Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial.

BACKGROUND: Although there is some evidence that massage therapy, especially compression at myofascial trigger points (MTrPs), is effective for sub-acute and chronic low back pain, the effectiveness of massage therapy with compression at MTrPs for acute low back pain has not been studied. METHODS: To evaluate the effectiveness of compression at MTrPs for acute low back pain, 63 patients with acute low back pain were randomly assigned to one of three groups: the MTrP group who received compression at MTrPs (N = 23), the non-MTrP group who received compression at non-trigger points (N = 21), and the effleurage massage group who received superficial massage (N = 19). The patients received the assigned treatment 3 times/week for 2 weeks. The subjective pain intensity in static and dynamic conditions and disability caused by low back pain were measured by the visual analogue scale (VAS) and Roland-Morris questionnaire (RMQ), respectively; along with the range of motion (ROM) at the lumbar region and pressure pain threshold (PPT) at trigger points before treatment (baseline), 1 week after the start of treatment, and 1 month after the end of treatment (follow-up). RESULTS: Static and dynamic VAS score, PPT and ROM were significantly improved in the MTrP group compared with those in the non-MTrP and effleurage groups. CONCLUSIONS: These results indicate that compression at MTrPs is effective to treat acute low back pain compared with compression at non-MTrPs and superficial massage. For this article, a commentary is available at the Wiley Online Library.

Hereditary paroxysmal ataxia with mental retardation: a clinicopathological study in relation to episodic ataxia type 2.

A case of hereditary acetazolamide-responsive paroxysmal ataxia with mild mental retardation in an autopsied Japanese man is described. His ataxic attacks had occurred for approximately 65 years since the age of 6. One of his daughters had severe mental retardation and epilepsy, and the other had paroxysmal ataxic attacks and mild mental retardation. Analysis of the subject's CACNA1A gene and that in his daughter revealed neither mutations nor CAG expansion. Neuropathologically, cortical degeneration consisting of the marked loss of Purkinje and granule cells was found exclusively in the cerebellar vermis. This was consistent with findings at autopsy for cases reported as spinocerebellar ataxia 6. In addition, there were minor anomalies, such as hypoplastic cerebellum and brainstem, heterotopic Purkinje cells, and cortical microdysgenesis of the temporal lobe. It is considered that the cerebellar cortical degeneration and the minor malformations found in the brain are closely related to one another, rather than having occurred independently.

Comparison of no airway device, the Guedel-type airway and the Cuffed Oropharyngeal Airway with mask ventilation during manual in-line stabilization.

STUDY OBJECTIVE: To compare two different types of oropharyngeal airway: the Guedel-type oral airway and the Cuffed Oropharyngeal Airway (COPA), with respect to the effectiveness of positive-pressure ventilation (PPV) through a face mask in patients with in-line stabilization of the head and neck. DESIGN: Prospective, randomized, crossover study. SETTING: University hospital. PATIENTS: 30 ASA physical status I and II patients undergoing elective surgery. INTERVENTIONS: General anesthesia was induced with propofol and muscle relaxation was produced with vecuronium. In a random sequence, no airway device, the Guedel-type airway, and the COPA were used in each patient while applying a face mask and lifting the jaw forward. MEASUREMENTS AND MAIN RESULTS: Tidal volumes were measured during PPV in each option. The position of the distal tip of each airway was assessed using a fiberscope, and the resulting views were graded and compared. When the Guedel-type airway was used, tidal volumes (V(T)s; means +/- SD) were significantly greater (12.3 +/- 4.5 mL/kg) than those with no airway device (8.5 +/- 4.5 mL/kg) (p < 0.001). When the COPA was used, V(T)s (14.6 +/- 4.4 mL/kg) were significantly greater than those with the Guedel-type airway (p < 0.05). The grade of the fiberscopic view through the distal tip was significantly better with the COPA than with the Guedel-type airway (p < 0.05). CONCLUSIONS: Although clinical differences often appear trivial, the COPA is more effective on mask ventilation than the Guedel-type airway when used in patients with manual in-line stabilization.

