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Highlights • A total of 88 patients experienced light flashes among 416 who received photon radiotherapy and 205 who received proton beam therapy in our prospective study. • The frequency of light flashes during radiotherapy was associated with the retina dose and younger age, and were commonly blue or white light for brain or head and neck irradiation. • Light flashes were seen by only 35/524 patients (6.7%) without retinal irradiation, but by 13/33 (39.4%) and 41/64 (64.1%) with retinal maximum isodose lines of 10–50% and 60–100%, respectively. • Totals of 52, 15, 15, 9, 16 and 8 patients sensed light of blue, purple, yellow, red, white and other colors, respectively., Background Patients who receive radiation therapy sometimes complain of a light flash during irradiation. The details of the characteristics of this light have not been described. Purpose To evaluate light flashes during photon and proton radiotherapy. Methods and Materials A prospective observational study was performed in all adult patients (≥20 years old) who received photon and proton therapy at two centers between January 2019 and August 2020, except for patients who could not communicate and those with visual abnormality. Evaluations were obtained for the presence or absence of light flashes, light darkness (7 levels), light intensity (5 levels), frequency, light movement, light flashing, and time seeing the light, using a weekly checklist. Results A total of 650 courses were examined for 621 patients, of whom 416 received photon radiotherapy and 205 received proton beam therapy. The checklist indicated that 88 patients (16.1%) sensed light during photon or proton radiotherapy. In multivariate logistic regression analysis, the factors that were significantly associated with a light flash were a higher retina dose and younger age (p

Background: Screening of plant kingdom for various pharmacologic activities with an aim of discovering new active constituents is a continuous process and a part of systemic analysis. Purpose: The purpose of this study was to investigate hypoglycemic, hypolipidemic, anti-ulcer, and thrombolytic effects of the ethanolic extract of Grewia hirsuta Vahl. (EEGH) in different in vivo and in vitro paradigms in both Swiss Albino mice and Long Evans rats. Materials and Methods: After an oral acute toxicity study, adult male mice and rats according to the testing procedure were treated with EEGH (200, 400, 2000 and 4000 mg/kg, p.o.) and (1000 mg/70kg B.W. p.o Metformin, 10 mg/70kg, B.W. p.o Simvastatin, and 30 mg/70kg, B.W. p.o Omeprazole), and subjected to three in vivo tests and one in vitro test according to various established testing protocol. Results: After testing glucose tolerance test, for hypoglycemic activities, 400 mg/kg EEGH both in 6 weeks and 12 weeks exhibited moderate anti-diabetic effect (8.89 ± 0.09 and 8.12±0.28 mmol/L respectively). Additionally, combination therapy of both 400 mg/kg EEGH + Metformin revealed a substantial fall of sugar level from 16.78± 0.1 to 6.4 ± 0.04 mmol/L, confirming a sign of moderate potentiation. No lipid-lowering effect was observed in the timed-treatment procedure. In the anti-ulcer effect, n-butanol showed a comparable ulcer inhibition index (90.56%) compared to the standard Omeprazole inhibition index of 91%. Additionally, ethyl acetate fraction showed 62% and 66% clot lysis capacity by 200 and 400 mg/kg EEGH, whereas standard Streptokinase’s capacity was 80%. The EEGH showed notable anti-ulcer activities and moderate anti-diabetic and thrombolytic activities. Conclusion: Results extend the current understanding of the impacts of Grewia hirsuta Vahl. on biological parameters and indicate that this plant might be promising for the management of diabetes mellitus, anticoagulant, and gastric ulcer disorders prominently.

Introduction: Isolated ultrafiltration (IUF) is an alternative treatment for diuretic-resistant patients with fluid retention. Although hemodialysis (HD) predominantly decreases extracellular water (ECW), the impact of IUF on fluid distribution compared with HD remains unclear. Methods: We compared the effect of HD (n = 22) and IUF (n = 10) sessions on the body fluid status using a bioimpedance analysis device (InBody S10). Results: The total ultrafiltration volume was similar between HD and IUF (HD 2.5 ± 0.3 vs. ICF 2.1 ± 0.3 L/session, p = 0.196). The reduction rate of ECW was significantly higher than that of intracellular water (ICW) after HD (ECW −7.9% ± 0.8% vs. ICW −3.0% ± 0.9%, p < 0.001) and IUF (ECW −5.8% ± 0.9% vs. ICW -3.6% ± 0.8%, p = 0.048). However, the change in the ratio of ECW to total body water in HD was significantly larger than that in IUF (HD −3.2% ± 0.3% vs. ICF −1.1% ± 0.4%, p < 0.001). The reduction rates in serum tonicity (effective osmolality) were higher after HD than after IUF (HD −1.8% ± 0.5% vs. IUF −0.6% ± 0.2%, p = 0.052). Among the components of effective osmolality, the reduction rates of serum K+ and glucose levels after HD were significantly higher than those after IUF (serum K+: HD −30.5% ± 1.6% vs. IUF −0.5% ± 3.8%, p < 0.001; serum glucose: HD −15.4% ± 5.0% vs. IUF 0.7% ± 4.8%, p = 0.026), while the serum Na+ level was slightly and similarly reduced (HD −0.8% ± 0.4% vs. IUF −0.8% ± 0.4%, p = 0.500). The reduction in the osmolal gap value (measured osmolality–calculated osmolarity) was significantly greater after HD sessions than after IUF sessions (HD −12.4 ± 1.4 vs. IUF 2.0 ± 1.0 mOsm/kg, p = 0.001). Conclusion: The extracellular fluid reduction effect of HD is stronger than that of IUF. The different changes in effective osmolality and osmolal gap after HD and IUF sessions may be related to the different effects of HD and IUF on fluid distribution.

