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Background and Objectives: Permanent magnet synchronous motors (PMSM) have received much attention due to their high torque as well as low noise values. However, several PI blocks are needed for field, torque, and speed control of the PMSM which complicates controller design in the vector control approach. To cope with these issues, a novel analytical approach for time-response shaping of the Pi controller in the filed oriented control (FOC) of the PMSM is presented in this manuscript. In the proposed method, it is possible to design the controlling loops based on the pre-defined dynamic responses of the motor speed and currents in dq axis. It should be noted that as decoupled model of the motor is employed in the controller development, a closed loop system has a linear model and hence, designed PI controllers are able to stabilize the PMSM in a wide range of operation. Methods: To design the controllers and choose PI gains, characteristic of the closed loop response is formulated analytically. According to pre-defined dynamic responses of the motor speed and currents in dq-axis e.g., desired maximum overshoot and rise-time values, gains of the controllers are calculated analytically. As extracted equation set of the controller tuning includes a nonlinear term, the Newton-Raphson numerical approach is employed for calculation of the nonlinear equation set. In addition, designed system is evaluated under different tests, such as step changes of the references. Finally, it should be noted that as the decoupled models are employed for the PMSM system, hence exact closed loop behavior of the closed loop system can be expressed via a linear model. As a result, stability of the proposed approach can be guaranteed in the whole operational range of the system. Results: Controlling loops of the closed loop system are designed for speed control of the PMSM. To evaluate accuracy and effectiveness of the controllers, it has been simulated using MATLAB/Simulink software. Moreover, the TMS320F28335 digital signal processor (DSP) from Texas Instruments is used for experimental investigation of the controllers. Conclusion: Considering the simulation and practical results, it is shown that the proposed analytical approach is able to select the controlling gains with negligible error. It has shown that the proposed approach for rise time and overshoot calculations has at most 0.01% for step response of the motor speed at 500 rpm. [ABSTRACT FROM AUTHOR]

Background and Objective: Retrograde urethrography (RUG) combined with voiding cystourethrography (VCUG) is the most common and preferred imaging modality for evaluating urethral strictures, despite its well-known limitations and disadvantages. In this study, we assessed the clinical relevance of RUG + VCUG, along with intraoperative assessment in measuring male urethral strictures., Method: This study was a single-center retrospective study involving 134 male patients diagnosed with urethral stricture disease. All participants underwent RUG + VCUG before the intervention, and the results were interpreted by a single radiologist. The location and length of urethral strictures were assessed. The accuracy of urethral stricture measurements obtained from combined VCUG and RUG imaging was compared to intraoperative measurements, which served as the reference standard. Urethral strictures were classified into three types: membranous and bulbomembranous, bulbar, and penile., Results: A total of 130 patients were included (38.14 ± 12.05 years) in the study. For patients with membranous and bulbar strictures, there were statistically significant differences in stricture length measurements between VCUG + RUG and surgical evaluation ( p  < 0.05). However, for patients with penile strictures, the differences in stricture length measurements between VCUG + RUG and surgical evaluation were not statistically significant ( p  = 0.448)., Conclusion: This study suggests that RUG + VCUG may underestimate urethral stricture, particularly in the membranous and bulbar regions., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Spermatogonial stem cells (SSCs) maintain spermatogenesis through self-renewal and differentiation. The proliferation of SSCs in culture systems can provide a valuable source of germ cells. Several studies have investigated new reproductive technologies, including the production of transgenic animals and recombinant proteins secreted from milk in goats. While studies in other species exist, research on goat SSC culture remains limited. We investigated the impact of different testosterone concentrations on the survival and colonisation of cocultured goat SSCs with Sertoli cells. Cells were isolated from immature goats using two-step enzymatic digestion and enriched by differential exclusion method. DMEM/F12 culture medium containing 1% antibiotic and 5% FBS, supplemented with GDNF (20 ng/mL), EGF, bFGF and LIF (10 ng/mL), was used with different testosterone concentrations (0, 60, 120 and 240 μg/mL) and cultured for 10 days. SC subpopulations were confirmed using PGP9.5 immunocytochemistry, and the expression of germ cell markers (ID-4, UCHL-1, THY-1, β1-integrin, BCL6B, VASA, PLZF and OCT-4) was evaluated through RT-PCR. Alkaline phosphatase activity provided additional SSC presence. The survival rate of SSCs after isolation and the number and area of colonies on Days 4, 7 and 10 were measured using an inverted microscope. The presence of PGP 9.5 antigens and germ cell markers (ID-4, UCHL-1, THY-1, β1-integrin, BCL6B, VASA, PLZF and OCT-4) was confirmed by immunocytochemistry and RT-PCR, respectively. According to the results, the group with 60 μg/mL testosterone had the highest number and area of colonies. The number of colonies in the 60 μg/mL testosterone group was significantly higher than the control group (p < 0.05), but no significant difference was observed compared to other groups (p ≥ 0.05). This study suggests that a low testosterone concentration (60 μg/mL) is optimal for goat SSC colonisation and viability in coculture with Sertoli cells, potentially leading to advancements in goat reproductive technologies., (© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.)