Autonomic failure in ALS with a novel SOD1 gene mutation.

The authors report a patient with ALS and a novel SOD1 gene mutation who was in the totally locked-in state and developed autonomic failure followed by sudden cardiac arrest. A neuropathologic study showed widespread multisystem degeneration, including involvement of the autonomic nuclei in the medulla and spinal cord. SOD1 gene analysis detected a missense mutation of V118L in exon 4. These findings show notable phenotypic heterogeneity for SOD1-associated ALS.

Controlled Formation of Low-Volume Liquid Pillars between Plates with a Lattice of Wetting Patches by Use of a Second Immiscible Fluid.

We describe a method for forming an array of microdroplets between two plates, at least one of which is patterned with a lattice of wetting patches, using a second immiscible fluid to control droplet formation. The method may be useful for performing multiple, small-volume biochemical reactions in parallel. We analyze the forces responsible for droplet formation, describe results of a computer simulation using Surface Evolver, and derive an analytic criterion for droplet formation in terms of the contact angles of the droplet:second fluid interface on the wetting patches and surrounding surface, the diameter of the wetting patches, the distance between wetting patches, and the distance between the plates. Copyright 1999 Academic Press.

Bond-specific chemical cleavages of peptides and proteins with perfluoric acid vapors: novel peptide bond cleavages of glycyl-threonine, the amino side of serine residues and the carboxyl side of aspartic acid residues.

Peptide bond cleavages by vapors composed of various from aqueous solutions of perfluoric acid were studied using synthetic peptides and proteins, and specific conditions were established for peptide bond cleavages including a novel cleavage of the glycyl-threonine bond. The peptide bonds on the aminosides of serine residues were cleaved by exposure to a vapor of 75% aqueous heptafluorobutyric acid at 30 or 50 degrees C for 24 h. Glycyl-threonine peptide bonds were cleaved with vapors of various concentrations (5, 75, and 90%) of heptafluorobutyric acid at 30-40 degrees C for 24 h. The peptide bonds on the carboxylsides of aspartic acid residues were cleaved by exposure to a vapor of 0.2% heptafluorobutyric acid at 90 degrees C for 4 to 24 h. The same vapor cleaved aspartyl-proline bonds under milder conditions such as at 60 degrees C for 16 h, under which the other aspartyl bonds were uncleaved. These specific chemical cleavages were applied to several proteins including newly characterized proteins.

Vocal cord abductor paralysis (VCAP) in Parkinson's disease: difference from VCAP in multiple system atrophy.

Vocal cord abductor paralysis (VCAP) is rare in Parkinson's disease (PD), while it is frequent in multiple system atrophy (MSA). Although VCAP is a life-threatening complication it has not yet been clarified whether there is any difference in the mechanism of VCAP between PD and MSA. Examining 3 autopsy-proven PD patients who developed severe VCAP requiring tracheostomy, we found the following differences in the mechanism of VCAP between MSA and PD: (1) clinical and laryngofiberscopic examination showed that VCAP in PD was not exacerbated during sleep, unlike in MSA; (2) On histological examination of the intrinsic laryngeal muscles, the posterior cricoarytenoid muscle demonstrated no abnormalities in PD, while the muscle showed characteristic neurogenic atrophy in MSA. There seemed to be two types of VCAP, namely the nonparalytic type observed in PD, and the paralytic type observed in MSA. Severe dysphagia requiring tube-feeding was common among PD patients who presented with VCAP. Although the relationship between VCAP and dysphagia is unknown, one should be aware of the possibility of fatal VCAP in PD patients with severe dysphagia.

Carboxy-terminal degradation of peptides using perfluoroacyl anhydrides. A C-terminal sequencing method.

