Search

Practical total syntheses of africane-type sesquiterpenoids were realized by reexamination of a divergent strategy employing optimized three-component coupling followed by ring-closing metathesis and substrate-controlled cyclopropanation. This sequential eight-step conversion provided Δ

To investigate the immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain.Randomized, controlled trial.Thoracic spine self-mobilization is performed after thoracic spine thrust manipulation to augment and maintain its effects. To the best of our knowledge, no study has investigated the effects of thoracic spine self-mobilization alone in individuals with mechanical neck pain. The purpose of this randomized, controlled trial was to evaluate the immediate effects of thoracic spine self-mobilization alone without any other intervention on disability, pain, and cervical range of motion in patients with mechanical neck pain.Fifty-two patients (39 females and 13 males) with mechanical neck pain were randomly allocated to either a thoracic spine self-mobilization group that was performing a thoracic spine active flexion and extension activity using two tennis balls fixed by athletic tape or a placebo thoracic spine self-mobilization group. Outcome measures were collected at pre-intervention and immediately after intervention, including the Neck Disability Index, visual analogue scale, and active cervical range of motion (ROM). The immediate effect of the intervention was analyzed using two-way repeated measures analysis of variance (ANOVA). If interactions were found, a simple main effect test was performed to compare the pre-post intra-group results.The results of two-way repeated measures ANOVA indicated that the main effect of time was significant (p 0.05) for all measurement outcomes. The main effect of group was not significant for all measurement outcomes (p 0.05). The group × time interactions for cervical flexion active ROM (p = 0.005) and cervical extension active ROM (p = 0.036) were significant. The tests of simple main effect in cervical flexion active ROM (p 0.0001) and cervical extension active ROM (p 0.0001) showed a significant difference before and after intervention in the thoracic spine self-mobilization group.Patients with mechanical neck pain who carried out thoracic spine self-mobilization showed increases in active cervical flexion and extension ROM.

The aims of this study were to translate and culturally adapt the Patient-Specific Functional Scale (PSFS) and validate the Japanese version of the PSFS (PSFS-J) in outpatients with neck pain.The PSFS was translated and adapted into Japanese in accordance with the published guidelines. A total of 103 outpatients with neck pain were recruited for this study. Psychometric evaluation included test-retest reliability, convergent validity by comparing the PSFS-J to the Neck Disability Index (NDI), patient's global impression of change (PGIC), and responsiveness (unpaired t test, minimal detectable change).The intraclass correlation coefficient for test-retest reliability was 0.98 (95% confidence interval = 0.95-0.99). The Pearson correlation coefficient with the NDI was -0.35. The Spearman correlation coefficient showed a strong relationship between the change score in the PSFS-J and PGIC (-0.70). The analysis of responsiveness was calculated with the unpaired t test showing a significant difference between the stable and improved patients (P0.01). The minimal detectable change was calculated as 0.64.The Japanese version of the PSFS is a valid, reliable, and responsive instrument to assess Japanese outpatients with neck pain.

The aim of this study was to show highly reliable normal values and three-dimensional characteristics for final range of motion during active movements of the upper extremity joints, and to develop a database from healthy participants, with the advantage of this database lying in the methods of defining shoulder axial rotation angle and of compensating for soft tissue artifacts.We used an electromagnetic tracking system (FASTRAK) to measure three-dimensional motions of the shoulder (thoracohumeral), elbow/forearm, and wrist in 20 healthy adults (age range: 18-34 years) during active joint motion tasks of the upper extremity.Joint angles of the upper extremity at the final position of joint motion tasks were determined. Highly reliable data for shoulder axial rotation angle were obtained, using a new definition of joint angle and regression analysis to compensate for estimation errors.These results should be useful in setting goals for the treatment of upper extremity joint functions in the fields of rehabilitation, orthopedics, and sports medicine.

Our report discusses a 29 year old female patient with nephrotic syndrome due to lupus nephritis, biopsy-proven World Health Organization classification Types IVb and V that was controlled with low-density lipoprotein (LDL) apheresis. She was initially treated with steroid therapy, including methylprednisolone pulse therapy, and the serological activity of her systemic lupus erythematosus was suppressed. However, her nephrotic state, accompanied by severe hyperlipidemia, persisted despite the steroid therapy. Since we could not obtain her consent to administer immunosuppressants such as cyclophosphamide, we tried to treat her using LDL apheresis (LDL-A). We found that her urine protein excretion, hyperlipidemia, hypoalbuminemia, and renal function improved following the initiation of LDL-A. This suggests that LDL-A may be an effective therapy for nephrotic syndrome due to lupus nephritis through short-term amelioration of hyperlipidemia.

Study design Translation and psychometric testing. Objective To translate and culturally adapt the Neck Disability Index (NDI) and to assess the reliability and validity of the Japanese version of the NDI (NDI-J) in Japanese outpatients with neck pain. Summary of background data To date, no previous report exists on the translation process and psychometric testing of the NDI-J. Methods The NDI was translated and culturally adapted into Japanese in accordance with published guidelines. A total of 110 outpatients with neck pain participated in the study. Psychometric testing included reliability by internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient), factor analysis, convergent validity by comparing the NDI-J with the short-form health survey (Pearson correlation) and responsiveness (unpaired t tests, standard error of measurement, and minimal detectable change). Results The Cronbach α of the NDI-J was 0.88 and the intraclass correlation coefficient for test-retest reliability was 0.91 (95% confidence interval, 0.82-0.95). Factor analysis demonstrated a 2-factor structure, explaining 61.8% of the total variance. The correlation between the NDI-J and the short-form health survey, version 36, subscales ranged from good to fair (-0.25 to -0.51). The analysis of responsiveness was calculated with an unpaired t test after 3 weeks of treatment demonstrating a statistically significant difference between the stable and improved patients (P ≤ 0.05). The standard error of measurement and minimal detectable change were calculated as 2.9 and 6.8, respectively. Conclusion The NDI-J is a valid, reliable, and responsive tool that can be used to assess neck pain in Japanese outpatients.

