Solvent Distribution Effects on Quantum Chemical Calculations with Quantum Computers.

We present a combination of three-dimensional reference interaction site model self-consistent field (3D-RISM-SCF) theory and the variational quantum eigensolver (VQE) to consider the solvent distribution effects within the framework of quantum-classical hybrid computing. The present method, 3D-RISM-VQE, does not include any statistical errors from the solvent configuration sampling owing to the analytical treatment of the statistical solvent distribution. We apply 3D-RISM-VQE to compute the spatial distribution functions of solvent water around a water molecule, the potential and Helmholtz energy curves of NaCl, and to analyze the Helmholtz energy component and related properties of H2O and NH4+. Moreover, we utilize 3D-RISM-VQE to analyze the extent to which solvent effects alter the efficiency of quantum calculations compared with calculations in the gas phase using the L1-norms of molecular electronic Hamiltonians. Our results demonstrate that the efficiency of quantum chemical calculations on a quantum computer in solution is virtually the same as that in the gas phase.

Disease Flares Following COVID-19 Vaccination in Patients with Inflammatory Bowel Disease.

Objective Flares of inflammatory bowel disease (IBD) can occur infrequently after vaccination for coronavirus disease 2019 (COVID-19), although the details of this phenomenon are poorly understood. To clarify the possibility of an unfavorable response in patients with IBD, we investigated IBD-related symptoms during the COVID-19 vaccination. Methods Between October 2021 and February 2022, we obtained the COVID-19 vaccination status of 411 IBD patients who were being treated at our institution. The disease course of IBD after vaccination was investigated in 188 patients with ulcerative colitis (UC) and 119 patients with Crohn's disease (CD) who had received at least one dose of the vaccine during the clinical remission phase. The baseline characteristics before vaccination were compared between the patients with UC with or without disease flares. Results During the 30-day follow-up period, eight patients with UC (4.3%) and one patient with CD (0.8%) experienced disease flares following vaccination. Disease flares occurred after the first vaccination in six patients and after the second vaccination in three patients. As for the timing of onset of disease flares, eight events (88.9%) occurred within one week of vaccination. Two patients required hospitalization, and one patient with CD required surgery for an intra-abdominal abscess. The baseline characteristics did not significantly differ between patients with UC who experienced flares and those who did not. Conclusion IBD flares following COVID-19 vaccination are rare and vaccination should therefore be recommended for patients with IBD. However, the possibility of disease flares should be considered for approximately one week after each vaccination, especially in patients with UC.

The impact of unconditional cash and food assistance on contraceptive expenditure of rural households in Coastal Bangladesh: Evidence from fuzzy RDD.

This study investigates the impact of unconditional cash and food (UCF) assistance on the monthly contraceptive expenditure of rural households in coastal Bangladesh using a fuzzy regression discontinuity design (RDD). Eligibility for UCF assistance was based on the running variable of land ownership in acres. We used eligibility as an instrumental variable to estimate the local average treatment effect of UCF assistance on contraceptive expenditures. The results show that UCF assistance results in increases in monthly contraceptive expenditures.

Assessment of dermal exposure to N,N-dimethylacetamide in spray workers by combining personal exposure monitoring, biological monitoring, and glove permeation monitoring: A pilot study.

OBJECTIVES: We assessed dermal exposure to N,N-dimethylacetamide (DMAC) in a spray worker by utilizing a combination of personal exposure monitoring, biological monitoring, and glove permeation monitoring. We also determined the protective effects of chemical protective gloves (CPGs). METHODS: Surveys with and without CPG usage were performed on different days. In the survey with CPG usage, the worker had worn leather gloves over the CPG. Personal exposure monitoring and glove permeation monitoring were performed using 3M Organic Vapor Monitor 3500 and PERMEA-TEC Pads respectively. Urinary concentration of DMAC and its metabolites (N-methylacetamide [NMAC], N-hydroxymethyl-N-methylacetamide [DMAC-OH], S-(acetamidomethyl) mercapturic acid [AMMA]) were measured in the before-shift and end-of-shift samples collected from the worker. RESULTS: Personal exposure DMAC concentration in the survey with CPG usage (0.32 ppm) was twice that in the survey without CPG usage (0.15 ppm). However, urinary concentrations of DMAC-OH and AMMA in the end-of-shift samples in the survey with CPG usage (DMAC-OH, 0.74 mg/g creatinine; AMMA, 0.10 mg/g creatinine) were lower than those in the survey without CPG usage (DMAC-OH, 1.27 mg/g creatinine; AMMA, 0.24 mg/g creatinine). Urinary concentrations of DMAC and NMAC were below the limit of detection in all samples. DMAC concentrations in PERMEA-TEC Pads that were used in the surveys with and without CPG usage were in the range of 0.3-2.1 µg/sample and 16.4-1985.2 µg/sample respectively. CONCLUSIONS: The combination of CPG usage and leather gloves was effective in preventing dermal exposure to DMAC.