An accurate carboxy-terminal sequencing method has long been sought to complement the Edman degradation procedure for amino-terminal amino acid sequence analysis. The method presented here is a unique and simple method to partly fulfill the needs. Exposure of a polypeptide to perfluoroacyl anhydride vapor at -20 degrees C for 0.5-1 h causes sequential chemical degradation of the molecule from the C-terminus. Fast-atom-bombardment mass spectrometric analysis of the resultant mixture of C-terminally truncated molecules permits the determination of the C-terminal sequence by simple calculation of the mass differences in molecular ions. Experiments suggested that this C-terminal degradation proceeds by active intermediates such as oxazolone at the C-terminal carboxyl residues.

[Neuroleptic malignant syndrome associated with the syndrome of inappropriate secretion of antidiuretic hormone].

We reported a case of neuroleptic malignant syndrome (NMS) associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A 71-year-old woman, who had been diagnosed as hypertension and multiple cerebral infarction, was given sulpiride 150 mg daily for depressive state. Three days after started sulpiride, she developed fever, sweating, difficulty of movement and was admitted to the hospital. The white blood cell count rose to 16,300/mm3 and serum creatine kinase (CK) to 3,063 IU/L. Two days later CK rose to 20,050 IU/L regardless of stopping the drug, so she was transferred to our hospital for further investigation. On admission, it was the 6th day from the onset, she was mute and akinetic accompanied by muscle pain and rigidity in extremities. Serum CK was 1,831 IU/L, Na 122 mEq/L, osmolality 244 mOsm/kg, plasma antidiuretic hormone (ADH) level 6.5 pg/ml and urine Na was 101 mEq/L, osmolality 467 mOsm/kg. Renal and adrenal functions, plasma renin activity were normal. From the history, course and these data, diagnosis of NMS associated with SIADH was made. Intravenous sodium (130-200 mEq/day) and fluids (1,000-1,200 ml/day) were carefully infused. She became active, muscle pain disappeared and rigidity, akinesia decreased. CK, serum Na and osmolality gradually improved to normal. About the transient increase in ADH secretion, we considered that hypothalamic disturbance in NMS might induce leakage of stored ADH from neuroendocrine neurons in it.

Expression of octopus rhodopsin in Escherichia coli.

Apoproteins, having various molecular weights, of octopus rhodopsin (oRh, 455 amino acids), which is a typical transmembrane protein, were expressed in Escherichia coli with an inducible expression system using promoter phi 10 of the T7 phage. Fifteen synthetic genes (212-1,365 bp) for oRh (1) were cloned downstream from gene 10 of the T7 phage (846 bp), under the control of promoter phi 10. An expression vector for mature oRh containing no extra peptide resulting from gene 10 was also constructed. Protein productivities were mainly evaluated by ELISA using monoclonal antibodies. The expression level in E. coli of the fused oRh genes varied between 1 and 200 mg/liter of the culture medium (from approximately 0.25 to 50% of the total cell protein, respectively), depending on the fused oRh genes. The amount of mature oRh protein expressed in E. coli was approximately 0.1 to 1 mg/liter. Hydropathy index analysis of gene products showed a significant negative correlation (rho = - 0.63) between expression level of oRh gene products in E. coli and their hydrophobic characteristics. Wavelength shifting of the absorption maximum by exogenous addition of retinal to apoprotein similar to that of authentic oRh was demonstrated in the membrane fraction of E. coli expressing mature opsin.

C-terminal sequencing of protein. A novel partial acid hydrolysis and analysis by mass spectrometry.

Peptides or proteins were hydrolyzed by vapors of 90% pentafluoropropionic acid or heptafluorobutyric acid at 90 degrees C for various time periods. The hydrolyzate mixtures analyzed by both fast-atom-bombardment and electrospray ionization mass spectrometry showed a series of C-terminal successive degradation molecular ions. The degradation reaction may be due to the selective formation of an oxazolone ring at the C-terminal amino acid, followed by hydrolytic removal of the C-terminal amino acid. The major side reactions were cleavages of the peptide bonds at the C side of the internal aspartic acid residue and the N side of serine residue.

Total synthesis of a gene for octopus rhodopsin and its preliminary expression.