The application of Botulinum toxin (Masport) in urology has a long history. We aimed to assess the effect of local Masport on improvement in patients with urethral stricture by reducing the recurrence of urethral stricture. This pilot study conducted was a double-blind randomized clinical trial with code IRCT20191222045852N1 on patients suffering from urethral stricture. Finally, 28 patients were allocated to intervention and control groups. Twelve patients received intralesional injection with Masport in addition to internal urethrotomy, while 16 patients underwent internal urethrotomy with normal saline. The Cox regression hazard model was used to evaluate the effect of treatment status on recurrence time adjusted for the age, length, and location of the stenosis, cause of the stenosis, and history of previous operations. The effect of treatment type was significant at the .05 level. The past medical history and cause of urethral stricture had a significant impact on relapse-free survival. Also, the improvement in the mean score of the EuroQol Visual Analogue Scale (EQ-VAS), International Prostate Symptom Score (IPSS), and Q-max in the group with Masport was significantly different from the group with normal saline. The internal urethrotomy with intralesional injection of Masport has a better survival prognosis than internal urethrotomy with normal saline group. Therefore, the authors suggest that, given this successful initial clinical trial, consideration be given to future studies involving the use of botox in the management of urethral strictures in conjunction with internal urethrotomy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Rape, as an adverse incidence, leads to irreparable complications and consequences in women. Provision of health services to women survivors of rape requires catering for their real needs and identifying current deficits as well as barriers. The present study aimed to explore health system-related needs in women survivors of rape., Methods: In the present qualitative study, the participants consisted of 39 individuals, including 19 women survivors of rape and 20 individuals with work experience in providing services to women survivors of rape. The participants were selected using the purposive sampling method with a maximum variation in Isfahan, Iran. Data were collected through in-depth interviews as well as field notes and were concurrently analyzed via conventional qualitative content analysis method., Results: After analyzing the interviews, the health system-related needs of women survivors of rape were classified into two main categories: 1- The need for efficient medical care services with three sub-categories, namely "receiving services with respect for privacy and confidentiality", "non-judgmental behavior and approach", and "the need to receive empathy and the feeling of not being alone", and 2- The need for desirable conditions and structure to provide services with two sub-categories, namely "the need to receive comprehensive and integrated services", and "establishing specialized centers for providing services to survivors"., Conclusions: Overall, explaining and highlighting the health system-related needs of women survivors of rape could provide a suitable basis for policy-making and planning according to their real needs. Receiving continuous services in separate centers with confidentiality and empathy could reduce the worries and concerns of women survivors of rape and help improve their health., (© 2024. The Author(s).)

