Background Spondylodiscitis is a spinal infection affecting primarily the intervertebral disk and the adjacent vertebral bodies. Currently many aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate. Purpose The aim of this study was to review the currently available literature systematically to determine the outcome of patients with pyogenic spondylodiscitis for conservative and surgical treatment strategies. Methods A systematic electronic search of MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science regarding the treatment of pyogenic spondylodiscitis was performed. Included articles were assessed on risk of bias according the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and strength of recommendation was evaluated according the GRADE approach. Results 25 studies were included. Five studies had a high or moderate quality of evidence. One RCT suggest that 6 weeks of antibiotic treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of treatment is required for S. aureus and 8 weeks of Daptomycin for MRSA. The articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis. No additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus antibiotic only treatment. Conclusion There is a strong level of recommendation for 6 weeks of antibiotic treatment in pyogenic spondylodiscitis although this has only been shown by one recent RCT. If surgical treatment is indicated, it has been suggested by two prospective studies with strong level of recommendation that an isolated anterior approach could result in a better clinical outcome.

The evolution of multiple myeloma (MM) depends on complex signals from the bone marrow (BM) microenvironment, supporting the proliferation and survival of malignant plasma cells. An interesting candidate signal is hepatocyte growth factor/ scatter factor (HGF), since its receptor Met is expressed on MM cells, while HGF is produced by BM stromal cells and by some MM cell lines, enabling para-or autocrine interaction. To explore this hypothesis, we studied the biological effects of HGF stimulation on MM cell lines and on primary MMs. We observed that Met is expressed by the majority of MM cell lines and by approximately half of the primary plasma cell neoplasms tested. Stimulation of MM cells with HGF led to the activation of the RAS/mitogen-activated protein kinase and phosphatidylinositol 3-kinase/protein kinase B (PI3K/PKB) pathways, signaling routes that have been implicated in the regulation of cell proliferation and survival. Indeed, functional studies demonstrated that HGF has strong proliferative and antiapoptotic effects on both MM cell lines and primary MM cells. Furthermore, by applying specific signal-transduction inhibitors, we demonstrated that MEK is required for HGF-induced proliferation, whereas activation of PI3K is required for both HGF-induced proliferation and for rescue of MM cells from apoptosis. Taken together, our data indicate that HGF is a potent myeloma growth and survival factor and suggest that the HGF/Met pathway is a potential therapeutic target in MM.

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Higher self-concept clarity is related to several adjustment indices and may be promoted by open communication with parents, while problems with self-concept clarity development could enhance internalizing problems (i.e., depressive and anxiety symptoms) in adolescence. This longitudinal study examined linkages between self-concept clarity, adolescents' open communication with parents, and adolescent depressive and anxiety symptoms. Dutch youths (N = 323; 51.1 % girls; mean age Time 1 = 13.3 years) reported on these constructs over four consecutive annual measurements. Concurrent positive links between open communication and self-concept clarity were found at Time 1. Over time, higher levels of open communication with parents predicted higher self-concept clarity only in middle adolescence (mean age between 14 and 15 years). We also found concurrent associations between self-concept clarity and both depressive and anxiety symptoms. Longitudinally, lower self-concept clarity predicted relatively higher levels of depressive symptoms across all waves, and also higher anxiety levels from Time 1 to Time 2. Conversely, higher levels of anxiety also predicted lower levels of self-concept clarity during the first three waves. Self-concept clarity did not mediate the longitudinal associations between open communication and internalizing symptoms. This study is one of the first to investigate self-concept clarity across adolescence. It highlights the possible importance of both anxiety symptoms and communication with parents in understanding the development of a clear self-concept, and demonstrates an association between lower self-concept clarity and higher levels of later depressive and anxiety symptoms.

Recent research has pointed to two possible causes of mathematical (dis-)ability: working memory and number sense, although only few studies have compared the relations between working memory and mathematics and between number sense and mathematics. In this study, both constructs were studied in relation to mathematics in general, and to mathematical learning disabilities (MLD) in particular. The sample consisted of 154 children aged between 6 and 10 years, including 26 children with MLD. Children performing low on either number sense or visual-spatial working memory scored lower on math tests than children without such a weakness. Children with a double weakness scored the lowest. These results confirm the important role of both visual-spatial working memory and number sense in mathematical development.