A novel type of neighbour perception elicits reproductive plasticity in an annual plant with a mixed mating system

Plants display various forms of phenotypic plasticity in anticipation of changing conditions, many of which are influenced by information obtained from neighbouring plants. Here, we tested the hypothesis that cleistogamic Lamium amplexicaule plants can adaptively modify production of chasmogamous (CH) and cleistogamous (CL) flowers based on the perception of conspecific neighbours. The production and proportion of CH and CL flowers was examined in individual L. amplexicaule grown at varying densities or treated with root leachates from plants grown at different densities. When growing at high density or treated with root leachates from high-density pots, L. amplexicaule increased production of more expensive, potentially outcrossing CH flowers. In contrast, single plants or plants treated with root leachates from empty pots or single-source plants predominantly developed cheaper, self-pollinated CL flowers. The results demonstrate a novel root-based neighbour-perception modality that enables plants to adaptively adjust production of CH and CL flowers in response to the presence of potential reproductive partners. Further research is needed to explore the broader ecological implications of this novel interplant cueing on reproductive bet-hedging and plasticity in natural settings, as well as to identify the involved cues and their mode of operation.

Towards optimal use of antithrombotic therapy of people with cancer at the end of life: A research protocol for the development and implementation of the SERENITY shared decision support tool

BACKGROUND

Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs.

METHODS

The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.

RESULTS

SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life.

CONCLUSIONS

We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

[Epidemiological profile of patients with COVID-19 admitted to a tertiary care public hospital]

BACKGROUND

The knowledge about the epidemiological profile of patients admitted to the hospital for severe COVID infection, allows an adequate health care planning and resource allocation.

AIM

To describe the epidemiology of patients with COVID-19 admitted to a public hospital between March 2020 and July 2021.

MATERIAL AND METHODS

Demographic variables, comorbidities, ventilatory support requirements, and hospital resources were recorded from clinical records and hospital databases of diagnosis related groups. The primary outcomes were overall mortality and need of ventilatory support.

RESULTS

In the study period, 4,474 patients (56% males) were hospitalized with a diagnosis of COVID-19. Overall mortality was 25.8% and in-hospital mortality was 18%. Invasive and non-invasive ventilatory support was required in 1349 (30.2%) and 2060 (46%) patients, respectively. The most common comorbidities in admitted patients were diabetes mellitus (29.2%), chronic kidney disease (11.1%), and chronic liver disease (10.4%). The readmission rate was 3.2%.

CONCLUSIONS

Mortality associated with COVID-19 in this hospital was similar to the rates reported abroad. Local risk predictors for this infection should be identified.

Nutritional composition of substitutes for meats and sausages on the German market

Background

Substitutes for meats and sausages are growing both in demand and supply in Germany. Monitoring their nutritional composition helps characterise this novel product group in terms of its dietary contribution.

Methods

Data on substitutes for meats and sausages were collected in a baseline survey in 2016 and an in-depth follow-up survey in 2021. In both surveys, mandatory nutrition declaration (“Big 7”) and other packaging information were collected via online research and supermarket visits. Products were categorised according to the substituted animal products and their contents of energy, fat, saturated fatty acids, and salt investigated. Changes in energy and nutrient contents between baseline and follow-up survey were assessed statistically using Welch’s t-test.

Results

The follow-up survey included 421 meat substitutes and 292 sausage substitutes, split into 27 subgroups. Substitutes for meat products like meat strips and schnitzel show widely varying energy contents. Sausage substitutes show higher medians for fat, saturated fatty acids and salt than meat substitutes; spans of salt content (0,1-4,0 g per 100 g product) and saturated fatty acids (0,1 g - 23,0 g per 100 g product) are particularly wide. Relative to the baseline survey, which included 69 meat substitutes and 61 sausage substitutes, the follow-up revealed significantly higher contents of energy and saturated fatty acids overall and in some subgroups (e.g. nuggets and burger patties). The sole significant reduction was seen for energy in substitutes of precooked sausages.