Risk of Rebleeding in Patients with Small Bowel Vascular Lesions.

Objective With recent advances in endoscopic modalities, small bowel vascular lesions (SBVLs) are often now detected in patients with gastrointestinal bleeding. Given the high invasiveness of endoscopic treatment, it is important to select patients at high risk for bleeding. To assess the risk of rebleeding in patients with SBVLs as a systemic disease rather than a gastrointestinal disease in relation to their general health. Methods We retrospectively analyzed the clinical data of 55 patients with SBVLs among patients with obscure gastrointestinal bleeding. The possible association between the clinical findings and the updated Charlson comorbidity index with rebleeding was evaluated. Results Gastrointestinal rebleeding occurred in 20 patients (36.4%) during the follow-up period. The presence of multiple comorbidities as indicated by an updated Charlson comorbidity index of ≥4 was a risk factor for rebleeding (hazard ratio, 3.64; p=0.004). Other risk factors were arteriosclerosis of the superior mesenteric artery and multiple SBVLs. Endoscopic hemostasis and the discontinuation of antithrombotic medications were not significantly associated with rebleeding. Patients with a high updated Charlson comorbidity index had a high risk of death of causes other than gastrointestinal rebleeding. Conclusion Gastrointestinal rebleeding is not a rare condition among patients with SBVLs. Patients with poor general health may therefore have a higher risk of rebleeding.

A quantum chemical model for a series of self-assembled nanocages: the origin of stability behind the coordination-driven formation of transition metal complexes up to [M12L24]24.

Herein, we present a systematic computational model to study the electronic states and free energies of a self-assembled multi-metal complex series. By combining the previously developed model Hamiltonian approach for transition-metal complexes and the generalized Born model, the thermodynamics, optimized geometries, and electronic states of the [Pd12L24]24+ nanocage are revealed, together with [PdnLm]2n+ complex series. The effective model Hamiltonian is a theoretical method to obtain the d-electron wavefunction and potential energy including interaction energy between the transition-metal and ligands. In the present improvement, the electronic state on each transition-metal center is focused as a building unit and solved under the whole electronic field of the assembling system. We realize a reliable and systematic treatment of multi-transition-metal complexes with different sizes and charges. Consequently, our model could reproduce binding energies of the [PdnLm]2n+ complex series quantitatively as compared to density functional theory (DFT). Regarding free energy, we revealed that the assembling solute becomes unstable due to the electrostatic interaction, and effects of the solvent and counter anions mainly compensated it. Optimized geometries were also analysed. The local square-planar coordination structures around the palladium centres were characterized in the complex series. The relationships between the entire symmetrical geometries and the local coordination structures are also discussed. Finally, electronic structures of the [Pd12L24]24+ nanocage were well characterized as a single-determinant, where only dx2-y2 is unoccupied due to the ligand-field effect. We also found that the solvent polarized the electronic states of the Pd ions, whereas the counter anion suppressed the polarization. The present method realizes size-independent reliable and rapid computations, and therefore can be expected to further application studies on self-assembly dynamics.

Energy landscape study of water splitting and H2 evolution at a ruthenium(II) pincer complex.

A bird's-eye view of the water splitting and H2 generation at a ruthenium(II) pincer complex is presented. Using a combination of density functional theory and efficient algorithms for exploration of potential energy hypersurface (PES), a total of 197 local minima and 186 transition states are identified, and a new mechanism for water splitting and H2 evolution via hydroxycarbonyl intermediates is presented. Furthermore, a global feature of the reaction PES, so-called potential energy landscape, is discussed on analyzing the obtained structures. As a result, the landscape is characterized by hierarchical structure, namely, PES consists of many "superbasins (SBs)" that are separated by relatively high energy barriers corresponding to bond breaking around Ru(II) center. Each SB involves a set of conformational isomers that can be interchanged with each other through relatively small barriers. To the best of our best knowledge, this is the first report on the quantum chemical computation of the hierarchical structure of PES for a realistic, catalytic reaction system.