Objective In order to evaluate the clinical utility even under general anesthesia, the present study aimed to clarify the effect of anesthesia on the cortico–cortical evoked potentials (CCEPs). Methods We analyzed 14 patients’ data in monitoring the integrity of the dorsal language pathway by using CCEPs both under general anesthesia with propofol and remifentanil and awake condition, with the main aim of clarifying the effect of anesthesia on the distribution and waveform of CCEPs. Results The distribution of larger CCEP response sites, including the locus of the maximum CCEP response site, was marginally affected by anesthesia. With regard to similarity of waveforms, the mean waveform correlation coefficient indicated a strong agreement. CCEP N1 amplitude increased by an average of 25.8% from general anesthesia to waking, except three patients. CCEP N1 latencies had no correlation in changes between the two conditions. Conclusions We demonstrated that the distribution of larger CCEP responses was marginally affected by anesthesia and that the CCEP N1 amplitude had tendency to increase from general anesthesia to the awake condition. Significance The CCEP method provides the efficiency of intraoperative monitoring for dorsal language white matter pathway even under general anesthesia.

Exploration of fruit tree-based agroforestry systems is essential for Bangladesh’s agriculture in the era of climate change scenarios and shrinking agricultural land in order to ensure food and nutrition security at household and national levels. In the present study, a traditional jujube/apple kul (Zizyphus mauritiana) orchard was converted into an agroforestry system by including summer vegetables (okra and Indian spinach) and spices (ginger and turmeric) with a view to achieving greater economic return, maximizing land use and providing food and nutritional support. Results revealed that heavily pruned jujube trees in the summer season displayed negligible loss of light accessibility to understory okra and Indian spinach, which contributed to their higher yields. Conversely, the growing canopy of jujube trees exerted moderate shade at the later stages of growth that helped to attain improved yield from ginger and turmeric, which are shade loving crops. Intriguingly, jujube trees were able to utilize a substantial amount of the fertilizers and irrigation applied to the understory crops, which eliminated the need for additional inputs for jujube trees under the agroforestry system. Soil nutrient dynamics also improved in the agroforestry system as crop residues and leaf litter were left in the field. Importantly, nutritionally-rich, sweet-tasting, attractively-colored apple kul has a greater market value and the lack of vegetable productionin the summer season triggered a higher market price for Indian spinach and okra. This collectively heightened the benefit–cost and land equivalent ratios. Concisely, the current study concluded that the jujube-based agroforestry system could be endorsed as a model approach throughout Bangladesh for upgrading food, nutrition and income security.

Highlights • This is a study focus on radiation dose-volume parameters in use of durvalumab. • Dose-volume relation and pneumonitis was retrospectively investigated in 91 patients. • Pneumonitis developed in 88% patients at a median of 4.1 months after radiotherapy. • ≥Grade 2 and ≥ grade 3 pneumonitis were observed in 34% and 12% of the patients. • In use of durvalumab after concurrent chemoradiotherapy, V20 should be, Objectives To estimate appropriate dose-volume parameters for avoidance of pneumonitis in use of chemoradiotherapy and durvalumab for treatment of lung cancer. Materials and methods Patients with non-small cell lung cancer treated with concurrent chemoradiotherapy followed by durvalumab at 9 centers were enrolled in the study. Three-dimensional radiotherapy, intensity modulated radiotherapy, and proton beam therapy were used. The frequency and severity of pneumonitis and the dose-volume relationship for normal lung were evaluated. Univariable and multivariable analyses were conducted to identify risk factors. A covariate adjusted hazard ratio was then estimated for the percentages of normal lung volume irradiated at ≥ X Gy (Vx) (X = 5–40) and lung volume non-irradiated at ≥ X Gy (X = 5–40), with the covariates selected in the variable selection. Cumulative incidence functions and covariate adjusted hazard ratios were also estimated for dichotomized variables, with estimated cut-off points. Results A total of 91 patients were enrolled in the study. The median time from the start of radiotherapy to development of pneumonitis was 4.1 months. Pneumonitis was observed in 80 patients (88%), including grade 2 or severe pneumonitis in 31 (34%) and ≥ grade 3 pneumonitis in 11 (12%). Pneumonitis was inside the irradiation field in 73 of the 80 patients (91%). The selected factors for ≥ grade 2 pneumonitis were V20, and primary site (upper lobe) in multivariable analysis. The cut off value of V20 was 18.99%, and there was a significant difference between V20 of

To assess the clinical indications for, and prognostic impact of surgery after, chemotherapy for type 4 gastric cancer. The subjects of this retrospective study were 67 patients who received chemotherapy for type 4 gastric cancer. The patients were grouped into those with progressive disease (PD group) and those without PD (non-PD group), according to the tumor response to chemotherapy. Distant metastases developed in 58 patients. With regard to tumor response, there were 16 patients in the PD group and 51 patients in the non-PD group. The prognosis of the PD group patients was significantly poorer than that of the non-PD group patients (p

Background Reported benefits of virtual programs include user satisfaction and feasibility to train nurses to utilize pain scales. However, the effectiveness of the virtual neonatal pain management program on nurses' knowledge and scoring skill acquisition has not been examined. Purpose This study developed a comprehensive virtual program on neonatal pain management and examined its effectiveness on nurses' knowledge and skill acquisition of selected pain scales. Methods Evidence-based content was designed as a virtual program and pre-and posttests to examine skill and knowledge acquisition were developed and validated. Analysis of covariance was used to assess the differences from pre- to posttest based on the intensity of participants' involvement while examining the overall effectiveness of the program. Results A total of 115 nurses representing 7 hospitals completed the virtual neonatal pain management program, and 52 nurses completed the posttest. The Student paired t test showed an increase in posttest scores from pretest scores among participants. Participants' final degrees and years of experience were not related to posttest scores. The analysis of covariance showed that the high study group had a significantly higher amount of change in total scores and pain measurement skill scores than the low study group on the posttest. Implications for practice The virtually delivered neonatal pain management program can be useful for nurses' attainment of knowledge and skills for managing neonatal pain, including an appropriate use of selected scoring tools. Implications for research It is necessary to examine how organizational unit attendance rate for e-learning and posttest results are related to patient outcomes.Video Abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=46.