Background: Balloon kyphoplasty (BKP) is a method for the management of osteoporotic vertebral body fracture (OVF). However, improvement in back pain (BP) is poor in some patients, also previous reports have not elucidated the exact incidence and risk factors for residual BP after BKP. We clarified the characteristics of residual BP after BKP in patients with OVF., Hypothesis: In this study, we hypothesize that some risk factors may exist for residual BP 2 years after the treatment of OVF with BKP., Patients and Methods: A multicenter cohort study was performed where patients who received BKP within 2 months of OVF injury were followed-up for 2 years. BP at 6 months after surgery and final observation was evaluated by Visual Analog Scale (VAS) score. Patients with a score of 40 mm or more were allocated to the residual BP group, and comparisons between the residual back pain group and the improved group were made for bone density, kyphosis, mobility of the fractured vertebral body, total spinal column alignment, and fracture type (fracture of the posterior element, pedicle fracture, presence or absence of posterior wall damage, etc.). Also, Short Form 36 (SF-36) for physical component summary (PCS) and mental component summary (MCS) at the final follow-up was evaluated in each radiological finding., Results: Of 116 cases, 79 (68%) were followed-up for 2 years. Two years after the BKP, 26 patients (33%) experienced residual BP. Neither age nor sex differed between the groups. In addition, there was no difference in bone mineral density, BKP intervention period (period from onset to BKP), and osteoporosis drug use. However, the preoperative height ratio of the vertebral body was significantly worse in the residual BP group (39.8% vs. 52.1%; p  = 0.007). Two years after the operation, the vertebral body wedge angle was significantly greater in the residual BP group (15.7° vs. 11.9°; p  = 0.042). In the multiple logistic regression model with a preoperative vertebral body height ratio of 50% or less [calculated by receiver operating characteristic (ROC) curve], the adjusted odds ratio for residual BP was 6.58 (95% confidence interval 1.64-26.30; p  = 0.007); similarly, patients with vertebral body height ratio less than 50% had a lower score of SF-36 PCS 24.6 vs. 32.2 p  = 0.08., Conclusion: The incidence of residual BP 2 years after BKP was 33% in the current study. The risk factor for residual BP after BKP was a preoperative vertebral body height ratio of 50% or less, which should be attentively assessed for the selection of a proper treatment scheme and to provide adequate stabilization., Level of Evidence: III., Competing Interests: Conflict of InterestThe authors declare that they have no competing interests., (© Indian Orthopaedics Association 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Venezuelan Equine Encephalitis virus (VEEV) may enter the central nervous system (CNS) within olfactory sensory neurons (OSN) that originate in the nasal cavity after intranasal exposure. While it is known that VEEV has evolved several mechanisms to inhibit type I interferon (IFN) signaling within infected cells, whether this inhibits virologic control during neuroinvasion along OSN has not been studied., Methods: We utilized an established murine model of intranasal infection with VEEV and a repository of scRNAseq data from IFN-treated OSN to assess the cellular targets and IFN signaling responses after VEEV exposure., Results: We found that immature OSN, which express higher levels of the VEEV receptor LDLRAD3 than mature OSN, are the first cells infected by VEEV. Despite rapid VEEV neuroinvasion after intranasal exposure, olfactory neuroepithelium (ONE) and olfactory bulb (OB) IFN responses, as assessed by evaluation of expression of interferon signaling genes (ISG), are delayed for up to 48 h during VEEV neuroinvasion, representing a potential therapeutic window. Indeed, a single intranasal dose of recombinant IFNα triggers early ISG expression in both the nasal cavity and OB. When administered at the time of or early after infection, IFNα treatment delayed onset of sequelae associated with encephalitis and extended survival by several days. VEEV replication after IFN treatment was also transiently suppressed in the ONE, which inhibited subsequent invasion into the CNS., Conclusions: Our results demonstrate a critical and promising first evaluation of intranasal IFNα for the treatment of human encephalitic alphavirus exposures., (© 2024. The Author(s).)

Methamphetamine (MA) abuse is related to risks to the cardiovascular system. The present study aimed to compare the effects of moderate-intensity aerobic training (MIAT) and vitamin E (Vit.E) supplementation on markers of cardiac apoptosis following MA exposure. Fifty-four rats were randomly divided into six groups. CON group did not receive MA, while the others received MA alone or in combination with MIAT, Vit. E, MIAT+Vit E, or paraffin (PAR). These groups received MA incrementally for 23 consecutive days. Vit.E and MIAT+Vit.E groups received vitamin E three times a week for six weeks. MIAT and MIAT+Vit.E groups exercised for 25-40 min. Immunohistochemical and gene expression analyses were performed on the heart tissues. Bax and TGF-β expression was significantly higher, while Bcl-2 and VEGF expression was significantly lower in the MA and PAR groups than in the other groups (p < 0.05). Bcl-2 and VEGF expression was higher, and Bax and TGF-β expression was significantly lower in the MIAT and MIAT+Vit.E groups than in the other groups (p < 0.05). In Vit.E treated groups, Bax and TGF-β expression were lower, and VEGF was higher than that in the MA and PAR groups, but higher than those in the CON, MIAT and MIAT+Vit.E groups. MA increased the expression of Bax and TGF-β, and decreased the expression of Bcl-2 and VEGF, suggesting increased cardiac apoptosis. In contrast, MIAT and Vit.E decreased the expression of Bax and TGF-β, suggesting a reduction in cardiac apoptosis induced by MA.