Conclusions

The observed wide spans of energy and nutrient content imply 1) the potential to reformulate substitutes for meats and sausages at the top end of the spectrum 2) the availability of healthier choices within the various subgroups. The increases shown in energy and saturated fatty acids content warrant further monitoring.

Key messages

• Wide spans of energy and nutrient contents reveal the potential for the development of more nutritionally favourable substitutes for meats and sausages.

• As substitutes for meats and sausages are perceived to have nutritional advantages the observed increases in energy and saturated fatty acids contents over time should be further monitored.

Near Infrared Reflectance Spectroscopy Coupled to Chemometrics as a Cost-Effective, Rapid, and Non-Destructive Tool for Fish Fraud Control: Monitoring Source, Condition, and Nutritional Value of Five Common Whitefish Species

Fish fraud is a problematic issue for the industry. For it to be properly addressed will require the use of accurate, rapid, and cost-effective tools. In this work, near infrared reflectance spectroscopy (NIRS) was used to predict nutritional values (protein, lipids, and moisture) as well as to discriminate between sources (farmed vs. wild fish) and conditions (fresh or defrosted fish). Samples of five whitefish species-Alaskan pollock (Gadus chalcogrammu), Atlantic cod (G. morhua), European plaice (Pleuronectes platessa), common sole (Solea solea), and turbot (Psetta maxima)-including farmed, wild, fresh, and frozen ones, were scanned by a low-cost handheld near infrared reflectance spectrometer with a spectral range between 900 and 1700 nm. Several machine learning algorithms were explored for both regression and classification tasks, achieving precisions and coefficients of determination higher than 88% and 0.78, respectively. Principal component analysis (PCA) was used to cluster samples according to classes where good linear discriminations were denoted. Loadings from PCA revealed bands at 1150, 1200, and 1400 nm as the most discriminative spectral regions regarding classification of both source and condition, suggesting the absorbance of OH, CH, CH2, and CH3 groups as the most important ones. This study shows the use of NIRS and both linear and non-linear learners as a suitable strategy to address fish fraud and fish QC.

Cooperative Chain Dynamics of Tracer Chains in Highly Entangled Polyethylene Melts

By neutron spin echo spectroscopy, we have studied the center of mass motion of short tracer chains on the molecular length scale within a highly entangled polymer matrix. The center of mass mean square displacements of the tracers independent of their molecular weight is subdiffusive at short times until it has reached the size of the tube d; then, a crossover to Fickian diffusion takes place. This observation cannot be understood within the tube model of reptation, but is rationalized as a result of important interchain couplings that lead to cooperative chain motion within the entanglement volume ∼d^{3}. Thus, the cooperative tracer chain motions are limited by the tube size d. If the center of mass displacement exceeds this size, uncorrelated Fickian diffusion takes over. Compared to the prediction of the Rouse model we observe a significantly reduced contribution of the tracer's internal modes to the spectra corroborating the finding of cooperative rather than Rouse dynamics within d^{3}.

Non-Destructive Measurement of the Internal Quality of Citrus Fruits Using a Portable NIR Device