Background: Gastrointestinal disease is a burden both for developed and developing countries. This diseases has long term complications and responsible for generation of other diseases.Aims and objectives: This work was designed to identify the age at which this disease first occurred, duration of disease, major complications like burning feelings, stool in blood, ulcer etc. Relationship between lifestyle and food habits with prevalence of disease was also assayed.Materials and methods: The data was collected from July to November 2020 by directly interviewing the patients.Results: This data was collected from 1176 patients, of them 53.74% are male and 46.25% are female. It was found that 60% of patients are taking treatments from directly supervision of physicians. This study revealed that 20.66% respondents first suffered from GI disease at 11-20 years old. Most of the patients of this study needs long time treatment and 30.27% patients are taking treatments for 1-3 years, and 25.43% for 3-6 years. Twenty nine percent of our study sample have experienced malnutrition, 83% have experienced stomach pain and 54% have experienced nausea. The food habit of patients shows that more than 70% of participants have habit of taking soft drinks, 79% have habit of street food and 43.54% participants are drinking about 2 liters of waiter daily.Conclusion: Gastrointestinal disease has a wide range of complications to the patients and disciplined lifestyle should be practiced to avoid this types of disease.

The aim of this study was to clarify the effect of a stable concentration of propofol on interictal high-frequency oscillations (HFOs), which may contribute to identifying the epileptogenic zone intraoperatively for resection surgery. Nine patients with drug-resistant focal epilepsy who underwent invasive pre-surgical evaluation with chronic subdural electrodes were recruited. Five-minute electrocorticograms during wakefulness, slow-wave sleep, and under a stable brain concentration of propofol were recorded with the same electrodes. In each patient, 1-10 pairs of electrodes were selected for both electrodes with EEG changes within 5 seconds from the ictal onset (ictal pattern for 5 seconds [IP5]) and those outside the area of IP5 with no interictal epileptiform discharges (non-epileptiform [nEPI]). The numbers of ripples (80-250 Hz) and fast ripples (>250 Hz) were measured semi-automatically using an established algorithm. Statistical testing was performed with a mixed effect model. Thirty-seven pairs of electrodes from nine patients were analysed for IP5 and 29 pairs from seven patients were analysed for nEPI. The numbers of HFOs differed between the areas (IP5 and nEPI) and among the conditions (wakefulness, slow-wave sleep, propofol anaesthesia) (all p

Objectives: To explore the feasibility of Vector-Field DXR (VF-DXR) using optical flow method (OFM). Methods: Five healthy volunteers and five COPD patients were studied. DXR was performed in the standing position using a prototype X-ray system (Konica Minolta Inc., Tokyo, Japan). During the examination, participants took several tidal breaths and one forced breath. DXR image file was converted to the videos with different frames per second (fps): 15 fps, 7.5 fps, five fps, three fps, and 1.5 fps. Pixel-value gradient was calculated by the serial change of pixel value, which was subsequently converted mathematically to motion vector using OFM. Color-coding map and vector projection into horizontal and vertical components were also tested. Results: Dynamic motion of lung and thorax was clearly visualized using VF-DXR with an optimal frame rate of 5 fps. Color-coding map and vector projection into horizontal and vertical components were also presented. VF-DXR technique was also applied in COPD patients. Conclusion: The feasibility of VF-DXR was demonstrated with small number of healthy subjects and COPD patients. Advances in knowledge: A new Vector-Field Dynamic X-ray (VF-DXR) technique is feasible for dynamic visualization of lung, diaphragms, thoracic cage, and cardiac contour.

Transcranial static magnetic stimulation (tSMS) has been focused as a new non-invasive brain stimulation, which can suppress the human cortical excitability just below the magnet. However, the non-regional effects of tSMS via brain network have been rarely studied so far. We investigated whether tSMS over the left primary motor cortex (M1) can facilitate the right M1 in healthy subjects, based on the hypothesis that the functional suppression of M1 can cause the paradoxical functional facilitation of the contralateral M1 via the reduction of interhemispheric inhibition (IHI) between the bilateral M1. This study was double-blind crossover trial. We measured the corticospinal excitability in both M1 and IHI from the left to right M1 by recording motor evoked potentials from first dorsal interosseous muscles using single-pulse and paired-pulse transcranial magnetic stimulation before and after the tSMS intervention for 30 min. We found that the corticospinal excitability of the left M1 decreased, while that of the right M1 increased after tSMS. Moreover, the evaluation of IHI revealed the reduced inhibition from the left to the right M1. Our findings provide new insights on the mechanistic understanding of neuromodulatory effects of tSMS in human.

Background Methotrexate (MTX) is a frequently used drug in the treatment of rheumatoid arthritis (RA), but occurrences of lymphoproliferative disorders (LPD) have been reported in patients undergoing an MTX regimen. Almost half of the patients with methotrexate-associated lymphoproliferative disorders (MTX-LPD) have extranodal lesions; moreover, although extremely rare, digestive tract perforations resulting from the extranodal lesions of MTX-LPD have also been reported. Case presentation We describe the case of an 81-year-old woman with RA who had been prescribed MTX at 6 mg per week for the past 11 years. She was admitted to our hospital with occasional abdominal pain and was first diagnosed with enteritis. Her abdominal pain did not improve, and a computed tomography scan showed abdominal effusion and free air in the abdominal cavity. She was diagnosed with a digestive tract perforation and underwent emergency surgery. The perforation site was identified in the jejunum, and she underwent small intestinal resection around the perforated region. The pathological findings showed an ulcer in the jejunum and infiltration of large atypical lymphocytes around the perforated region. An immunohistochemical examination revealed the expression of a cluster of differentiation 20 and latent membrane protein 1. Considering the patient’s history of RA treated with MTX, she was diagnosed as having Epstein–Barr virus (EBV)-related MTX-LPD with a histological diagnosis of EBVMCU. MTX was discontinued after the surgery, and her soluble interleukin-2 receptor (sIL-2R) levels had returned to normal 1 year later. She has had a good course for the 2 years since surgery and remains asymptomatic with no recurrence of MTX-LPD, as confirmed by the sIL-2R levels. Conclusion We experienced a rare case of the jejunum perforation induced by MTX-LPD. Since only a few cases have been reported of a patient with small intestinal perforation induced by MTX-LPD, further research is necessary to evaluate the clinicopathological features of MTX-LPD. The patient had disease remission after surgery and by discontinuing MTX treatment; our case did not require chemotherapy. EBV-positive patients, especially those with a pathological presentation of EBVMCU, could have a higher likelihood of remission, which could have been a factor in the present case.