Clinical Significance of a Gene Signature Generated from Tumor Budding Grade in Colon Cancer.

BACKGROUND: Tumor budding, a microscopic finding of dedifferentiation at the invasive margin, has been reported as a definite prognostic marker in colon cancer (CC). Herein, we aimed to generate a molecular budding signature (MBS) based on DNA microarray data and to examine its prognostic significance. METHODS: Frozen tissue samples from 85 patients with stage II/III CC were used for DNA microarray analyses. First, we selected candidate genes that were differentially expressed (twofold change) between the invasive frontal regions and corresponding tumor centers of three extremely high-grade budding tumors. Subsequently, using microarray data from whole-tissue sections of the 85 patients, we selected MBS-constituent genes from the candidates based on correlation to the pathological budding grade. The MBS score was calculated using the sum of the logarithm of the expression of each gene. RESULTS: We selected seven MBS-constituent genes: MSLN, SLC4A11, WNT11, SCEL, RUNX2, MGAT3, FOXC1. A comparison of relapse-free survival (RFS) rates revealed a significant impact of the MBS score [5-year RFS, 77.4% (score-high) vs. 95.1% (score-low); P = 0.044]. Analyses of public databases revealed that low MBS score patients exhibited better prognosis than those with high-score cancers (GSE14333: 5-year RFS, 83.1% vs. 66.6%, P = 0.028; GSE39582: 5-year disease-free survival, 72.2% vs. 58.1%, P = 0.0005). Multivariate analysis revealed that the MBS score is an independent prognostic indicator in GSE39582 (hazard ratio, 1.611; P = 0.013). CONCLUSIONS: We developed a new gene classification method, i.e., MBS, and demonstrated its clinical relevance as an indicator of high recurrence risk of CC.

Genetic and clinical prediction models for the efficacy and hepatotoxicity of methotrexate in patients with rheumatoid arthritis: a multicenter cohort study.

The objective of the study is to develop genetic and clinical prediction models for the efficacy and hepatotoxicity of methotrexate (MTX) in patients with rheumatoid arthritis (RA). Among RA patients treated with MTX, 1966 polymorphisms of 246 enzymes/transporters relevant to pharmacokinetics and pharmacodynamics were measured by the Drug Metabolism Enzymes and Transporters (DMET) microarray and direct sequencing, and clinical variables at baseline were collected. For efficacy, response criteria of the European League Against Rheumatism were used to classify patients as responders or non-responders. Hepatotoxicity was defined as elevations of aspartate aminotransferase or alanine aminotransferase ≥1.5 times the reference range upper limit. Among 166 patients, a genetic prediction model for efficacy using seven polymorphisms showed the area under the receiver operating characteristic curve (AUC) was 0.822, with 74.3% sensitivity and 76.8% specificity. A combined genetic and clinical model indicated the AUC was 0.844, with 81.5% sensitivity and 76.9% specificity. By incorporating clinical variables into the genetic model, the overall category-free net reclassification improvement (NRI) was 0.663 (P < 0.0001) and the overall integrated discrimination improvement (IDI) was 0.083 (P = 0.0009). For hepatotoxicity, a genetic prediction model using seven polymorphisms showed the AUC was 0.783 with 70.0% sensitivity and 80.0% specificity, while the combined model indicated the AUC was 0.906 with 85.1% sensitivity and 87.8% specificity (overall category-free NRI: 1.002, P < 0.0001; overall IDI: 0.254, P < 0.0001). Our genetic and clinical models demonstrated moderate diagnostic accuracy for MTX efficacy and high accuracy for hepatotoxicity. These findings should, however, be validated and interpreted with a caution until external validation.

A kinetics study of ligand substitution reaction on dinuclear platinum complexes: Stochastic versus deterministic approach.

