Smartphone Use Is Associated with Low Prevalence of Locomotive Syndrome among Elderly Individuals with Musculoskeletal Disorders.

Objectives: Physical activity management through smartphone applications is increasing worldwide; however, it is unclear whether smartphone users among elderly Japanese individuals with musculoskeletal disorders are less likely to experience "locomotive syndrome" (LoS). We aimed to test the hypothesis that LoS in smartphone users had lower prevalence than that in non-smartphone users among elderly individuals with musculoskeletal disorders. Methods: Elderly participants, aged ≥60 years, who visited the outpatient clinic were enrolled. All participants were asked whether or not they used smartphones and were allocated into either the smartphone group or the non-smartphone group. After completing the 25-question Geriatric Locomotive Function Scale (GLFS-25), LoS prevalence was determined by 3-stage cutoff values of the GLFS-25 score (≥7, ≥16, and ≥24), and the total and three subdomain scores (body pain, movement-related difficulty, and psychosocial complications) were compared between the two groups. Generalized linear regression was then performed to confirm whether the use of smartphones was associated with lower GLFS-25 scores, even after controlling for confounders. Results: Overall, 266 participants, aged ≥60 years, were recruited. LoS prevalence was significantly higher in the non-smartphone group than in the smartphone group at all stages (all p < 0.001). Mean GLFS-25 total and subdomain scores were significantly lower in the smartphone group than in the non-smartphone group (all p < 0.001), and these statistical relationships were maintained even after controlling for age and sex. Conclusions: Smartphone use was associated with low LoS prevalence and low GLFS-25 scores among elderly individuals with musculoskeletal disorders, although the causal relationship remains unclear.

Does the timing of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder affect the clinical outcome?

BACKGROUND: Although the clinical outcomes of manipulation under ultrasound-guided fifth and sixth cervical nerve root block for frozen shoulder have been reported, few studies have focused on the timing of manipulation. This study aimed to determine whether the timing of manipulation impacts the clinical outcomes. METHODS: We retrospectively reviewed the outcomes of 103 frozen shoulder patients (mean age 51.5 years) who underwent manipulation in one shoulder (n = 103 shoulders) between January 2012 and April 2019. Stiff shoulder was defined as limited range of motion in at least three directions, i.e., passive forward flexion of ≤100°, passive external rotation at the side of ≤10°, and internal rotation of ≤L5. The patients were categorized into two groups: those mobilized within 6 months after symptom onset (early group, 44 shoulders) and those mobilized >6 months after symptom onset (late group, 59 shoulders). The range of motion (forward flexion, external rotation, and internal rotation), Japanese Orthopaedic Association shoulder scores, Constant Shoulder Score, and University of California, Los Angeles scores before and 3, 6, and 12 months after manipulation were compared between groups. RESULTS: The late group exhibited significant improvement in forward flexion, external rotation, internal rotation, Japanese Orthopaedic Association scores, Constant Shoulder Score, and University of California, Los Angeles scores at 3 months; forward flexion at 6 months; and forward flexion and University of California, Los Angeles scores at 12 months after manipulation compared to the early group. CONCLUSIONS: Our results indicate that timing has a significant influence on the outcome of manipulation for frozen shoulders. The optimal time for manipulation may be >6 months after symptom onset. These findings can be applied in counselling for frozen shoulder patients and for improved outcomes after manipulation.

Purity Determination of Cyclophosphamide Hydrate by Quantitative 31P-NMR and Method Validation.