The citrus industry has grown exponentially as a result of increasing demand on its consumption, giving it high standing among other fruit crops. Therefore, the citrus sector seeks rapid, easy, and non-destructive approaches to evaluate in real time and in situ the external and internal changes in physical and nutritional quality at any stage of fruit development or storage. In particular, vitamin C is among the most important micronutrients for consumers, but its measurement relies on laborious analytical methodologies. In this study, a portable near infrared spectroscopy (NIRS) sensor was used in combination with chemometrics to develop robust and accurate models to study the ripeness of several citrus fruits (oranges, lemons, clementines, tangerines, and Tahiti limes) and their vitamin C content. Ascorbic acid, dehydroascorbic acid, and total vitamin C were determined by HILIC-HPLC-UV, while soluble solids and total acidity were evaluated by standard analytical procedures. Partial least squares regression (PLSR) was used to build regression models which revealed suitable performance regarding the prediction of quality and ripeness parameters in all tested fruits. Models for ascorbic acid, dehydroascorbic acid, total vitamin C, soluble solids, total acidity, and juiciness showed Rcv2 = 0.77-0.87, Rcv2 = 0.29-0.79, Rcv2 = 0.77-0.86, Rcv2 = 0.75-0.97, Rcv2 = 0.24-0.92, and Rcv2 = 0.38-0.75, respectively. Prediction models of oranges and Tahiti limes showed good to excellent performance regarding all tested conditions. The resulting models confirmed that NIRS technology is a time- and cost-effective approach for predicting citrus fruit quality, which can easily be used by the various stakeholders from the citrus industry.

Self-Similar Dynamics of Large Polymer Rings: A Neutron Spin Echo Study

This work clarifies the self-similar dynamics of large polymer rings using pulsed-field gradient nuclear magnetic resonance and neutron spin echo spectroscopy. We find center of mass diffusion taking place in three dynamic regimes starting (i) with a strongly subdiffusive domain ⟨r^{2}(t)⟩_{com}∼t^{α} (0.4≤α≤0.65); (ii) a second subdiffusive region ⟨r^{2}(t)⟩_{com}∼t^{0.75} that (iii) finally crosses over to Fickian diffusion. While the t^{0.75} range previously has been found in simulations and was predicted by theory, we attribute the first to the effect of cooperative dynamics resulting from the correlation hole potential. The internal dynamics at scales below the elementary loop size is well described by ring Rouse motion. At larger scales the dynamics is self-similar and follows very well the predictions of the scaling models with preference for the self-consistent fractal loopy globule model.

Direct Assessment of Tube Dilation in Entangled Polymers

A key ingredient within theories focusing on the rheology of entangled polymers is the way how the topological constraints of an entangled chain are lifted by unconstrained segments, i.e., how the constraining tube is dilated. This important question has been addressed by directly measuring the tube diameter d at the scale of the tube by neutron spin echo spectroscopy. The tube diameter d and plateau modulus G_{N}^{0} of highly entangled polyethylene oxide (PEO) chains of volume fraction c that are diluted by low molecular PEO show a concentration dependence d∝c^{a/2} and G_{N}^{0}∝c^{1+a} with an exponent a close to 4/3. This result allows the clear discrimination between different theoretical models that predict 4/3 or other values between 1 and 2 and provides an important ingredient to tube model theories.

Die sonographische Untersuchung des vorderen Augenabschnittes beim Kleintier

Gegenstand: Diese zweiteilige Arbeit beschreibt den Einsatz eines hochauflösenden Linear-Array-Schallkopfes mit einer Mittelfrequenz von 12 MHz zur Darstellung des vorderen Augenabschnittes und der Netzhaut-Glaskörper-Peripherie beim Kleintier. Material und Methoden: Im ersten Teil der Studie wurden die Adnexe und der vordere Augenabschnitt bei gesunden Hunden und Katzen sonographisch erfasst. Zusätzlich erfolgte eine Untersuchung des gesamten Bulbus, der Adnexe sowie der Orbita von gesunden Kaninchen und Meerschweinchen. Die Sonographie wurde unter Lokalanästhesie, in Sedation oder Allgemeinnarkose durchgeführt. Ergebnisse: Im Anschluss an die Untersuchungen traten in keinem Fall durch die Sonographie bedingte Komplikationen auf. Mit der hochauflösenden Ophthalmosonographie ließen sich anteriore und bulbuswandständige Strukturen des Augapfels und die okulären Adnexe beurteilen. Die entstehenden Bilder ähnelten histologischen Schnittbildern niedriger Vergrößerung, ohne jedoch deren Präparationsartefakte aufzuweisen. Zusätzlich konnten dabei der gesamte Bulbus und seine Adnexe sowie die Orbita mit einem Ultraschallgerät untersucht werden. Schlussfolgerung und klinische Relevanz: Die hochauflösende Ophthalmosonographie liefert Bilder vom gesunden Hunde-, Katzen-, Kaninchenund Meerschweinchenauge, die mit konventionellen Geräten bisher nicht zu erreichen sind. Limitiert ist der Einsatz der Sonde durch deren Größe, vor allem in der vertikalen Schnittebene.