The kinetics on a basic ligand substitution reaction on dinuclear platinum complexes [Pt(PEt3 )2 PhPt(PEt3 )2 ]2+ and [Pt(PEt3 )2 PhCOPhPt(PEt3 )2 ]2+ , with the ligands pyridine and 3-chloropyridine, is studied. This is a fundamental step in a self-assembly, and the time evolution has been observed with a new experimental technique, QASAP (quantitative analysis of self-assembly process), which is recently developed by Hiraoka's group. As a result of numerical calculations based on master equation, we succeed in specifying the reaction rate constants with a simple reaction model. In addition, the time evolutions of all the intermediate components produced and consumed in chemical reaction are revealed, including those unobserved in the experiments. The convergence behavior of the existence ratios of specific chemical species calculated with the stochastic algorithm method is compared with those obtained from deterministic formalism based on rate equations, revealing a clear dependence on the number of constituent molecules. © 2018 Wiley Periodicals, Inc.

Measuring the impact of modern waste collection and processing service attributes on residents' acceptance of waste separation policy using a randomised conjoint field experiment in Yogyakarta Province, Indonesia.

Indonesia is one of the countries that is facing serious solid waste problems. Although the issue has been addressed in the capital city of Jakarta, many secondary cities have been left behind. This research attempts to analyse the impact of relevant waste management policy components on respondents' policy acceptance probabilities in Yogyakarta Province. Using a randomised conjoint field experiment based on the proposal of modern waste collection services, this article shows that a new waste management policy that includes waste separation with frequent organic waste collection will gain popular support, especially with the rich. Indeed, if the government introduces waste collection and processing services that consist of the most preferred levels of these attributes, including five-times-a-week organic waste collection, a majority of the residents will support this new waste management policy, which will reduce waste at its source.

Theoretical approaches for dynamical ordering of biomolecular systems.

BACKGROUND: Living systems are characterized by the dynamic assembly and disassembly of biomolecules. The dynamical ordering mechanism of these biomolecules has been investigated both experimentally and theoretically. The main theoretical approaches include quantum mechanical (QM) calculation, all-atom (AA) modeling, and coarse-grained (CG) modeling. The selected approach depends on the size of the target system (which differs among electrons, atoms, molecules, and molecular assemblies). These hierarchal approaches can be combined with molecular dynamics (MD) simulation and/or integral equation theories for liquids, which cover all size hierarchies. SCOPE OF REVIEW: We review the framework of quantum mechanical/molecular mechanical (QM/MM) calculations, AA MD simulations, CG modeling, and integral equation theories. Applications of these methods to the dynamical ordering of biomolecular systems are also exemplified. MAJOR CONCLUSIONS: The QM/MM calculation enables the study of chemical reactions. The AA MD simulation, which omits the QM calculation, can follow longer time-scale phenomena. By reducing the number of degrees of freedom and the computational cost, CG modeling can follow much longer time-scale phenomena than AA modeling. Integral equation theories for liquids elucidate the liquid structure, for example, whether the liquid follows a radial distribution function. GENERAL SIGNIFICANCE: These theoretical approaches can analyze the dynamic behaviors of biomolecular systems. They also provide useful tools for exploring the dynamic ordering systems of biomolecules, such as self-assembly. This article is part of a Special Issue entitled "Biophysical Exploration of Dynamical Ordering of Biomolecular Systems" edited by Dr. Koichi Kato.

Metastatic esophageal cancer presenting as shock by injury of vagus nerve mimicking baroreceptor reflex: A case report.

RATIONALE: Neurogenic shock is generally typified by spinal injury due to bone metastases in cancer patients, but continuous disturbance of the vagus nerve controlling the aortic arch baroreceptor can cause shock by a reflex response through the medulla oblongata. PATIENT CONCERNS: A 43-year-old woman with dysphagia presented to our hospital. Computed tomography showed a primary tumor adjacent to and surrounding half the circumference of the descending aorta, and multiple cervical lymph node metastases, including a 55 × 35-mm lymph node overlapping the root of the left vagus nerve. Squamous esophageal cancer (T4bN3M1, stage IV) was diagnosed. Whereas shock status initially appeared soon after left cervical pain, suggesting pain-induced neutrally-mediated syncope, sustained bradycardia and hypotension occurred even after alleviation of pain by opioids. DIAGNOSIS: Disturbance of the left vagus nerve associated with the aortic arch baroreceptor by a large left cervical lymph node metastasis was considered as the cause of shock, pathologically mimicking the baroreceptor reflex. INTERVENTIONS: Systemic steroid administration was performed, and radiotherapy for both the primary site and lymph node metastasis was started 2 days after initiating steroid treatment. OUTCOMES: Four days after initiating steroid administration, hypotension and bradycardia were improved and stable. LESSONS: Disturbance of the vagus nerve controlling the aortic arch baroreceptor should be kept in mind as a potential cause of neurogenic shock in cancer patients, through a pathological reflex mimicking the baroreceptor reflex.

