Research of thoracolumbar spine lateral vascular anatomy and imaging

This study introduces an anatomical basis for surgeries such as thoracoscope-assisted thoracolumbar spinal anterior interbody fusion in terms of image observing and corpse specimen anatomising. The observation of the 3-dimensional computed tomography (CT) image indicates that segmental arteries are visible and run in the central supersulcus of the corresponding vertebral body's side, while the branches are invisible. The distances between adjacent segmental arteries in T(10/11), T(11/12), T₁₂/L₁, L(1/2), and L(2/3) are 23.35 ± 1.48, 25.61 ± 2.08, 29.12 ± 2.30, 32.53 ± 2.18, and 33.73 ± 2.29 (mm), respectively. And the observation by the thoracolumbar spine side of the adult corpse specimens shows that segmental arteries and veins constantly exist and run in the central supersulcus of the corresponding vertebral body's side; each segmental artery has some small branches; the zone between the upper and lower segmental arteries form a relatively non-vascular nerve safe zone, where the intervertebral space (disc) locates. The distances between adjacent segmental arteries in T(10/11), T(11/12), T₁₂/L₁, L(1/2), L(2/3) are 23.34 ± 0.78, 25.54 ± 0.85, 29.11 ± 1.01, 32.82 ± ± 1.28, and 33.71 ± 1.42 (mm), respectively. The safe zone, with the intervertebral disc as the reference mark, can provide enough operation space for surgeries like thoracoscope-assisted anterior interbody fusion and reducing damage to blood vessels as well as surgical complications. Additionally, the arrangement and distribution of segmental arteries can be clearly displayed on the 3-dimensional CT image and the result is basically consistent with that of corpse specimens. Therefore, the 3-dimensional CT image can be regarded as the reference for video-assisted thoracoscopic surgery plans.

Diagnostic interval of inflammatory bowel disease in Chinese children and its relationship with growth parameters: a retrospective study

Background

Delayed diagnosis of inflammatory bowel disease (IBD) is common in Europe and North America, with limited research in Asia. We aimed to investigate factors influencing delayed diagnosis of IBD in Chinese children and the impact of delayed diagnosis on growth.

Methods

This was a retrospective study. Clinical data on children with IBD were collected through electronic medical records. The diagnostic interval includes the time from symptom onset to hospital admission and admission to diagnosis. Diagnostic delay was defined as the upper quartile of the time interval from the first symptom to the diagnosis of IBD. For the effect on growth indicators, the length of follow-up was at least 3 months from diagnosis.

Results

This study included 222 children with IBD, predominantly with Crohn's disease (86.0%). Approximately one-quarter of children require more than 366 days to be diagnosed with IBD, primarily due to the extended interval between the onset of initial symptoms and hospital admission. Multivariate logistic regression models showed that fever was associated with a prolonged time interval from first symptom onset to admission and the odds ratio (OR) was 0.45 [95% confidence interval (CI) 0.22-0.94]. Age and bloody stools were associated with prolonged intervals from admission to diagnosis, with ORs of 0.84 (95% CI 0.77-0.92) and 0.36 (95% CI 0.14-0.94), respectively. Delayed diagnosis was associated with height at first admission and follow-up. Children with a delayed diagnosis had a 5.87-fold higher chance of growth retardation upon initial admission compared to children without a delayed diagnosis (95% CI 1.59-24.05). After 15.7 months of follow-up, this elevated risk remained (OR 3.28, 95% CI 1.00-10.50).

Conclusion

Delayed diagnosis is common in Chinese children with IBD and is associated with persistent height impairment.