Background: Elderly people are posing a significant health burden in our country for their multi morbidity as economic growth has increased our life expectancy. Pattern of multi morbidity of this older people varies according to geography, ethnicity, culture and life style. Aim: The aim of this study was to identify the prevalence and pattern of multi morbidity of elderly patients admitted in a tertiary care hospital. Method: 50 random cases of elderly patients aged more than 60 years admitted in medicine and allied wards of Dhaka medical college hospital were observed at this cross-sectional study from January 2017 to June 2017(total 6 months period). Data were reviewed and analyzed using simple frequency and percentage. Protocol was reviewed by institutional ethical board (IRB) of Dhaka medical college hospital. Result: A total number of 50 elderly patients with age ranging from 60 to 95 years were observed with male and female ratio 1.3:1 having multi morbidity among 92.0% patients and female is more affected than male. Hypertension, ischemic heart disease, diabetes mellitus and stroke were found most common diseases as individual. Hypertension and diabetes mellitus was found as the most common multi morbidity pattern followed by hypertension and IHD, stroke & diabetes mellitus. Conclusion: This study sheds light on priority needs of elderly patients in terms of medical facility in tertiary care hospital of Bangladesh. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 56-59

Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

Complex abdominal wall reconstruction is challenging, and vascularized fascia is preferred for active infection cases. Pedicled tensor fascia lata flap is commonly used for lower abdominal wall reconstruction, and free vascularized fascial flap based on the lateral circumflex femoral artery (LCFA) is used for upper abdominal wall reconstruction. However, LCFA-based flap transfer requires invasive and time-consuming muscle dissection and a large recipient vessel. The purpose of this report was to present a new application of superficial circumflex iliac artery (SCIA) perforator (SCIP)-based fascial flap for upper abdominal wall reconstruction. A 70-year-old male suffered from a long-lasting extensive abdominal wall herniation complicated with mesh infection and cutaneous fistulae following multiple herniation repair with synthetic mesh. After complete debridement of infected tissues, there was a 29 x 26 cm full-thickness abdominal wall defect. Components separation was performed to minimize the defect size, after which 12 x 7 cm defect remained in the upper abdominal wall. A 20 x 10 cm SCIP deep fascial flap was elevated based on the deep branch of the SCIA. The SCIP flap was transferred to the defect to reconstruct the upper abdominal wall. The SCIP was anastomosed to the deep inferior epigastric artery perforator with supermicrosurgical perforator-to-perforator anastomosis. Postoperative course was uneventful with good functional and esthetic results of the donor and recipient sites 11 months after the surgery. Although further studies are required, SCIP fascial flap may be an option for upper abdominal wall reconstruction.

Background: The news regarding the successful treatment of uncured diseases is extremely exciting. Recently, the study of stem cells has been widely considered. Objectives: The stem cells have the potential to be converted to all specialized functional cells. Methods: Advances in cell engineering and genetic reprogramming of the stem cells have contributed to novel approaches that may bring hope to HIV and cancer patients. Results: In this regard, HIV patients recently received a stem-cell transplant that replaced their white blood cells with HIV-resistant versions (obtained from stem cells). However, only a few clinically successful approaches are available on new stem cells. Conclusion: This review includes two parts; in the first section, the reader can obtain a basic idea about stem cells, whereas the second part emphasizes new opportunities and directions in translating stem cells basic research to the clinical applications.

Cancer remains one of the most deadly diseases globally, but carbon-based nanomaterials have the potential to revolutionize cancer diagnosis and therapy. Advances in nanotechnology and a better understanding of tumor microenvironments have contributed to novel nanotargeting routes that may bring new hope to cancer patients. Several low-dimensional carbon-based nanomaterials have shown promising preclinical results; as such, low-dimensional carbon dots (CDs) and their derivatives are considered up-and-coming candidates for cancer treatment. The unique properties of carbon-based nanomaterials are high surface area to volume ratio, chemical inertness, biocompatibility, and low cytotoxicity. It makes them well suited for delivering chemotherapeutics in cancer treatment and diagnosis. Recent studies have shown that the CDs are potential applicants in biomedical sciences, both as nanocarriers and nanotransducers. This review covers the most commonly used CD nanoparticles in nanomedicines intended for the early diagnosis and therapy of cancer.

Background Management of diminutive pharyngeal neoplasms is controversial. Thus, we conducted a single-center, prospective pilot study to investigate the efficacy and safety of endoscopic excision with cold forceps biopsy (CFB) of these lesions. Patients and methods Thirty-nine lesions endoscopically diagnosed with narrow-band imaging as pharyngeal neoplasms of 3 mm or smaller were excised with CFB using jumbo biopsy forceps (cap diameter 2.8 mm, jaw volume 12.4 mm3 ). The primary outcome was endoscopically determined local remnant/recurrence rate 3 months after CFB. The secondary outcomes were histopathologically determined local remnant/recurrence rate; risk factors associated with the endoscopic remnant/recurrence; and incidence of intraoperative or delayed bleeding and other adverse events. Results Histological diagnosis of the 39 CFB-excised lesions were: 11 high-grade dysplasia (28.2%), 22 low-grade dysplasia (56.4%), two basal cell hyperplasia (5.1%) and four atypical squamous epithelium (10.3%).Twenty-seven patients (30 lesions) underwent follow-up endoscopy 3 months after CFB; the endoscopic and pathological local remnant/recurrence rate was 20% (6/30; 95% confidence interval (CI), 7.7-36.6%) and 16.7% (5/30; 95% CI, 5.6-34.7%), respectively. Location of the lesion in the hypopharynx was a significant risk factor associated with the endoscopic local remnant/recurrence (P = 0.049). No significant adverse events occurred. Conclusions Cold forceps biopsy with jumbo biopsy forceps appears to be a safe and effective technique for excising diminutive pharyngeal neoplasms. Although small, the excised lesions may have a remarkably high frequency of high-grade dysplasia. (Clinical trial registration number: UMIN000037980).

Ectopic intrapulmonary thyroid tissue is extremely rare and considerably difficult to diagnose without surgery. Ectopic thyroid tissue, described as a mediastinal tumor, and intrapulmonary lesions are infrequent. An abnormal shadow was detected upon chest X-ray in a 60-year old woman with a history of benign thyroid goiter. A computed tomography scan revealed a solitary nodule measuring 27 mm in diameter in the left lower lobe, the diameter of which had increased by 5 mm since initial observation eight years ago. A thoracoscopic wedge resection was performed and the lesion was determined to be a non-invasive, soft-tissue tumor. It was pathologically diagnosed as an ectopic thyroid follicular adenoma. The course of the tumor was uneventful. A diagnosis of ectopic intrapulmonary thyroid should be made cautiously and only after ruling out metastasis of a follicular adenoma or thyroid carcinoma. This diagnosis of ectopic thyroid tissue was made possible by the surgical approach.