Die sonographische Untersuchung des vorderen Augenabschnittes beim Kleintier

Gegenstand und Ziel: Überprüfung des Einsatzes der hochauflösenden Ophthalmosonographie bei krankhaften Zuständen am Auge. Material und Methoden: Bei 125 Hunden und 36 Katzen wurden pathologische Veränderungen des vorderen Augenabschnittes und der Netzhaut-Glaskörper-Peripherie mit einem hochauflösenden Linear-Array-Schallkopf mit einer Mittelfrequenz von 12 MHz dargestellt. Zusätzlich wurden Veränderungen des gesamten Bulbus, der Adnexe und der Orbita von zwei Meerschweinchen und drei Kaninchen untersucht. Bei allen Augen, die enukleiert werden mussten, erfolgte zum Vergleich eine histologische Untersuchung. Ergebnisse: Die hochauflösende Ophthalmosonographie erlaubte die detaillierte Beurteilung anteriorer und bulbuswandständiger Läsionen des Augapfels und der okulären Adnexe. Die nicht invasive Untersuchungsmethode wurde von den Tieren gut toleriert. Beim Vergleich der eingesetzten Methode mit dem in der Humanmedizin verwendeten Ultraschallbiomikroskop zeigte sich Letzteres zwar in der Darstellung feinster Gewebsstrukturen überlegen, doch stellt der verwendete Schallkopf durch seine höhere Eindringtiefe, die leichtere Anwendbarkeit und die flexiblen Einsatzmöglichkeiten für tiermedizinische Fragestellungen insgesamt eine geeignete Alternative dar. Klinische Relevanz: Mit dieser Technik gelangen Darstellungen, die mit konventionellen Geräten bisher nicht erreicht werden konnten. Als Einsatzschwerpunkte sind Läsionen im Bereich von Iris, Ziliarkörper und Linse, die Glaukomdiagnostik, Traumata, Verlaufskontrollen und die Überprüfung des Operationsergebnisses von Linsenextraktionen und Kunstlinsenimplantationen zu nennen.

Reduced hematopoietic stem cell frequency predicts outcome in acute myeloid leukemia

In patients with acute myeloid leukemia and low percentages of aldehyde-dehydrogenase-positive cells, non-leukemic hematopoietic stem cells can be separated from leukemic cells. By relating hematopoietic stem cell frequencies to outcome we detected poor overall- and disease-free survival of patients with low hematopoietic stem cell frequencies. Serial analysis of matched diagnostic and follow-up samples further demonstrated that hematopoietic stem cells increased after chemotherapy in patients who achieved durable remissions. However, in patients who eventually relapsed, hematopoietic stem cell numbers decreased dramatically at the time of molecular relapse demonstrating that hematopoietic stem cell levels represent an indirect marker of minimal residual disease, which heralds leukemic relapse. Upon transplantation in immune-deficient mice cases with low percentages of hematopoietic stem cells of our cohort gave rise to leukemic or no engraftment, whereas cases with normal hematopoietic stem cell levels mostly resulted in multi-lineage engraftment. Based on our experimental data, we propose that leukemic stem cells have increased niche affinity in cases with low percentages of hematopoietic stem cells. To validate this hypothesis, we developed new mathematical models describing the dynamics of healthy and leukemic cells under different regulatory scenarios. These models suggest that the mechanism leading to decreases in hematopoietic stem cell frequencies before leukemic relapse must be based on expansion of leukemic stem cells with high niche affinity and the ability to dislodge hematopoietic stem cells. Thus, our data suggest that decreasing numbers of hematopoietic stem cells indicate leukemic stem cell persistence and the emergence of leukemic relapse.

