinoma,characterized by normal serum calcitonin levels,which often leads to misdiagnosis or missed diagnosis.The pathogenesis of CNMTC remains unclear and may involve impaired secretion mechanisms or assay-related false negatives.Diagnostic approaches include ultrasound-guided fine needle aspiration cytology,serum CEA and ProGRP measurements,and RET gene testing.Surgical resection remains the mainstay of treatment,while neoadjuvant therapy may be considered in selected cases.This review summarizes recent advances in the understanding,diagnosis,treatment,and prognosis of CNMTC,aiming to provide clinical guidance for better management of this challenging condition.

Purpose: Although some immune protection from close contact with individuals who have coronavirus disease 2019 (COVID-19) has been documented, there is limited data on the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals who were in lockdown with confirmed COVID-19 cases. This study investigated immunogenicity against SARS-CoV-2 in household members and people who lived near home-quarantined patients with COVID-19. Materials and Methods: This cross-sectional study was conducted during the community-based care that took place during lockdowns in District 10, Ho Chi Minh City, Vietnam from July to September 2021. SARS-CoV-2 antibody levels were determined in index cases of COVID-19, household contacts, and a no-contact group from the same area. Results: A total of 770 participants were included (355 index cases, 103 household contacts, and 312 no contacts). All index cases were unvaccinated, but >90% of individuals in the household and no-contact groups had received ≥1 vaccine dose. SARS-CoV-2 neutralizing antibodies (Nabs) were present in >77% of unvaccinated index cases versus 64%/65.4% in the householdo-contact groups (p=0.001). Antibody concentrations in unvaccinated index cases were significantly higher than those in household contacts and no contacts, with no difference between the latter groups. In all cases, antibody levels declined markedly ≥6 weeks after infection, and failed to persist beyond this time in the household and no-contact groups. Conclusion Community-based care may have helped to create community immunogenicity, but Nabs did not persist, highlighting a need for vaccination for all individuals before, or from 6 weeks after, infection with SARS-CoV-2.

Objective:To explore the current status of lipid-lowering therapy, the distribution of low-density lipoprotein cholesterol (LDL-C) levels and the risk assessment of cardiovascular events recurrence in patients with coronary heart disease (CHD) complicated by hypertension.Methods:This was a cross-sectional study. Patients with CHD combined with hypertension were hospitalized in the Department of Cardiology, General Hospital of Chinese People′s Liberation Army from August 5, 2008 to July 22, 2018 were included, and were divided into standard group and substandard group according to whether LDL-C reached the standard. Study data were obtained from inpatient coronary angiography records and electronic medical records database of Department of Cardiology, General Hospital of Chinese People′s Liberation Army, who used data from the first diagnosis of CHD. Clinical data of the selected patients were collected. Multivariate logistic regression model was used to analyze the associated factors of whether LDL-C reached the standard in CHD patients with hypertension.Results:A total of 18 800 patients were selected from 31 provinces/autonomous regions/municipalities directly under the central government in China, with Beijing accounting for the largest proportion (5 692 patients (30.28%)), followed by Hebei (3 621 patients (19.26%)), Henan (1 837 patients (9.77%)), and Shandong (1 618 patients (8.61%)). Among the selected patients, 1 493 had LDL-C<1.4 mmol/L (standard group), and 17 307 had LDL-C≥1.4 mmol/L (substandard group). Only 1 493 patients (7.94%) had LDL-C<1.4 mmol/L. There were 4 518 patients (24.03%), 4 366 patients (23.22%), 6 924 patients (36.83%) and 1 499 patients (7.97%) with LDL-C for 1.4-<2.0, 2.0-<2.5, 2.5-<3.8 and≥3.8 mmol/L levels, respectively. 17 855 patients (95.15%) were treated with statins, but only 1 334 patients (7.10%) were treated with statins and ezetimibe. Of the selected patients, 4 986 patients (26.52%) were at low risk, 6 515 patients (34.65%) were at intermediate risk, and 7 299 patients (38.82%) were at high risk. The combined lipid-lowering treatment rates of statin and ezetimibe in the middle-and high-risk patients were 7.43% (484/6 515) and 7.48% (546/7 299), respectively. The results of multivariate logistic regression analysis showed that increasing age, male, diabetes mellitus, stroke, and history of percutaneous coronary intervention (PCI) were positively associated with LDL-C standards in patients with CHD and hypertension, whereas obesity and acute myocardial infarction (AMI) were negatively associated with LDL-C standards (all P<0.01). Conclusions:The rate of achieving the standard LDL-C in patients with CHD combined with hypertension was low in China. Although the majority of patients had received moderate-intensity statin therapy, the proportion of statin-treated patients combined with ezetimibe was extremely low. The proportion of high-risk patients with recurrent cardiovascular events was higher in patients with CHD and hypertension in China, whereas the proportion of such patients receiving statin combined with ezetimibe lipid-lowering therapy was lower. This study also found that increasing age, male, diabetes mellitus, stroke, and history of PCI were positively associated with LDL-C standards, while obesity and AMI were negatively associated with LDL-C standards in patients with CHD and hypertension.