Mycobacterium abscessus (M. abscessus) infection is resistant to multi-antibacterial treatment, and surgical resection is often recommended. We report a case of M. abscessus infection in a young patient suspected of having a GATA2 mutation. A 19-year-old woman with a medical history of severe sinusitis and a family history of non-tuberculous mycobacteriosis presented at our hospital. M. abscessus was confirmed by sputum culture. The patient received multidrug therapy, including clarithromycin. CT scan demonstrated bronchodilation and capacity decrease due to non-obstructive atelectasis in the middle lobe. We performed thoracoscopic resection without complications. Congenital immunodeficiency was suspected given the patient's past medical and family history. The result of lymphocyte subset analysis revealed a GATA2 mutation, but no genetic mutation was detected by a next-generation sequencer. The patient followed a good clinical course. This paper reports the successful treatment of an M. abscessus infection and the importance of checking the genetic background of young patients.

Introduction Sarcopenia, a condition characterized by decreased skeletal muscle mass, has increasingly been attracting attention in Japan, which has an aged society. The association between chronic low back pain (CLBP) and muscle mass is important. This study aimed to investigate the effect of exercise therapy for CLBP with or without sarcopenia. Methods This study was a prospective cohort study. Patients who were aged >65 years during 2017-2018 and had CLBP, with pain lasting >12 weeks and pain intensity being ≥3, were included in the study. The patients were divided into two groups: sarcopenia (S) and nonsarcopenia (NS) groups. The numerical rating scale (NRS) for pain intensity, Roland-Morris Disability Questionnaire (RMDQ), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Hospital Anxiety and Depression Scale (HADS), trunk muscle strength, a European Quality of Life instrument, and an NRS of treatment satisfaction were assessed. All patients underwent a high-intensity exercise therapy during 2 weeks of hospitalization and were followed up for 1 and 3 months. Results Twenty-eight patients with CLBP were included. The prevalence rate of sarcopenia was 42.9%. The NRS and RMDQ scores and gait function were clinically improved at the end points in all patients with or without sarcopenia. Moreover, high treatment satisfaction was achieved. The quality of life, treatment satisfaction, psychological disorder subscale score of the JOABPEQ, and HADS score tended to be lower in the S group than in the NS group. Conclusions Our short-term exercise therapy was effective for low back pain, disability, and gait disturbance in elderly patients with CLBP with or without sarcopenia. However, the prevalence of sarcopenia was high in elderly patients with CLBP. Although low back pain and disability in patients in the S group were improved by exercise therapy, their quality of life and treatment satisfaction might be lower than those of patients without sarcopenia.

BACKGROUND: Vitamin D metabolites support innate immune responses to Mycobacterium tuberculosis. Data from phase 3, randomized, controlled trials of vitamin D supplementation to prevent tuberculosis infection are lacking. METHODS: We randomly assigned children who had negative results for M. tuberculosis infection according to the QuantiFERON-TB Gold In-Tube assay (QFT) to receive a weekly oral dose of either 14,000 IU of vitamin D(3) or placebo for 3 years. The primary outcome was a positive QFT result at the 3-year follow-up, expressed as a proportion of children. Secondary outcomes included the serum 25-hydroxyvitamin D (25[OH]D) level at the end of the trial and the incidence of tuberculosis disease, acute respiratory infection, and adverse events. RESULTS: A total of 8851 children underwent randomization: 4418 were assigned to the vitamin D group, and 4433 to the placebo group; 95.6% of children had a baseline serum 25(OH)D level of less than 20 ng per milliliter. Among children with a valid QFT result at the end of the trial, the percentage with a positive result was 3.6% (147 of 4074 children) in the vitamin D group and 3.3% (134 of 4043) in the placebo group (adjusted risk ratio, 1.10; 95% confidence interval [CI], 0.87 to 1.38; P = 0.42). The mean 25(OH)D level at the end of the trial was 31.0 ng per milliliter in the vitamin D group and 10.7 ng per milliliter in the placebo group (mean between-group difference, 20.3 ng per milliliter; 95% CI, 19.9 to 20.6). Tuberculosis disease was diagnosed in 21 children in the vitamin D group and in 25 children in the placebo group (adjusted risk ratio, 0.87; 95% CI, 0.49 to 1.55). A total of 29 children in the vitamin D group and 34 in the placebo group were hospitalized for treatment of acute respiratory infection (adjusted risk ratio, 0.86; 95% CI, 0.52 to 1.40). The incidence of adverse events did not differ significantly between the two groups. CONCLUSIONS: Vitamin D supplementation did not result in a lower risk of tuberculosis infection, tuberculosis disease, or acute respiratory infection than placebo among vitamin D–deficient schoolchildren in Mongolia. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02276755.)

The realization of molecular devices via metal–molecule–metal junctions necessitates the fabrication of a steady molecular bridging structure, where the number of bridging structures should be fixe...

Objective To propose a method for intraoperative mapping and monitoring of the medial frontal motor areas (MFMA). Methods We estimated the location of the MFMA using the corticocortical evoked potential (CCEP) provoked by electric stimuli to the primary motor area (M1) of the upper limb. We localized or defined the MFMA by recording the motor evoked potentials (MEPs) provoked by electric stimuli to the medial frontal cortex around the estimated area. We monitored the patients' motor function during awake craniotomy and sequentially recorded the MEPs of the upper and/or lower limbs. This method was applied to 8 patients. Results Four patients who had part of the areas identified as the MFMA removed showed transient hemiparesis postoperatively (supplementary motor area [SMA] syndrome). The MEP from the M1 was preserved in the 4 patients. The resection of the identified MFMA might have caused their SMA syndrome. The CCEP showed a strong connection between the M1 and the SMA of the upper limb. Our method did not provoke any seizures. Conclusions This is a safe and sensitive method for intraoperative mapping and monitoring of the MFMA by combining electrophysiologic monitoring and awake craniotomy. It is clinically useful for mapping the MFMA and can prevent permanent motor deficits.