This study was designed as a questionnaire survey to reveal the preference in technique of patients faced with anterior cruciate ligament (ACL) reconstruction.One hundred and ten subjects (35 patients and 75 medical students) were included in this study. A questionnaire survey was conducted, and the following questions were asked: (1) How old are you? (2) Prior to this survey, did you know what the ACL was? (3) Prior to this survey, did you have any knowledge about ACL reconstruction technique? (4) Prior to this survey, did you know the difference between anatomical double bundle (DB) technique and traditional single bundle (SB) technique? (5) If you had to have an ACL reconstruction, which technique would you prefer? In the same questionnaire, between questions (3) and (4), a description of SB and DB was provided.Sixty-nine percent of patients and 100% of medical students knew what the ACL was. Forty-three percent of patients and 85% of medical students had previous knowledge about ACL reconstruction. None of the patients and only 29% of the medical students had prior knowledge about the difference between DB and SB. Six percent of patients selected SB, and 40% selected DB. Nine percent of medical students selected SB, and 67% selected DB.In this study, 46% of patients and 76% of medical students selected one of the operation techniques. The trend in selection of the operation technique was significantly influenced by the subjects' prior medical knowledge. It might be possible to apply the principle of "informed patient choice" to the selection of DB or SB for ACL reconstruction.Decision analysis, Level III.

Highly reliable information on the range of motion (ROM) required to perform activities of daily living (ADL) is important to allow rehabilitation professionals to make appropriate clinical judgments of patients with limited ROM of the upper extremity joints. There are, however, no data available that take full account of corrections for gimbal-lock and soft tissue artifacts, which affect estimation errors for joint angles. We used an electromagnetic three-dimensional tracking system (FASTRAK) to measure the three-dimensional ROM of the upper extremity joints of healthy adults (N=20, age range 18-34) during 16 ADL movement tasks. The ROM required for the performance of each movement was shown in terms of the joint angle at the completion of the task, using a new definition of joint angle and regression analysis to compensate for estimation errors. The results of this study may be useful in setting goals for the treatment of upper extremity joint function.

Good sleep is essential for the growth and the development of children. However, sleep is often impaired in patients with atopic dermatitis (AD). It is important to assess the sleep quality in pediatric AD patients. For that purpose, we utilized actigraphy as an objective method for the assessment of sleep quality.Childhood patients with AD (16 cases) and 8 non-allergic volunteers were recruited. Actiwatch (AW-64) was attached to each subject's wrist for 11 days at maximum. Sleep parameters were calculated with Actiware and compared among various patient groups.Results demonstrate that sleep was significantly compromised in patients with AD, according to the severity. Subjective scoring of the sleep quality by parents showed limited correlation with actigraphy.Actigraphy is an objective and unobtrusive method to measure the sleep quality in childhood AD patients and can provide useful outcome in clinical trial.

A 60-year-old man with polycystic disease (PCD) undergoing hemodialysis was admitted to our hospital because of refractory ascites in September 2000. He had been diagnosed with probable chronic inflammatory demyelinating polyradiculopathy 6 months before admission. Though the ascites was bloody and exudative, the cytology was normal and cultures of bacteria and acid-fast bacillus were both negative. Hepatic venous outflow obstruction was excluded by several radiological examinations. Because of the presence of polyneuropathy, organomegaly, endocrine abnormality, M-protein, plasma cell dyscrasia, and skin lesions, POEMS, syndrome was diagnosed; this had caused the refractory ascites. Initial prednisolone therapy was effective for the refractory ascites, but it was not effective in preventing recurrence. He died due to cachexia in December 2000. This is a very rare case of the presence of both PCD and POEMS syndrome in a patient.

Background: In pathological states various cytokines are produced by mesangial cells (MC) and contribute to disease progression. It is likely that interactions between monocytes and MC partially regulate these cytokines, including hepatocyte growth factor (HGF). Because HGF might have a potent therapeutic effect on the kidney, it is believed to play a critical role in the pathogenesis and development of glomerulonephritis. However, there is little knowledge about HGF production by MC or infiltrated monocytes in glomerulonephritis. Methods: To investigate HGF expression in pathological states, we cultured human MC (hMC) with a human monocytoid cell line and assessed HGF mRNA expression and protein production. Next, we performed immunohistochemical staining to explore which types of cell in the co-culture system expressed HGF. Because several humoral factors that can induce HGF production have been reported, we also performed noncontact co-culture to explore the contribution of humoral factors. Results: The HGF concentration of the co-culture system showed a time-dependent increase, and was fourfold greater than that of hMC alone. Expression of HGF mRNA was also increased. Both THP-1 cells and hMC in the co-culture demonstrated staining of HGF. The HGF concentration in the noncontact co-cultures was smaller than in the ordinary ones, but was greater than hMC alone. Conclusion: Direct cell-to-cell interaction between hMC and monocytes induced HGF production of both types of cells, indicating that local HGF production induced by cell-to-cell interaction plays an important role in the pathogenesis of glomerulonephritis. While direct cell-to-cell contact was important for HGF production, it is considered that some humoral factors might contribute.