An exploratory analysis on how geographic, socioeconomic, and environmental drivers affect the diversity of livestock breeds worldwide

This study investigates the relationships between various environmental and geographic, demographic, and socioeconomic factors with the diversity of livestock breeds reported within countries across the world. Statistical analyses were performed considering the numbers of breeds reported by 158 countries for 4 livestock mammalian species (cattle, sheep, goats, and pigs). Organization for Economic Cooperation and Development (OECD) countries reported more breeds than non-OECD countries in general. Strong and positive correlations were found between agricultural area, human population size, species population size, and number of breeds per country. When considering regression models, the species population size was found as the most important explanatory factor for the number of breeds reported by countries in the 4 species. Diversity of production systems in the country had a significant association with the number of breeds reported for sheep, goats, and pigs. The number of ruminant breeds was positively associated with the size of agricultural area and the diversity of land cover in the country. While demographic and cultural importance of a given species is a major factor associated with the number of livestock breeds within countries, this diversity is also connected to the variability in environmental and production conditions.

Twenty-five-year-old Woman with Bilateral Borderline Ovarian Tumour Desiring to Preserve Fertility - Case Report and Literature Review on the Current State of Fertility Preservation in Women with Borderline Ovarian Tumours

Borderline ovarian tumours are semimalignant tumours occurring unilaterally or bilaterally with a peak incidence among women of reproductive age. Since the affected women often wish to preserve fertility, particular precautions must be taken when counselling the patient and obtaining consent prior to planning an individual treatment. Options for preserving fertility include an organ-sparing surgical procedure and cryopreservation of oocytes and/or ovarian tissue. In this article, we report on a 25-year-old patient with a bilateral seromucinous borderline tumour who desired all fertility-preserving options. In order to perform the procedure without delay, we opted to perform luteal phase stimulation prior to oocyte retrieval. We conclude by discussing the current literature on the state of fertility preservation in the treatment of borderline ovarian tumours.

Nicotine consumption may lead to aseptic loosening in proximal mega-prosthetic femoral replacement

Background

Aseptic loosening after total hip arthroplasty is likely related to nicotine ingestion. However, aseptic loosening as a direct consequence of smoking habits has not been described with regard to proximal mega-prosthetic femoral replacement. The aim of the present study was to evaluate the association between nicotine consumption and aseptic loosening rates after proximal mega-prosthetic femoral replacement.

Materials and methods

A consecutive series of patients who received mega-prosthetic replacement of the proximal femur at our hospital between 2005 and 2015 were included. Their files were reviewed and evaluated for the influence of smoking on aseptic loosening rates. All living patients were invited to complete a functional follow-up assessment at our clinic.

Results

Twenty-six patients with 27 prostheses were included. Five patients were active smokers, and 21 patients were non-smokers. Aseptic loosening was observed in three patients in the smoking group, whereas none of the non-smokers developed aseptic loosening. Fisher’s exact test showed a relationship between nicotine consumption and aseptic loosening of the prostheses (p = 0.003).

Conclusions

Smoking increases the likelihood of aseptic loosening after proximal mega-prosthetic femoral replacement.

Level of evidence

Level 4 according to Oxford Centre of Evidence-Based Medicine 2011.

Electronic supplementary material

The online version of this article (doi:10.1007/s10195-016-0426-7) contains supplementary material, which is available to authorized users.

