Diagnostic Value of Various Morphological Features of Horizontal and Vertical Laminar Fractures for Posterior Ligamentous Complex Injury of the Thoracolumbar Spine as Defined by Magnetic Resonance Imaging.

OBJECTIVE: To determine diagnostic value of morphological features of horizontal laminar fracture (HLF) and vertical laminar fracture (VLF) for diagnosis of posterior ligamentous complex (PLC) injury. METHODS: This retrospective review comprised 271 consecutive patients with acute thoracolumbar fractures presenting to a Level 1 trauma center between January 2014 and January 2021. Two reviewers evaluated computed tomography and magnetic resonance imaging. VLFs were subclassified based on length and depth of lamina involved, as follows: type 1, full-length complete; type 2, full-length incomplete; type 3, partial-length complete or incomplete. HLFs were subclassified as follows: bilateral versus unilateral, displaced >2 mm versus nondisplaced, and lamina-only versus laminar and pedicle. We examined the diagnostic accuracy and the univariate and multivariate associations of laminar fracture subtypes with PLC injury as defined by black stripe discontinuity. RESULTS: Bilateral HLFs, laminar and pedicle fractures, displaced HLFs, and type 1 VLFs yielded a high positive predictive value for PLC injury (95%, 91%, 100%, and 86%, respectively). Type 2 and 3 VLFs did not show significant univariate associations with PLC injury. Bilateral HLFs, laminar and pedicle fractures, and displaced HLFs showed independent associations with PLC injury (adjusted odds ratio = 13.6, 8.4, 6, and 10.3, respectively; P < 0.002). Type 1 VLFs did not show a significant association with PLC (adjusted odds ratio = 10.3; P = 0.06). CONCLUSIONS: Bilateral HLFs, laminar and pedicle fractures, and displaced HLFs, but not any VLF subtypes, were independently associated with PLC injury. These findings may improve the reliability of PLC assessment by computed tomography.

Analysis of the Combined Computed Tomography Findings Improves the Accuracy of Computed Tomography for Detecting Posterior Ligamentous Complex Injury of the Thoracolumbar Spine as Defined by Magnetic Resonance Imaging.

OBJECTIVE: To determine the diagnostic accuracy of combined computed tomography (CT) findings for detecting posterior ligamentous complex (PLC) injury in thoracolumbar fractures using magnetic resonance imaging as a reference. METHODS: A retrospective review of 263 consecutive patients with thoracolumbar fractures who underwent CT and magnetic resonance imaging within 10 days of injury. Two reviewers evaluated CT for the following findings: facet joint malalignment, facet joint widening, horizontal laminar fracture, spinous process fracture, and interspinous widening. We examined the independent association of CT findings with PLC injury before combining the CT findings to calculate the diagnostic accuracy: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and positive and negative likelihood ratios. PLC injury was defined by black stripe discontinuity caused by supraspinous or ligamentum flavum rupture. RESULTS: Facet joint malalignment, spinous process fracture, horizontal laminar fracture, and interspinous widening were independently associated with PLC injury (adjusted odds ratio range, 4.4e17.4). A single positive CT finding yielded a PPV of 31% and NPV of 66% for PLC injury. Two or more CT findings yielded a PPV of 91% for PLC injury. A negative CT for all the 4 CT sings had a 94% NPV for PLC injury. CONCLUSIONS: Two or more CT findings provided the best combination to confirm PLC injury; thus, this combination could be used as a criterion for injured PLC. A single CT finding lacks sufficient predictive value to confirm or rule out PLC injury. A negative CT for the 4 CT findings provided the highest sensitivity for PLC injuries.

Early T precursor acute lymphoblastic leukaemia/lymphoma shows differential immunophenotypic characteristics including frequent CD33 expression and in vitro response to targeted CD33 therapy.

The differential immunophenotypic characteristics of early T precursor (ETP) acute lymphoblastic leukaemia/lymphoma (ALL) remain incompletely characterized. The study group (n = 142) included 106 (74·7%) men and 36 (25·3%) women with a median age of 34·9 years (range, 2-79) at diagnosis. Patients were subtyped by flow cytometry immunophenotyping as follows: 33 (23·2%) ETP; 32 (22·5%) early non-ETP; 60 (42·2%) thymic; and 17 (12·1%) mature. Excepting definitional markers, there was a significant differential expression of the markers CD2, CD10, CD33 and TdT between ETP-ALL and non-ETP-ALL. Positive CD33 expression (≥20% of leukaemic blasts) was detected in 21/33 (63%) ETP-ALL compared with 17/95 (17·9%) non-ETP-ALL (P < 0·001). Notably, targeted anti-CD33 therapy with IMGN779 resulted in significant growth inhibition and increased apoptosis in ETP-ALL cells in vitro. An 11-marker T-ALL immunophenotype score discriminated reliably between ETP and non-ETP ALL. Longitudinal analysis of ETP-ALL cases in this study demonstrated that the immunophenotype may be occasionally dynamic but is largely stable over the disease course. In summary, identification of ETP-ALL might be enhanced by using an 11-marker T-ALL immunophenotype score. CD33 expression is frequent in ETP-ALL, and in vitro data suggest that exploring anti-CD33 therapy in ETP-ALL is warranted.

The effect of parental socioeconomic class on children's body mass indices.

OBJECTIVE: To assess the effect of education and economic status of parents on obesity in children. METHODS: A cross-sectional survey was conducted in 2006 among school children in Riyadh, Saudi Arabia. A representative sample of 1243 (542 male and 701 female) children aged 6-16 years were contacted using multistage cluster sampling strategy. Social and demographic variables were collected using questionnaires completed by parents. Height and weight of the children were recorded by a trained team. RESULTS: The mean body mass index for all children was 19.8±5.4. The prevalence rates of overweight and obesity were 21.1% and 12.7%, respectively. Overweight and obesity were more prevalent in males than in females. By multivariate analysis, children were more likely to be overweight if they were male (OR=0.6, p<0.01), 12 years of age (OR=3.79, p<0.01, compared to age 6 years), and if their families had higher income (OR=3.12, p<0.01, compared to families with low income). Being male (OR=0.545, p<0.01), aged 12 years (OR=3.9, p=0.005, compared to the age of 6), and having a mother who is more educated were determined to be significant risk factors for obesity in children. Mothers educated at university level were found to have a three-fold higher risk of having obese children(OR=3.4, p<0.01, compared to mothers with lower education levels). CONCLUSIONS: Overweight and obesity among Saudi children is associated with educated mothers and higher family income. This finding calls for introducing interventions in health education for both children and parents.