Economic abuse, in the context of intimate relationships, is a pervasive form of violence that merits further empirical attention. We know from limited research that the rates of economic abuse appear to be high in Iran; however, there is a lack of culturally appropriate measures that can assess the extent to which women experience economic harm as a result of their partners' actions. The present study was conducted with the aims of (a) investigating the psychometric properties of the 14-item Revised Scale of Economic Abuse (SEA2) which was translated into Persian for this study and (b) examining the prevalence of economic abuse among a sample of 371 married housewives in Qazvin, Iran. Confirmatory factor analysis supports the two-factor structure of the SEA2, with the exception of one item. Composite reliability and Cronbach's alpha demonstrated good internal consistency. The average variance extracted method, along with correlations with other financial variables, demonstrated evidence of good convergent validity. Correlations with related, but distinct forms of abuse, support the scale's discriminant validity. Based on the collective findings, this measure can be used as a reliable and valid tool to study economic abuse among Iranian women which, within our sample, appears to be a common phenomenon. Implications for future research and practice are discussed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Background: Rape is a serious global problem linked to long-term physical health complications in women. Women survivors of rape have different needs, the identification of which ensures optimal services and improves their health conditions. This study aimed to explore the needs of women survivors of rape through a narrative review., Materials and Methods: This review was conducted by searching databases of ISI Web of Science, Scopus, Science Direct, Cochrane, PubMed, Scientific Information Database (SID), the Iranian Magazine Database (Magiran), Iranian Research Institute for Information Science and Technology (IranDoc), Iranian Medical Articles Database (IranMedex), and the Google Scholar engine. All English and Persian articles published from January 2000 to August 2022 were searched using the keywords rape, sexual assault, sexual violence, victim, survivor, demands, and needs. Two independent researchers conducted all steps of article extraction and review to avoid possible bias, and a third person reviewed the articles in the case of disagreement between the two researchers. The final related articles were selected and evaluated using a pre-prepared checklist., Results: Out of 112 articles, 26 articles were selected for final evaluation. The needs of women survivors of rape were divided into six categories, including sociocultural, educational, legal and judicial, psychological, spiritual and religious, and healthcare., Conclusions: Women survivors of rape need survivor-centered, culturally appropriate services, necessitating careful planning and policymaking to address health and judicial issues from different dimensions considering their real-world needs., Competing Interests: Nothing to declare., (Copyright: © 2023 Iranian Journal of Nursing and Midwifery Research.)