Electron transport experiments for molecular devices have been evaluated by using single-molecule bridging nano- and/or sub-nanoscale junctions between two metallic electrodes. Thus, although sever...

Objective: Chemotherapy is generally recommended as the first-line standard treatment in patients with liver metastasis from gastric cancer. However, the clinical impact of surgical treatment remains unclear in responders after chemotherapy. The present study aimed to investigate the tumor response and prognosis after chemotherapy and to assess the clinical indication of conversion surgery in responders. Methods: The study retrospectively reviewed the clinical data of 44 patients with liver metastasis from gastric cancer who were treated with chemotherapy between February 2002 and January 2019. These patients were classified into progressive disease (PD) and non-PD groups according to tumor response. Results: Among the 44 patients, 7 and 26 had peritoneal dissemination and ≥5 had metastatic liver nodules. Additionally, 15 and 29 patients had PD and non-PD, respectively. Surgical treatment was significantly correlated with tumor response (p < 0.0321). Prognostic differences between the PD and non-PD groups were significant (p < 0.0001). Moreover, gastrectomy and hepatectomy were significantly correlated with the number of liver metastases (≥5 vs. p = 0.0025 and p = 0.0169, respectively). The 3-year survival rates among patients with non-PD undergoing both gastrectomy and hepatectomy (n = 6), gastrectomy alone (n = 7), and nonsurgical treatments (n = 16) were 100, 66.7, and 0%, respectively (p = 0.0026). Multivariate analysis identified peritoneal dissemination as an independent prognostic factor (p = 0.0225). Conclusion: Our preliminary results suggest that conversion surgery for gastric cancer with liver metastasis might be clinically indicated in chemotherapy responders with

We report on a highly sensitive gallium nitride (GaN) micro-electromechanical (MEMS) resonator with a record quality factor (Q) exceeding 105 at the high resonant frequency (f) of 911 kHz by the strain engineering for the GaN-on-Si structure. The f of the double-clamped GaN beam bridge is increased from 139 to 911 kHz when the tensile stress is increased to 640 MPa. Although it is usually regarded that the energy dissipation increases with increasing resonant frequency, an ultra-high Q-factor which is more than two orders of magnitude higher than those of the other reported GaN-based MEMS is obtained. The high Q-factor results from the large tensile stress which can be intentionally introduced and engineered in the GaN epitaxial layer by utilizing the lattice mismatch between GaN and Si, leading to the stored elastic energy and drastically decreasing the energy dissipation. The developed GaN MEMS is further demonstrated as a highly sensitive mass sensor with a resolution of 10���12 g/s through detecting the microdroplet evaporation process. This work provides an avenue to improve the f �� Q product of the MEMS through an internally strained structure.

Objective: Although chemotherapy has been clinically recommended as the initial treatment for patients with peritoneal dissemination of gastric cancer, poor prognosis has been noted among the same patients. However, the prognostic significance of conversion surgery after chemotherapy remains unclear. The present study therefore aimed to assess the clinical impact of conversion surgery among patients with peritoneal dissemination of gastric cancer. Methods: A total of 93 patients with peritoneal dissemination of gastric cancer undergoing chemotherapy between February 2002 and October 2019 were retrospectively enrolled and subsequently divided into progressive disease (PD) and non-PD groups based on tumor response to chemotherapy. Results: Among the included patients, 17 developed distant metastases at another site besides peritoneal dissemination. Based on tumor response, 24 and 69 patients were determined to have PD and non-PD, respectively, with the former having significantly poorer prognosis than the latter (p < 0.0001). A total of 19 patients underwent conversion surgery after chemotherapy, with the presence or absence of conversion surgery being significantly correlated with age, first-line chemotherapy regimen, and tumor response (p = 0.0134, p = 0.0337, and p = 0.0024, respectively). Patients in the non-PD group who underwent conversion surgery or chemotherapy alone had 3-year overall survival rates of 55.6 and 6.6%, respectively. Multivariate analysis identified conversion surgery alone as an independent prognostic factor in the non-PD group (p < 0.0001). Conclusion: Our retrospective study demonstrated that conversion surgery for gastric cancer with peritoneal dissemination might improve the prognosis of responders who developed no peritoneal dissemination after chemotherapy.

ObjectiveTo estimate the proportion of SARS-CoV-2 and influenza virus coinfection among severe acute respiratory infection (SARI) cases-patients during the first wave of COVID-19 pandemic in Bangladesh.DesignDescriptive study.SettingNine tertiary level hospitals across Bangladesh.ParticipantsPatients admitted as SARI (defined as cases with subjective or measured fever of ≥38 C° and cough with onset within the last 10 days and requiring hospital admission) case-patients.Primary and secondary outcomesProportion of SARS-CoV-2 and influenza virus coinfection and proportion of mortality among SARI case-patients.ResultsWe enrolled 1986 SARI case-patients with a median age: 28 years (IQR: 1.2–53 years), and 67.6% were male. Among them, 285 (14.3%) were infected with SARS-CoV-2; 175 (8.8%) were infected with the influenza virus, and five (0.3%) were coinfected with both viruses. There was a non-appearance of influenza during the usual peak season (May to July) in Bangladesh. SARS-CoV-2 infection was significantly more associated with diabetes (14.0% vs 5.9%, pConclusionsOur findings suggest that coinfection with SARS-CoV-2 and influenza virus was not very common and had less disease severity considering mortality in Bangladesh. There was no circulating influenza virus during the influenza peak season during the COVID-19 pandemic in 2020. Future studies are warranted for further exploration.