Acute leg pain with suspected beginning leg compartment syndrome and deep vein thrombosis as differential diagnoses in an unusual presentation of Brodie's abscess: a case report

Background

Brodie’s abscess is an uncommon form of subacute osteomyelitis where the main presenting symptom is mild to moderate pain of insidious onset for several months’ duration. We report a case of a patient presenting with acute leg pain resembling that of a deep vein thrombosis, and a beginning leg compartment syndrome following a suspected ruptured Baker’s cyst. Our case is unusual because of the acute presentation of the Brodie’s abscess with acute leg pain and acute swelling without any preceding trauma; to the best of our knowledge, this presentation has not been reported before.

Case presentation

A 17-year-old white boy presented to our out-patient clinic with a 6-month history of pain in his left knee joint of insidious onset. There was no history of trauma to the extremity. After performing physical and radiological (X-ray) examinations, we initially diagnosed medial meniscus damage. One week later he presented to our emergency department with acute sudden increase in the pain and swelling of his left knee, and pain and swelling of his left leg, without any trauma. Deep vein thrombosis and beginning leg compartment syndrome from ruptured Baker’s cyst were initially diagnosed. Magnetic resonance imaging was performed and Brodie’s abscess was the most probable diagnosis. We performed open surgical debridement and curettage with drainage of the abscess and administered postoperative antibiotics. He presented to our out-patient clinic 3 months postoperatively, where he was pain-free with no residual local tenderness.

Conclusions

In cases of sudden acute increase in joint or extremity pain or swelling that has been insidiously present for months, Brodie’s abscess should be considered as one of the differential diagnoses, as it may present acutely in cases with accompanying fasciitis and myositis and be clinically mistaken for deep vein thrombosis or limb compartment. Magnetic resonance imaging remains the gold standard imaging study, and surgical treatment followed by postoperative antibiotics remains the standard treatment.

Rare phenotypes in domestic animals: unique resources for multiple applications

Preservation of specific and inheritable phenotypes of current or potential future importance is one of the main purposes of conservation of animal genetic resources. In this review, we investigate the issues behind the characterisation, utilisation and conservation of rare phenotypes, considering their multiple paths of relevance, variable levels of complexity and mode of inheritance. Accurately assessing the rarity of a given phenotype, especially a complex one, is not a simple task, because it requires the phenotypic and genetic characterisation of a large number of animals and populations and remains dependent of the scale of the study. Once characterised, specific phenotypes may contribute to various purposes (adaptedness, production, biological model, aesthetics, etc.) with adequate introgression programmes, which justifies the consideration of (real or potential) existence of such characteristics in in situ or ex situ conservation strategies. Recent biotechnological developments (genomic and genetic engineering) will undoubtedly bring important changes to the way phenotypes are characterised, introgressed and managed.

Fertility Protection in Female Oncology Patients: How Should Patients Be Counseled?

Protecting the fertility of patients with oncologic disease is becoming more and more important, as fulfilling the wish to have children is increasingly occurring at a later stage in life and long-term survival rates after cancer are continuing to improve. A number of fertility-preserving options exist. In addition to techniques which have been around for some time such as medical ovarian suppression, ovarian transposition, and organ-preserving surgery, there are other, more recent, innovative methods which have developed over the last few years such as cryopreservation of oocytes or ovarian tissue transplantation after completing cancer therapy. As every procedure has its specific advantages and disadvantages, informed patient consent is essential. The physician's aim must be to select the optimal procedure for each patient. The extent of patients' information about the options to preserve fertility in women with oncologic disease remains limited. One of the main reasons for this is that clinicians are not sure how to inform patients about existing procedures and methods. The aim of this review article is to provide help in clinical practice.