Background: Rape is one of the principal forms of sexual violence leading to numerous psychological consequences for women. Providing effective psychological services to women survivors of rape requires identifying and considering their real needs. This study aimed to explore the psychological needs of women survivors of rape., Methods: In this exploratory-descriptive qualitative study, the participants consisted of 19 women survivors of rape and 20 people with experience in providing services to survivors of rape, selected via purposive sampling method in Isfahan, Iran. In-depth individual semi-structured interviews and field notes were used to collect data, which were then analyzed using the conventional content analysis method., Results: Based on the analysis of the interviews, the psychological needs of women survivors of rape were classified into three main categories: facing psychological problems, attention to emotional reactions, and the need to accept and adapt to reality., Conclusions: The results revealed that women survivors of rape have different psychological needs. Thus, to meet these needs, supportive and psychological interventions can be considered at both individual and environmental levels. Also, eliminating gender stereotypes affecting the occurrence of rape in the dimensions of Iranian culture can lead to the liberation of the society from the culture of rape., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Due to the negative effects of sexual identity disorder and the lack of attention from family and society, this study aimed to investigate the relationship between Young's Early Maladaptive Schemas (YEMS) and sexual self-confidence and sexual self-efficacy in individuals with gender dysphoria (GD) after surgery., Materials and Methods: This cross-sectional study was performed on 45 individuals with GD undergoing sex reassignment surgery (SRS). Three of YEMS questionnaire (YEMSQ), sexual self-confidence, and sexual self-efficacy were completed., Results: The YEMSQ score had a significant inverse relationship with sexual self-efficacy (correlation = -0.333, P -value = 0.025). In addition, dimensions of emotional deprivation, failure to achieve, dependence/incompetence, vulnerability to harm and Illness, insufficient self-control/self-discipline, and subjugation had an adverse effect on the self-confidence and sexual self-efficacy in these individuals ( P -value <0.05)., Conclusion: According to the results of this study, YEMSQ score, sexual self-confidence, and self-efficacy were not significantly different between the two groups of male-to-female (MF) and female-to-male (FM). Also, the formation or development of these schemas in childhood in these individuals can be influential in reducing their sexual self-efficacy., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Advanced Biomedical Research.)

Background: Rape can lead to various physical and psychological consequences. Thus, survivors should receive immediate interventions and need-based care. The present study aims to design and psychometric evaluation of needs in women survivors of rape., Materials and Methods: This mixed methods study is conducted using a sequential exploratory approach. In the first phase, the participants (women survivors of rape and healthcare providers) are selected through purposive sampling in Isfahan. Data are collected through in-depth semi-structured interviews and field notes and are analyzed using conventional qualitative content analysis. The draft of the questionnaire is prepared based on the findings of the qualitative phase and literature review. Then, the face validity, content validity, and reliability of the questionnaire are assessed. Construct validity is assessed using the exploratory factor analysis through a descriptive cross-sectional study on women survivors of rape in the quantitative phase. Using a convenience sampling method, the data are collected in the research environment and analyzed via descriptive and inferential statistical methods. Cronbach's alpha coefficient is used to assess the internal correlation of the questionnaire., Conclusion: The valid and reliable questionnaire that is developed in this study can be used by planners to provide services and care according to the needs of women survivors of rape., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Ligamentum flavum (LF) hypertrophy is a major cause of lumbar spinal canal stenosis. Although mechanical stress is thought to be a major factor involved in LF hypertrophy, the exact mechanism by which it causes hypertrophy has not yet been fully elucidated. Here, changes in gene expression due to long-term mechanical stress were analyzed using RNA-seq in a rabbit LF hypertrophy model. In combination with previously reported analysis results, periostin was identified as a molecule whose expression fluctuates due to mechanical stress. The expression and function of periostin were further investigated using human LF tissues and primary LF cell cultures. Periostin was abundantly expressed in human hypertrophied LF tissues, and periostin gene expression was significantly correlated with LF thickness. In vitro, mechanical stress increased gene expressions of periostin, transforming growth factor-β1, α-smooth muscle actin, collagen type 1 alpha 1, and interleukin-6 (IL-6) in LF cells. Periostin blockade suppressed the mechanical stress-induced gene expression of IL-6 while periostin treatment increased IL-6 gene expression. Our results suggest that periostin is upregulated by mechanical stress and promotes inflammation by upregulating IL-6 expression, which leads to LF degeneration and hypertrophy. Periostin may be a pivotal molecule for LF hypertrophy and a promising therapeutic target for lumbar spinal stenosis., (© 2022 The Authors. The FASEB Journal published by Wiley Periodicals LLC on behalf of Federation of American Societies for Experimental Biology.)