Psychogenic Low-Back Pain and Hysterical Paralysis in Adolescence.

STUDY DESIGN: A retrospective review. OBJECTIVE: The purpose of this study was to investigate the clinical outcomes in adolescents diagnosed with psychogenic low-back pain and hysterical paralysis and to evaluate the efficacy of differential diagnosis methods. SUMMARY OF BACKGROUND DATA: The incidence of low-back pain in adolescence is similar to that in adults, but the causes of low-back pain are difficult to determine in most cases. For these patients, a definitive diagnosis of psychogenic low-back pain and hysterical paralysis as well as adequate treatment are clinically important to avoid unnecessary surgical treatment. METHODS: Eleven patients (3 males and 8 females; mean age, 16.5 years; range, 13-19 y) diagnosed with psychogenic low-back pain and hysterical paralysis were followed up for 2-10.25 years (mean, 4.67 y). Nonorganic signs were observed in almost all patients. For the purpose of excluding organic disorders, the thiopentone pain study was used in patients who complained mainly of pain, and motor evoked potentials using transcranial magnetic stimulation were measured in patients experiencing primarily muscle weakness. RESULTS: The psychiatric diagnosis was neurosis in 9 patients, whereas it was psychosomatic disorder in 2 patients. Conservative treatment, such as physiotherapy, was performed, and at the final follow-up evaluation, outcomes were regarded as excellent in 7 patients and good in 4 patients. CONCLUSIONS: The prognosis of psychogenic low-back pain and hysterical paralysis in adolescence is relatively good. However, it is important to understand the characteristics of psychogenic low-back pain and hysterical paralysis in childhood and young adulthood and to perform accurate diagnosis by screening for nonorganic signs and excluding organic disorders by using the thiopentone pain study and motor evoked potentials obtained using transcranial magnetic stimulation.

Operative methods for delayed paralysis after osteoporotic vertebral fracture.

PURPOSE: How to select operative methods for delayed paralysis after osteoporotic vertebral fracture remains a matter of debate. It is unclear which procedure provides better neurological and functional recovery. This study aimed to compare the various operative methods and investigate postoperative outcomes. METHODS: The study included 42 delayed paralysis patients (mean age 73.7 years). The operative methods were posterior spinal shortening osteotomy with direct decompression and short or long fusion and posterior laminectomy and short fusion with vertebroplasty. All patients in the vertebroplasty group were fitted with hooks to prevent correction loss. We investigated postoperative complications, surgery time, intraoperative blood loss, and changes in walking ability and local kyphotic angle (LKA). Patients were divided into three groups: shortening with a peripheral fusion range of one intervertebral level (the SS group, n = 18), the same procedure with a peripheral fusion range of ≥2 intervertebral levels (the SL group, n = 12), and posterior laminectomy and short fusion with vertebroplasty (the VP group, n = 12). RESULTS: Postoperative complications were observed in five patients, all of whom were in the SS and SL group. There were no significant differences between the SS and SL groups. The VP group experienced significantly shorter mean surgery times, significantly lower mean intraoperative blood loss, and an improvement in paralysis, walking ability, LKA, and correction loss. Overall, the VP group had significantly better outcomes. CONCLUSION: Posterior laminectomy and short fusion with vertebroplasty with the addition of hooks is useful in cases of delayed paralysis in elderly patients.

Neurologic findings caused by ossification of ligamentum flavum at the thoracolumbar junction.