We assessed the development of lymphopenia during concurrent chemoradiotherapy (CRT) using X-ray versus proton beams and the impact on survival in patients with esophageal cancer. Among patients with esophageal cancer who were administered concurrent CRT with a curative intent at our institute from 2014 to 2018, 69 (15 receiving X-ray radiotherapy (XRT) and 54 receiving proton beam therapy [PBT]) who underwent weekly blood testing during treatment were enrolled. The absolute lymphocyte counts (ALC) at 1, 5 and 6 weeks were significantly higher in the patients who received PBT than in those who received XRT (p = 0.002, p = 0.006 and p = 0.009, respectively), and a similar trend in the neutrophil-to-lymphocyte ratio (NLR) was observed (p = 0.003 at 5 weeks). The 2-year overall survival (OS) and progression-free survival (PFS) rates tended to be higher in the patients who maintained an ALC ≥200 compared with those who did not (p = 0.083 and p = 0.053, respectively), and similar trends were observed in the NLR (p = 0.061 and p = 0.038, respectively). Dose–volume analysis revealed significant correlations between volumes of the thoracic bones irradiated by 5–50 Gy and minimum ALCs and maximum NLR. These findings suggested that PBT prevented the development of lymphopenia during CRT by reducing the irradiated volume of the thoracic bone, and the maintained lymphocyte count is possibly one of the early predictors for survival in patients with esophageal cancer.

Lateral lumbar interbody fusion (LLIF) is increasingly performed as corrective surgery for patients with adult spinal deformity (ASD). This paper compares the surgical results of LLIF and conventional posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) in ASD using a propensity score matching analysis. We retrospectively reviewed patients with ASD who received LLIF and PLIF/TLIF, and investigated patients’ backgrounds, radiographic parameters, and complications. The propensity scores were calculated from patients’ characteristics, including radiographic parameters and preoperative comorbidities, and one–to-one matching was performed. Propensity score matching produced 21 matched pairs of patients who underwent LLIF and PLIF/TLIF. All radiographic parameters significantly improved in both groups at the final follow-up compared with those of the preoperative period. The comparison between both groups demonstrated no significant difference in terms of postoperative pelvic tilt, lumbar lordosis (LL), or pelvic incidence–LL at the final follow-up. However, the sagittal vertical axis tended to be smaller in the LLIF at the final follow-up. Overall, perioperative and late complications were comparable in both procedures. However, LLIF procedures demonstrated significantly less intraoperative blood loss and a smaller incidence of postoperative epidural hematoma compared with PLIF/TLIF procedures in patients with ASD.

Bronchial atresia is a rare congenital condition that may lead to infectious complications. Almost all patients with this condition are diagnosed early in life with normal lungs, making them particularly suitable candidates for thoracoscopic surgery. A 30-year-old man was referred to our hospital due to an abnormal shadow on chest radiography taken 7 years prior. Despite being diagnosed with B5 bronchial atresia, he refused to undergo surgical resection. Seven years later, he developed right chest pain. Computed tomography showed B5 bronchial occlusion, mucoid impaction and emphysematous changes. Treatment with thoracoscopic right middle lobectomy and S3 partial resection using four ports resulted in good lung expansion after discharge. This study highlights that thoracoscopic surgical resection should be considered in patients with bronchial atresia.

In a number of circumstances, the Kachanov–Rabotnov isotropic creep damage constitutive model has been utilized to assess the creep deformation of high-temperature components. Secondary creep behavior is usually studied using analytical methods, whereas tertiary creep damage constants are determined by the combination of experiments and numerical optimization. To obtain the tertiary creep damage constants, these methods necessitate extensive computational effort and time to determine the tertiary creep damage constants. In this study, a curve-fitting technique was proposed for applying the Kachanov–Rabotnov model into the built-in Norton–Bailey model in Abaqus. It extrapolates the creep behaviour by fitting the Kachanov–Rabotnov model to the limited creep data obtained from the Omega-Norton–Bailey regression model and then simulates beyond the available data points. Through the Omega creep model, several creep strain rates for SS-316 were calculated using API-579/ASME FFS-1 standards. These are dependent on the type of the material, the flow stress, and the temperature. In the present work, FEA creep assessment was carried out on the SS-316 dog bone specimen, which was used as a material coupon to forecast time-dependent permanent plastic deformation as well as creep behavior at elevated temperatures and under uniform stress. The model was validated with the help of published experimental creep test data, and data optimization for sensitivity study was conducted by applying response surface methodology (RSM) and ANOVA techniques. The results showed that the specimen underwent secondary creep deformation for most of the analysis period. Hence, the method is useful in predicting the complete creep behavior of the material and in generating a creep curve.

Different vaccines for SARS-CoV-2 are approved in various countries, but few direct comparisons of the antibody responses they stimulate have been reported. We collected plasma specimens in July 2021 from 196 Mongolian participants fully vaccinated with one of four Covid vaccines: Pfizer/BioNTech, AstraZeneca, Sputnik V and Sinopharm. Functional antibody testing with a panel of nine SARS-CoV-2 viral variant RBD proteins reveal marked differences in the vaccine responses, with low antibody levels and RBD-ACE2 blocking activity stimulated by the Sinopharm and Sputnik V vaccines in comparison to the AstraZeneca or Pfizer/BioNTech vaccines. The Alpha variant caused 97% of infections in Mongolia in June and early July 2021. Individuals who recover from SARS-CoV-2 infection after vaccination achieve high antibody titers in most cases. These data suggest that public health interventions such as vaccine boosting, potentially with more potent vaccine types, may be needed to control the COVID-19 pandemic in Mongolia and worldwide.

Tuberculoma is a manifestation of pleural tuberculosis. Although the clinical manifestation of tuberculoma has been widely reported, the pathogenesis of this condition still remains unclear. An abnormal shadow was detected on the chest radiograph of a 44-year-old man with a history of pulmonary tuberculosis. Computed tomography revealed a well-defined, elliptical 44 mm nodule located in the right posterior thoracic cavity. Thoracoscopic surgery was performed to rule out malignant tumors. Although loose adhesions were observed throughout the thoracic cavity, a nodule was found between the visceral pleura and parietal pleura. En bloc resection was performed, and the patient was pathologically diagnosed with tuberculoma. An acid-fast bacterium culture was negative, and the patient’s recovery was uneventful without chemotherapy. Surgical resection should be considered to rule out malignancy, because tuberculomas are difficult to distinguish from malignant pleural tumors.