Background: One of the most important goals of sexual intercourse is to arouse the psychological effects of intercourse and to increase sexual self-concept, which changes following sexual behaviors such as the use of contraception methods. This study was performed to investigate the relationship between sexual self-concept and contraception sexual behavior in 15-49-year-old women covered by community health centers., Materials and Methods: The present descriptive correlational study was performed on 297 married women referring to Isfahan community health centers in 2020 who were selected as cluster that randomly classified. The tools included demographic information and the Snell's Multidimensional Sexual Self-Concept Questionnaire, the data of which were analyzed via SPSS version 22 software by Mann-Whitney U test and Pearson correlation., Results: Among a total of 297 women, 5.4% of the samples used hormonal methods and 94.6% used non-hormonal methods, which was the most common intermittent method. The results also showed that the mean score of negative sexual self-concept in women using the hormonal level method was significantly higher ( P = 0.012). Positive and positive sexual self-concept score was significantly higher in women using non-hormonal methods ( P = 0.048 and P = 0.002). Therefore, there was a significant relationship between sexual self-concept and contraception method., Conclusion: Due to the relationship between contraception and sexual self-concept, it is recommended to pay attention to the aspects of sexual self-concept and contraception during reproductive health counselling sessions so that if there is a disorder, useful advice can be provided or referred, if necessary., Competing Interests: Nil., (Copyright: © 2023 Journal of Education and Health Promotion.)

Background: Stem cell-based therapy has received considerable attention as a potential candidate in the treatment of ischemic stroke; however, employing an appropriate type of stem cells and an effective delivery route are still challenging. In the present study, we investigated the therapeutic effect of safe, noninvasive, and brain-targeted intranasal administration of hair follicle-derived stem cells (HFSCs) in a rat model of ischemic stroke., Methods: Stem cells were obtained from the adult rat hair follicles. In experiment 1, stroke was induced by 30 min middle cerebral artery occlusion (MCAO) and stem cells were intranasally transplanted immediately after ischemia. In experiment 2, stroke was induced by 120 min MCAO and stem cells were administered 24 h after cerebral ischemia. In all experimental groups, neurological performance, short-term spatial working memory and infarct volume were assessed. Moreover, relative expression of major trophic factors in the striatum and cortex was evaluated by the quantitative PCR technique. The end point of experiment 1 was day 3 and the end point of experiment 2 was day 15., Results: In both experiments, intranasal administration of HFSCs improved functional performance and decreased infarct volume compared to the MCAO rats. Furthermore, NeuN and VEGF expression were higher in the transplanted group and stem cell therapy partially prevented BDNF and neurotrophin-3 over-expression induced by cerebral ischemia., Conclusions: These findings highlight the curative potential of HFSCs following intranasal transplantation in a rat model of ischemic stroke., (© 2022. The Author(s).)

Aim: To identify the associated factors of hope therapy during treatment in cancer patients., Background: Hope is very important to cancer patients at all stages of the disease process. Several and different factors are associated with hope., Design: A systematic literature review of quantitative empirical studies on hope and quality of life in cancer patients., Data Sources: Search in MEDLINE, Psychinfo, and Cochrane (January 2010-December 2020)., Review Methods: A coherent search strategy was designed where MESH terms were combined with "free text" terms: hope (e.g., hope therapy, Herth Hope Index, quality of life) and cancer (e.g. neoplasm, tumor). Two authors independently screened all the studies and assessed their quality., Results: Twenty studies were included. The overall score of Herth Hope Index in cancer patients was 36.93, and the overall score of quality of life in cancer patients were 47.52. Also, the trend of quality of life and Herth Hope Index in cancer patients has been decreasing, from 2010 to 2020., Conclusions: This systematic literature review of associated factors of hope in cancer patients receiving treatment shows that hope seems to be positively related mainly by intrinsic factors, such as perceived health, quality of life, and social support., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background Context: Recently, the number of patients with lumbar spinal stenosis (LSS) who present with a coexisting spinal deformity such as degenerative spondylolisthesis (DS) and scoliosis (DLS) has been increasing. Lumbar decompression without fusion can lead to a reactive improvement in the lumbar and sagittal