To carry out systematic structure-function studies of octopus rhodopsin, photoreceptor protein of octopus visual cells, by means of specific amino-acid replacements, we have totally synthesized a DNA duplex of 1,365 base pairs that encodes the entire octopus rhodopsin of 455 amino acids [Ovchinnikov et al. (1988) FEBS Lett. 232, 69-72] by introducing codons preferred in Escherichia coli. Total synthesis simplifies site-specific mutagenesis in all parts of the gene by replacement of short restriction fragments by their newly synthesized counterparts containing the required nucleotide alterations. Thirty unique restriction sites were introduced in the octopus rhodopsin gene, which was assembled on a plasmid in two steps. Five cartridge genes of 344, 296, 320, 212, and 317 base pairs capable of being expressed independently were first constructed by using 48 synthetic oligonucleotides ranging in size from 54 to 73 nucleotides. The entire gene was constructed by consecutive linkage of cartridge genes. These cartridge genes were designed to correspond to the transmembrane helical unit of octopus rhodopsin, resulting in easy construction of various chimeric rhodopsins. The nucleotide sequences were confirmed by sequencing the cartridges as well as the entire gene. These synthetic genes were cloned into an expression vector carrying the trp promoter of E. coli, and were preliminarily expressed in vitro and in vivo.

The role of catalase in protecting erythrocytes against methemoglobin formation.

Some mechanisms to reduce methemoglobin (metHb) formation for the maintenance of normal oxygen transport have been proposed. To study the role of catalase (EC 1.11.1.6), metHb formation in the hemolysate of normal and Japanese acatalasemic human subjects were examined spectrophotometrically. Significantly increased level of metHb was induced by potassium ferrocyanide in the hemolysate of acatalasemic subject. The addition of catalase reduced the metHb formation, while 3-amino-1,2,4-triazole (AT), a specific inhibitor of catalase-H2O2 compound I, increased it. These results obtained from human subjects were well consistent with those from mice and suggested that catalase plays a role in protecting erythrocytes against metHb formation.

[An approach to development of skeletal malocclusion with mandibular lateral displacement].

Mandibular lateral displacement (MLD) is a result of temporarily accelerated growth of unilateral condyle. Structure of lower face of typical mandibular lateral displacement malocclusion was analysed by means of modified denture frame analysis. Results of measurement indicated that noteworthy present on difference of maxillary occlusal plane between right and left dentitions. It suggested that the MLD malocclusion result from unilateral elongation of the molars due to posterior discrepancy and functional displacement of mandible associated with the differential condylar growth.

[Morphological feature and incidence of TMJ disorders in mandibular lateral displacement cases].

In the malocclusion with mandibular lateral displacement (MLD), it is difficult to establish the functional occlusion by orthodontic means. The careful diagnosis brings us to recognize that MLD condition is the rule rather than the exception. In order to examine the characteristics of the cranio-facial morphology in the cases with MLD, the posteroanterior cephalograms were analyzed. Furthermore, the incidence of temporomandibular joint (TMJ) disorders (joint sound and joint pain) were examined clinically. The results were as follows: 1) Occlusal plane and mandibular plane (the plane running through the anti-gonialnotch bilaterally) inclined superiorly toward the mandibular displaced side. 2) The position of mandibular head shifted to the opposite direction of the mandibular displaced side. 3) The symptoms of TMJ disorders were found in 65.0% of patients with MLD, and more frequently at the TMJ of mandibular displaced side. Considering the evidences, the symptoms of TMJ disorders were much detected and occlusal deviation was found in MLD, it is suggested that mandibular dysfunctions derived from occlusal problems relate to the appearance of MLD. Since both the mandibular plane and the occlusal plane revealed the similar changes in response to mandibular deviation, it is considered that the condition of MLD as skeletal problem may be induced by the functional lateral shift of mandibular position come from occlusal interference during growth period. The deviation of mandibular head may relate to the appearance of TMJ disorders in MLD. Therefore, it is important to recognize the adequate mandibular position prior to occlusal reconstruction, and the vertical dimension control of the occlusal plane is necessary for improving the condition of TMJ and establishing the functional occlusion in the cases with MLD.