Background: The association between childhood food deprivation (FD) and health in later life has been extensively studied, however, studies on the association between childhood food deprivation and frailty are scarce. This study assessed the associations between childhood FD and the risk of frailty at middle-age and old age. Methods: Three waves of the China Health and Retirement Longitudinal Study (CHARLS), including 11,615 individuals aged over 45 years, were used for this research. Frailty was operationalized according to the FRAIL scale as a sum of fatigue, resistance, ambulation, illness, and the loss of weight. Childhood FD experiences and levels were measured by self-reported FD and historical content. Logistic mixed-effects models and proportional odds ordered logistic regression models were used to analyse the association between childhood FD and frailty. Findings: Childhood FD increased the odds of frailty at old age (1.30, 95% CI: 1.26–1.36). Compared with subjects with mild FD, those with extreme FD experiences had increased risks of frailty (1.34, 95% CI: 1.26–1.43). Subjects exposed to hunger at different ages all had an increased risk of frailty, and subjects who had FD during ages 6–12 (1.15, 95% CI: 1.09–1.22) were more likely to have an increased risk of frailty than those who had experienced FD in younger ages. The interaction of experience of FD at ages 0–6 and the experience of FD at ages 6–12 is not statistically significant after adjusting all covariates. Conclusions: Our findings suggest that childhood FD exerts long-lasting effects on frailty among older adults in China. The prevention of childhood FD may delay or even avert the emergence of frailty in people of middle-age and old age.

Polycystic Ovary Syndrome is mainly metabolic and reproductive endocrinopathy and an extremely complicated disorder among women. It causes hormonal imbalance, menstruation problems, hair loss, facial acne, facial pimple, dark skin, diabetics, overweight etc. Early detection is important for getting the curation for PCOS. Early detection brings early prevention. In our paper, we were able to collect 550 data of Bangladeshi women. Out of them, 462 are affected by this disorder. We have highlighted common symptoms of PCOS Bangladesh women and it's effect on women. We have used machine learning methods like Random Forest, Naive Bayes Classification, Decision Tree Classification, Super Vector Machine Learning, K-nearest Neighbor, Logistic Regression, XGBoost Classifier, Gradient Boosting Classifier to detect PCOS and comparing which algorithms work best for detecting the PCOS based on our real datasets. Also choose the best model on our real time dataset. We analyze our data set and find out the accuracy, confusion matrix, f1-score, cross validation, recall, precision, support. Among all classification SVM has the highest accuracy. The accuracy of the Super Vector Machine Learning is 99.09%.

The use of Eye Tracking (ET) has been investigated as an auxiliary mechanism to diagnose Autism Spectrum Disorder (ASD). One of the paradigms investigated using ET is Joint Attention (JA), which refers to moments when two individuals are focused on the same object/event so that both are aware that the focus of attention is shared. The computational tools that assist in the diagnosis of ASD have used Image Processing and Machine Learning techniques to process images, videos and ET signals. However, the JA paradigm is still little explored and presents challenges, as it requires analyzing the gaze trajectory and needs innovative approaches. The purpose of this article is to propose a model capable of extracting features from a video used as a stimulus to capture ET signals in order to verify JA and classify individuals as belonging to the ASD or Typical Development (TD) group. The main differential in relation to the approaches in the literature is the definition and implementation of the concept of floating Regions of Interest, which allows monitoring the gaze in relation to an object, considering its semantics, even if the object presents different characteristics throughout the video. A model based on ensembles of Random Forest classifiers was implemented to classify individuals as ASD or TD using the trajectory features extracted from the ET signals. The method reached 0.75 accuracy and 0.82 F1-score, indicating that the proposed approach, based on trajectory and JA, has the potential to be applied to assist in the diagnosis of ASD.

This chapter introduces approaches of electronic travel (walking) aid (ETA) interface for visual information deficit and gives discussions on the high integrity design concept under restrictions of visualtactile sensational characteristics in substitution process. Here, we start from the concept formulation of ETA. The concept of ETA human interface is based on the sensory substitution between visual and tactile sensation. If human has lost the visual information caused by some sort of environment interference or physical troubles, this ETA assist the subjects to obstacle avoidance self-walking with transferring some environment information (depth, image, object and so on). Since the first prototype ETA model of TVSS (Tactile Vision Substitution System) in early 1960’s, enormous number of research and commercial instruments are developed with visual sensory substitution. Some of these models are still available in markets with improvements (e.g. sonic torch/guide, MOWAT sensor and so on.). The user with visually impaired using these devices claimed on the difficult understanding at complex environment like in crowds and ‘sensory overload’ in use as complexity of understanding, inhibition to other sensory function.

It is controversial whether lumbar spinal stenosis (LSS) itself contributes to low back pain (LBP). Lower truncal skeletal muscle mass, spinopelvic malalignment, intervertebral disc degeneration, and endplate abnormalities are thought to be related to LBP. However, whether these factors cause LBP in patients with LSS is unclear.To identify factors associated with LBP in patients with LSS.Cross-sectional design.A total of 260 patients (119 men and 141 women, average age 72.8 years) with neurogenic claudication caused by LSS, as confirmed by magnetic resonance imaging (MRI).Ratings of LBP, buttock and leg pain, and numbness on a numerical rating scale (NRS), 36-Item Short Form Survey (SF-36) scores, muscle mass measured by bioelectrical impedance analysis, and radiographic measurements including slippage and lumbopelvic alignment. The severity of LSS, endplate defects, Modic endplate changes, intervertebral disc degeneration, and facet joint osteoarthritis were assessed on MRI.The presence of LBP was defined as an NRS score ≥3. The demographic data, patient-reported outcomes, and radiological and MRI findings were compared between patients with and without LBP. Multivariate logistic regression analysis was used to identify the factors that were independently associated with the presence of LBP.There were significant differences between patients with and without LBP for buttock and leg pain and numbness on the NRS, general health on the SF-36, presence of endplate defects, presence of Modic changes, disc degeneration grading, and disc height grading (all p.05). Multivariate logistic regression analysis showed significant associations between LBP and diabetes (OR 2.43; 95% CI 1.07-5.53), buttock and leg numbness on the NRS (OR 1.34; 95% CI 1.17-1.52), general health on the SF-36 (OR 0.97; 95% CI 0.95-0.99), and the presence of erosive endplate defects (OR 3.04; 95% CI 1.51-6.11) (all p.05).These results suggest that LBP in patients with LSS should be carefully assessed not only for spinal stenosis but also clinical factors and endplate defects.