spinopelvic alignment, even if a sagittal imbalance exists preoperatively. However, the mid- to long-term impact of the coexistence of DS and DLS on the change in sagittal spinopelvic alignment and clinical outcomes after decompression surgery remains unknown., Purpose: This study aimed to investigate whether the coexistence of DS or DLS in patients with LSS is associated with differences in radiological and clinical outcomes after minimally invasive lumbar decompression surgery., Study Design/setting: A retrospective analysis of prospectively collected data., Patient Sample: A total of 169 patients who underwent minimally invasive lumbar decompression surgery and follow-up >5 years postoperatively., Outcome Measures: Self-report measures: Low back pain (LBP) and/or leg pain and/or leg numbness visual analog scale (VAS) scores and the Japanese Orthopedic Association scores., Physiologic Measures: Standing sagittal spinopelvic alignment., Methods: In total, 81 patients with LSS, 50 patients with LSS and DS (≥3 mm anterior slippage), and 38 patients with LSS and DLS (≥15° coronal Cobb angle) were included in the current study. Clinical and radiological outcome results before surgery and at 2 and 5 years after surgery were compared among the groups., Results: In patients with LSS with coexisting DS, the clinical outcomes at 2, and 5 years after surgery were similar to those of patients with only LSS. In patients with LSS with coexisting DLS, the VAS LBP and leg pain at 2 years after surgery was significantly higher (34.7 vs. 27.8, p=0.014; 27.8 vs. 14.7, p=0.028) and the achievement rate of the minimal clinically important difference in VAS LBP and leg pain was significantly lower than that of the LSS group (36.1% vs. 54.2%, p=0.036; 58.3% vs. 69.9%, p=0.10). The clinical outcomes except VAS leg numbness at 5 years after surgery were similar to those of patients with only LSS. The reoperation rate of the DS group was significantly lower than that of the LSS group (4.0% vs. 14.8%; p=0.01); however, the reoperation rate of the DLS group was comparable to that of the LSS group (15.8% vs. 14.8%; p=0.493). Lumbar lordosis (LL), sacral slope, pelvic tilt, and pelvic incidence-LL had significantly improved and been maintained for 5 years after the surgery in both the DS and the DLS groups. The sagittal vertical axis had improved at two-year follow-up; however, no significant difference was observed at the 5-year follow-up in both the DS, and the DLS groups., Conclusions: Mid-term clinical outcomes in patients with LSS with and without deformity were comparable. Lumbar decompression without fusion can result in a reactive improvement in the lumbar and sagittal spinopelvic alignment, even with coexisting DS or DLS. Minimally invasive surgery could be considered for most patients with LSS., Competing Interests: Declarations of Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Fibrosis is one of the main pathologies caused by hypertrophy of the ligamentum flavum (LF), which leads to lumbar spinal stenosis (LSS). The fibroblast growth factor (FGF) family is a key mediator of fibrosis. However, acidic fibroblast growth factor (FGF-1) expression and function are not well understood in LF. This study sought to evaluate FGF-1 expression in the hypertrophied and non-hypertrophied human LF, and to investigate its function using primary human LF cell cultures., Methods: We obtained hypertrophied lumbar LF from LSS patients and non-hypertrophied lumbar LF from control patients during surgery. Immunohistochemistry and qPCR were performed to evaluate FGF-1 expression in LF tissue. The function of FGF-1 and transforming growth factor beta 1 (TGF-β1) was also investigated using primary LF cell culture. The effects on cell morphology and cell proliferation were examined using a crystal violet staining assay and MTT assay, respectively. Immunocytochemistry, western blotting, and qPCR were performed to evaluate the effect of FGF-1 on TGF-β1-induced myofibroblast differentiation and fibrosis., Results: Immunohistochemistry and qPCR showed higher FGF-1 expression in hypertrophied LF compared to control LF. Crystal violet staining and MTT assay revealed that FGF-1 decreases LF cell size and inhibits their proliferation in a dose-dependent manner, whereas TGF-β1 increases cell size and promotes proliferation. Immunocytochemistry and western blotting further demonstrated that TGF-β1 increases, while FGF-1 decreases, α-SMA expression in LF cells. Moreover, FGF-1 also caused downregulation of collagen type 1 and type 3 expression in LF cells., Conclusion: FGF-1 is highly upregulated in the LF of LSS patients. Meanwhile, in vitro, FGF-1 exhibits antagonistic effects to TGF-β1 by inhibiting cell proliferation and decreasing LF cell size as well as the expression of fibrosis markers. These results suggest that FGF-1 has an anti-fibrotic role in the pathophysiology of LF hypertrophy., Competing Interests: Conflicts of interest and sources of funding No financial support was received for this research, and the authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)