Recently, quantitative NMR (qNMR), especially 1H-qNMR, has been widely used to determine the absolute quantitative value of organic molecules. We previously reported an optimal and reproducible sample preparation method for 1H-qNMR. In the present study, we focused on a 31P-qNMR absolute determination method. An organophosphorus compound, cyclophosphamide hydrate (CP), listed in the Japanese Pharmacopeia 17th edition was selected as the target compound, and the 31P-qNMR and 1H-qNMR results were compared under three conditions with potassium dihydrogen phosphate (KH2PO4) or O-phosphorylethanolamine (PEA) as the reference standard for 31P-qNMR and sodium 4,4-dimethyl-4-silapentanesulfonate-d6 (DSS-d6) as the standard for 1H-qNMR. Condition 1: separate sample containing CP and KH2PO4 for 31P-qNMR or CP and DSS-d6 for 1H-qNMR. Condition 2: mixed sample containing CP, DSS-d6, and KH2PO4. Condition 3: mixed sample containing CP, DSS-d6, and PEA. As conditions 1 and 3 provided good results, validation studies at multiple laboratories were further conducted. The purities of CP determined under condition 1 by 1H-qNMR at 11 laboratories and 31P-qNMR at 10 laboratories were 99.76 ± 0.43 and 99.75 ± 0.53%, respectively, and those determined under condition 3 at five laboratories were 99.66 ± 0.08 and 99.61 ± 0.53%, respectively. These data suggested that the CP purities determined by 31P-qNMR are in good agreement with those determined by the established 1H-qNMR method. Since the 31P-qNMR signals are less complicated than the 1H-qNMR signals, 31P-qNMR would be useful for the absolute quantification of compounds that do not have a simple and separate 1H-qNMR signal, such as a singlet or doublet, although further investigation with other compounds is needed.

Absolute Purity Determination of a Hygroscopic Substance, Indocyanine Green, Using Quantitative NMR (qNMR).

Quantitative NMR (qNMR) is applied to determine the absolute quantitative value of analytical standards for HPLC-based quantification. We have previously reported the optimal and reproducible sample preparation method for qNMR of hygroscopic reagents, such as saikosaponin a, which is used as an analytical standard in the assay of crude drug section of Japanese Pharmacopoeia (JP). In this study, we examined the absolute purity determination of a hygroscopic substance, indocyanine green (ICG), listed in the Japanese Pharmaceutical Codex 2002, using qNMR for standardization by focusing on the adaptation of ICG to JP. The purity of ICG, as an official non-Pharmacopoeial reference standard (non-PRS), had high variation (86.12 ± 2.70%) when preparing qNMR samples under non-controlled humidity (a conventional method). Additionally, residual ethanol (0.26 ± 0.11%) was observed in the non-PRS ICG. Next, the purity of non-PRS ICG was determined via qNMR when preparing samples under controlled humidity using a saturated sodium bromide solution. The purity was 84.19 ± 0.47% with a lower variation than that under non-controlled humidity. Moreover, ethanol signal almost disappeared. We estimated that residual ethanol in non-PRS ICG was replaced with water under controlled humidity. Subsequently, qNMR analysis was performed when preparing samples under controlled humidity in a constant temperature and humidity box. It showed excellent results with the lowest variation (82.26 ± 0.19%). As the use of a constant temperature and humidity box resulted in the lowest variability, it is recommended to use the control box if the reference ICG standard is needed for JP assays.

Determination of troglitazone stereoisomers in rat plasma using semi-micro HPLC with electrochemical detection.

A highly sensitive determination method for troglitazone stereoisomers was developed by high-performance liquid chromatography with electrochemical detection (HPLC-ECD). The oxidation behavior of troglitazone was investigated for the application of ECD by measuring the cyclic voltammogram. The separation was performed on a semi-micro chiral column (Chiralcel OJ-RH) using a mobile phase consisting of methanol-acetic acid (1000:1, v/v) containing 50mM LiClO4 at a flow rate of 20 microl/min. The peak areas of the stereoisomers separated from 0.1 to 50 ng/ml of troglitazone had good linearity with correlation coefficients of >0.999, and had similar response. The limit of detection was 1.3 fmol (signal-to-noise ratio of 3). This method was applied to the determination of troglitazone stereoisomers in rat plasma. The levels of troglitazone stereoisomers in rat plasma could be monitored until 24h after the oral administration.

Determination of catechins in human plasma after commercial canned green tea ingestion by high-performance liquid chromatography with electrochemical detection using a microbore column.

Determination of catechins in human plasma was carried out by high-performance liquid chromatography with electrochemical detection using a microbore octadecylsilica column. Peak heights for catechins were found to be linearly related to the amount of each catechin injected, from 2 pmol/ml to 2 nmol/ml (r>0.999). Conjugated-form catechins in plasma were hydrolyzed enzymatically using beta-glucuronidase and sulfatase. Catechins in plasma and the hydrolyzed solution were extracted with ethyl acetate and determined by the present method. The time courses of concentrations of catechins in human plasma showed maxima at 1-2 h after ingestion of 340 ml of commercial canned green tea.