Comparison of Whole Ovary Cryotreatments for Fertility Preservation

The goal of this study was to compare a traditional slow-freeze method (TF) with an open unidirectional slow freeze cooling system (UF) for whole ovary cryopreservation. Therefore, whole pig ovaries were randomly assigned to (A) fresh control, (B) traditional slow freeze (TF) or (C) unidirectional slow freeze (UF). Ovaries were perfused with 10% DMSO in Krebs-Ringer. For TF, whole ovaries were placed in specimen jars containing 10% DMSO and placed into a specialized container for freezing filled with propan-2-ol. For UF, whole ovaries were placed within a specially designed container containing 10% DMSO and transferred to a specialized freezing machine (CTE 920). Histological evaluation demonstrated intact morphology of follicles in all groups; however, an overall decrease of follicle numbers in TF (46%) and UF (50%) compared to fresh control. Live/dead assay indicated significantly lower populations of live cells in both TF (60%) and UF (58%) compared to fresh tissue (74%). TUNEL assay confirmed a difference in percentage of apoptotic follicles between fresh and TF, but there was no significant difference between fresh and UF. To improve the structural and functional integrity of whole ovaries, further investigation, especially into directional freezing, is needed. Whole ovary cryopreservation could provide opportunities for women facing fertility loss due to chemo- or radiotherapy treatment.

Set screw fracture with cage dislocation after two-level transforaminal lumbar interbody fusion (TLIF): a case report

Introduction

Transforaminal lumbar interbody fusion is a popular procedure used to achieve spondylodesis in patients with degenerative lumbar spinal diseases. We present a rare case of a patient with a set screw fracture with cage dislocation after an open transforaminal lumbar interbody fusion procedure. To the best of our knowledge, this case is the first of its kind to be reported.

Case presentation

A 44-year-old Caucasian woman attended a follow-up appointment at our hospital 3 months after treatment for second-degree lumbar spondylolisthesis (L4/L5) and osteochondrosis (L5/S1) with transforaminal lumbar interbody fusion and dorsal spondylodesis. She complained of severe leg pain on the left side. Her physical examination revealed a normal neurological status, except for paresthesia of the entire left lower limb and at the ball of the left foot. Radiological imaging showed breaking of the set screws with cage dislocation. Surgical revision was then performed with exchange of the whole dorsal instrumentation and the dislocated cage. Six weeks post-operatively, the patient was seen again at our clinic without neurological complaints, except for decreased sensitivity on the dorsum of her left foot. The wound healing and radiological follow-up were uneventful.

Conclusions

Hardware-related complications are rarely seen in patients with open transforaminal lumbar interbody fusion, but must be kept in mind and can potentially cause severe neurological deficits.

The rarity of ALDH(+) cells is the key to separation of normal versus leukemia stem cells by ALDH activity in AML patients

To understand the precise disease driving mechanisms in acute myeloid leukemia (AML), comparison of patient matched hematopoietic stem cells (HSC) and leukemia stem cells (LSC) is essential. In this analysis, we have examined the value of aldehyde dehydrogenase (ALDH) activity in combination with CD34 expression for the separation of HSC from LSC in 104 patients with de novo AML. The majority of AML patients (80 out of 104) had low percentages of cells with high ALDH activity (ALDH(+) cells; <1.9%; ALDH-rare AML), whereas 24 patients had relatively numerous ALDH(+) cells (≥1.9%; ALDH-numerous AML). In patients with ALDH-rare AML, normal HSC could be separated by their CD34(+) ALDH(+) phenotype, whereas LSC were exclusively detected among CD34(+) ALDH(-) cells. For patients with ALDH-numerous AML, the CD34(+) ALDH(+) subset consisted mainly of LSC and separation from HSC was not feasible. Functional analyses further showed that ALDH(+) cells from ALDH-numerous AML were quiescent, refractory to ARA-C treatment and capable of leukemic engraftment in a xenogenic mouse transplantation model. Clinically, resistance to chemotherapy and poor long-term outcome were also characteristic for patients with ALDH-numerous AML providing an additional risk-stratification tool. The difference in spectrum and relevance of ALDH activity in the putative LSC populations demonstrates, in addition to phenotypic and genetic, also functional heterogeneity of leukemic cells and suggests divergent roles for ALDH activity in normal HSC versus LSC. By acknowledging these differences our study provides a new and useful tool for prospective identification of AML cases in which separation of HSC from LSC is possible.