OBJECTIVE: To evaluate neurologic findings caused by a single ossification of ligamentum fravum (OLF) and identify the level of the lumbar segment of spinal cord. DESIGN: Retrospective study. METHODS: Subjects were 28 patients with a single OLF at T10-11 level (15 patients), T11-12 (11), and T12-L1 (2). The tip of the conus medullaris was assessed using computed tomographic myelography or magnetic resonance imaging. Neurologic evaluations were performed for patellar tendon reflex (PTR), sensory disturbance, and motor weakness. RESULTS: The tip of the conus medullaris was located at the L1 vertebral body level. At the T10-11 level, all patients showed hyperreflexia of PTR. Sensory disturbance was observed for L1 dermatome and weakness of the iliopsoas was noted. At the T11-12 level, 8 of 11 patients didn't show hyperreflexia of PTR. Sensory disturbance was observed for L5 dermatome and weakness of the tibialis anterior was noted. At the T12-L1 level, all patients showed normal reflex of PTR, sensory disturbance of L5 dermatome, and weakness of the tibialis anterior. CONCLUSION: With regard to the relationship between PTR and OLF level, all patients at the T10-11 level showed involvement of the L3 segment of spinal cord proximally. On the other hand, most patients at the T11-12 level showed involvement of the L4 segment of spinal cord distally. From all neurologic findings, we confirmed the presence of the L4 segment of spinal cord from the lower third of T11 vertebral body to the T11-12 intervertebral disc level.

Effects of differences in age and body height on normal values of central motor conduction time determined by F-waves.

OBJECTIVES: To investigate the effect on central motor conduction time (CMCT) based on the relationship between age and height in normal subjects. DESIGN: Retrospective study. METHODS: One hundred and ninety nine normal subjects (107 men and 92 women; mean age 39.0 ± 16.4 years; mean height 164.5 ± 8.8 cm) participated in the study. The approximate ages of subjects were as follows: 82 (20-29 years old), 32 (30-39 years old), 32 (40-49 years old), 28 (50-59 years old), and 25 (≧60 years old). The heights of 9, 49, 79, 53, and 9 subjects were <150 cm, 150-160 cm, 160-170 cm, 170-180 cm, and >180 cm, respectively. CMCT- abductor digiti minimi (ADM) and abductor hallucis (AH) were calculated by subtracting the peripheral motor conduction time (PMCT) from the onset latency of motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation. PMCT was calculated from the latencies of the compound muscle action potentials (CMAPs) and F-waves as follows: (latency of CMAPs + latency of F-waves -1)/2. OUTCOME MEASURES: CMCT-ADM and CMCT-AH. RESULTS: The normative values were 5.2 ± 0.8 ms and 11.8 ± 1.3 ms for CMCT-ADM and CMCT-AH, respectively. CMCT-ADM was not significantly correlated with age (P = 0.196) and body height (P = 0.158). CMCT-AH had significantly positive, linear correlations with age and body height (CMCT-AH = 0.014 × age + 10.971, P = 0.011, R = 0.179 and CMCT-AH = 0.026 × body height + 7.158, P = 0.010, R = 0.182). CONCLUSIONS: We suggest normative values of 3.2-7.2 ms in CMCT-ADM for subjects exerting slight effort on ADM regardless age and body height. CMCT-AH had significantly positive, linear correlations with age and body height.

Cervical ossification of the posterior longitudinal ligament: factors affecting the effect of posterior decompression.

OBJECTIVE: Decompression procedures for cervical myelopathy of ossification of the posterior longitudinal ligament (OPLL) are anterior decompression with fusion, laminoplasty, and posterior decompression with fusion. Preoperative and postoperative stress analyses were performed for compression from hill-shaped cervical OPLL using 3-dimensional finite element method (FEM) spinal cord models. METHODS: Three FEM models of vertebral arch, OPLL, and spinal cord were used to develop preoperative compression models of the spinal cord to which 10%, 20%, and 30% compression was applied; a posterior compression with fusion model of the posteriorly shifted vertebral arch; an advanced kyphosis model following posterior decompression with the spinal cord stretched in the kyphotic direction; and a combined model of advanced kyphosis following posterior decompression and intervertebral mobility. The combined model had discontinuity in the middle of OPLL, assuming the presence of residual intervertebral mobility at the level of maximum cord compression, and the spinal cord was mobile according to flexion of vertebral bodies by 5°, 10°, and 15°. RESULTS: In the preoperative compression model, intraspinal stress increased as compression increased. In the posterior decompression with fusion model, intraspinal stress decreased, but partially persisted under 30% compression. In the advanced kyphosis model, intraspinal stress increased again. As anterior compression was higher, the stress increased more. In the advanced kyphosis + intervertebral mobility model, intraspinal stress increased more than in the only advanced kyphosis model following decompression. Intraspinal stress increased more as intervertebral mobility increased. CONCLUSION: In high residual compression or instability after posterior decompression, anterior decompression with fusion or posterior decompression with instrumented fusion should be considered.