Multiple Hemivertebrae: The Natural History and Treatment of 50 Patients

Objective

Multiple hemivertebrae (MHV) is defined as three or more hemivertebrae, and is relatively uncommon among patients with congenital scoliosis. This study aimed to compare the natural history of different kinds of MHV and describe the surgical outcome of MHV.

Methods

In this retrospective cohort study, a total of 50 patients diagnosed with MHV were enrolled from June 2007 to June 2018. The medical records and radiographs of these patients were reviewed to summarize the characteristics of MHV. Patients with MHV were divided into the unbalanced (UB) group, partially unbalanced (PUB) group, and completely balanced (CB) group. Medical records and radiographs of MHV patients were reviewed to collect HV position, natural history, coronal and sagittal parameters. A Mann–Whitney U test was used to compare the radiographical data, such as the cobb angle of main curve and secondary curve, and Fisher's exact test was used to compare the patients in different kinds of MHV with surgical indication or not.

Results

The average number of hemivertebrae was 3.6 and the average main curve was 57.5°. Twenty-four of 50 patients had associated anomalies, including four patients with sacral agenesis, one with tetralogy of Fallot, two with congenital imperforate anus, and 17 with Klippel-Feil syndrome. In 22 patients who underwent MRI imaging, three patients had mild syringomyelia and three patients had diastematomyelia. The UB and PUB groups had a larger main curve and compensatory curve than the CB group. Of the 25 patients with follow-up before surgery, the curve progression rate was highest in the UB group (12.1°/year) but similar in the PUB group (4.2°/year) and CB group (3.6°/year). All patients in the UB and PUB group met the criteria for surgery. In contrast, only 10 of 23 patients in the CB group had surgical indications. Eighteen of the 37 patients with surgical indications chose to undergo surgery and the correction rate of the main curve was 51.4%.

Conclusions

Early surgical intervention should be considered for most patients with UB or PUB MHV. For patients with CB MHV, surgical treatment may not be urgently needed at the first visit. Posterior hemivertebrectomy could be used for the treatment of MHV with satisfying radiographic outcome.     

Free-breathing half-radial dual-echo balanced steady-state free precession thoracic imaging with wobbling Archimedean spiral pole trajectories

PurposeTo demonstrate free-breathing thoracic MRI with a minimal-TR balanced steady-state free precession (bSSFP) technique using wobbling Archimedean spiral pole (WASP) trajectories.MethodsPhantom and free-breathing in vivo chest imaging in healthy volunteers was performed at 1.5T with a half-radial, dual-echo, bSSFP sequence, termed bSTAR. For maximum sampling efficiency, a single analog-to-digital converter window along the full bipolar readout was used. To ensure a homogeneous coverage of the k-space over multiple breathing cycles, radial k-space sampling followed short-duration Archimedean spiral interleaves that were randomly titled by a small polar angle and rotated by a golden angle about the polar axis; depticting a wobbling Archimedean spiral pole (WASP) trajectory. In phantom and in vivo experiments, WASP trajectories were compared to spiral phyllotaxis sampling in terms of eddy currents and were used to generate in vivo thorax images at different respiratory phases.ResultsWASP trajectories provided artifact-free bSTAR imaging in both phantom and in vivo and respiratory self-gated reconstruction was successfully performed in all subjects. The amount of the acquired data allowed the reconstruction of 10 volumes at different respiratory levels with isotropic resolution of 1.77 mm from a scan of 5.5 minutes (using a TR of 1.32ms), and one high-resolution 1.16 mm end-expiratory volume from a scan of 4.7 minutes (using a TR of 1.42ms). The very short TR of bSTAR mitigated off-resonance artifacts despite the large field-of-view.ConclusionWe have demonstrated the feasibility of high-resolution free-breathing thoracic imaging with bSTAR using the wobbling Archimedean spiral pole in healthy subjects at 1.5T.     

以平衡计分卡思路开展医疗技术动态管理的体会

随着新一轮医药卫生体制改革的实施，提高医疗技术、加强技术管理将成为医院医疗管理工作的重点内容。文章根据平衡计分卡思路，通过将医疗技术实施能效评价分为效益指标、内部质量管理与运营指标、个人学习与成长指标以及安全性指标4个维度，来探讨开展医疗技术动态管理模式及方法，以期加强医疗技术管理，提升医疗质量。     

现代医学科学体系的不均衡发展

近400年来，基于西方哲学理论的现代科学体系对物质世界时空关系有效而精准的控制成就了现代医学与生命科学的诸多成就。但是，在该体系下人类对精神世界缺少最基本的认识与有效研究方法，因此，针对兼具物质与精神二元特征的人本身进行研究的现代医学与生命科学体系的发展存在着必然的局限性与漏洞。本文探讨了西方“超自然”理念下现代医学科学与生命科学体系不均衡发展的原因与特征，思考并预测医学和生命科学未来可能的发展方向。