Nutritional Status Is Associated With Survival Following Spinal Surgery in Patients With Metastatic Spinal Tumors.

Background Preoperative and postoperative nutritional statuses are reported to influence the outcomes and complications of multidisciplinary treatment, including patient survival. However, a causal relationship between nutritional status and survival following spinal surgery has not been demonstrated in patients with metastatic spinal tumors. The present study was, therefore, designed to evaluate the correlation between the nutritional status and survival following spinal surgery in patients with metastatic spinal tumors. Methods Nutritional status was evaluated using the Japanese version of the modified Glasgow prognostic score (JmGPS), C-reactive protein-to-albumin ratio (CAR), prognostic nutrition index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), which were calculated from the results of preoperative laboratory tests. The survival period was defined as the interval between the day preoperative data were obtained and the day of death. Results Data from 57 of 113 consecutive surgeries were retrieved. The CAR, JmGPS, and PNI were significantly correlated with the survival period (CAR, r = -0.576, P < 0.01; JmGPS, r = -0.537, P < 0.01; PNI, r = 0.316, P = 0.02). Furthermore, patients with 0 points on the JmGPS had significantly longer survival. Using receiver operating characteristic curves, CAR cutoffs of ≥0.880 and ≤0.220 were found to be optimal in predicting the 90- and 180-day postoperative survival, respectively. Conclusions The findings of the present study indicate that preoperative assessment of the JmGPS, CAR, and PNI has utility in estimating nutritional status and predicting survival following spinal surgery in patients with metastatic spinal tumors.

Effects of sturgeon fillet intake on top-ranked Japanese female long-distance runners.

AIMS: The aim of this study is to investigate whether consumption of sturgeon fillets reduces the oxidative stress marker urinary 8-hydroxy-2'-deoxyguanosine (8OHdG) in top-ranked Japanese female long-distance runners. METHODS: In a before-and-after study, nine professional long-distance female athletes ate 100 g/day of sturgeon fillets for 2 weeks. Urinalysis (8OHdG, an oxidative stress marker, and creatinine), blood tests (fatty acids and 25-hydroxyvitamin D [25OHD]), exercise intensity, subjective fatigue, muscle elasticity, muscle mass, body fat mass, and nutritional intake using image-based dietary assessment (IBDA) were compared before, immediately after, and 1 month after the intervention. RESULTS: Consumption of sturgeon fillets suppressed 8OHdG (p < 0.05) in the increased exercise intensity female athletes. Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and 25OHD levels in blood increased from before to immediately after and 1 month after the intervention (p < 0.05). IBDA showed that intake of n-3 fatty acid increased after and one month after the intervention, whereas DHA, imidazole dipeptide and vitamin D intake increased after the intervention (p < 0.05) and then decreased after 1 month (p < 0.05). There were no significant changes in subjective fatigue, muscle elasticity, muscle mass, and body fat. CONCLUSIONS: The results suggest that eating sturgeon fillets during intense training may increase blood levels of EPA, DHA, and 25OHD, which may suppress urinary oxidative stress (8OHdG) in top-ranked Japanese long-distance runners.

Synthesis of cinchona urea polymers using Yamamoto coupling and their application to asymmetric reaction.

Cinchona urea compounds having 3,5-diiodophenyl moieties were subjected to Yamamoto coupling polymerization to afford the chiral urea polymers. These polymers showed high activities as heterogeneous catalysts in asymmetric Michael reactions comparable with those of the corresponding monomeric catalyst in solution systems. Furthermore, the polymeric catalysts are easily recovered from their reaction mixtures due to their insolubility and can be reused several times without loss of catalytic activity.

Active Consumption of Konjac and Konjac Products Improves Blood Glucose Control in Patients with Type 2 Diabetes Mellitus.

OBJECTIVE: Konjac is a food mainly consumed in Asian countries with high fiber and low energy. Although glucomannan, a component of konjac, have been used for several clinical studies, there is few reports using konjac itself. This study examined the effects of the active consumption of konjac in patients with type 2 diabetes mellitus (T2DM). METHODS: The study included 26 Japanese patients with T2DM. Participants were recommended to take konjac at least once a day using free konjac products (various noodles, rice, and desserts) and plate konjac for 12 weeks. RESULTS: HbA1c and fasting plasma glucose levels significantly decreased from 8.3 ± 0.9% to 8.0 ± 0.8% and from 173.2 ± 44.4 to 152.8 ± 36.7 mg/dL, respectively. No significant changes were observed in body weight and insulin resistance indices, but the index for insulin secretion significantly increased. Serum high molecular weight adiponectin levels significantly increased. Plasma ghrelin, leptin and glucagon-like peptide-1 levels tended to decrease (p = 0.084), decrease (p = 0.057) and increase (p = 0.071), respectively. Actual konjac intake positively correlated with age (r = 0.61, p = 0.001). Body weight and HbA1c significantly decreased in patients aged ≥50 years than in those aged <50 years, and the changes significantly inversely correlated with age. CONCLUSION: Active consumption of konjac and konjac products seems to be a useful dietary therapy with multifaceted action for T2DM. Further studies with greater sample size and long-term are needed to confirm these findings.

Simple production of resilin-like protein hydrogels using the Brevibacillus secretory expression system and column-free purification.

Resilin, an insect structural protein, has excellent flexibility, photocrosslinking properties, and temperature responsiveness. Recombinant resilin-like proteins (RLPs) can be fabricated into three-dimensional (3D) structures for use as cell culture substrates and highly elastic materials. A simplified, high-yielding production process for RLPs is required for their widespread application. This study proposes a simple production process combining extracellular expression using Brevibacillus choshinensis (B. choshinensis) and rapid column-free purification. Extracellular production was tested using four representative signal peptides; B. choshinensis was found to efficiently secrete Rec1, an RLP derived from Drosophila melanogaster, regardless of the type of signal peptide. However, it was suggested that Rec1 is altered by an increase in the pH of the culture medium associated with prolonged incubation. Production in a jar fermentor with controllable pH yielded 530 mg Rec1 per liter of culture medium, which is superior to productivity using other hosts. The secreted Rec1 was purified from the culture supernatant via (NH4 )2 SO4 and ethanol precipitations, and the purified Rec1 was applied to ring-shaped 3D hydrogels. These results indicate that the combination of secretory production using B. choshinensis and column-free purification can accelerate the further application of RLPs.

Synthesis of homo- and copolymer containing sulfonic acid via atom transfer radical polymerization.

Well-defined functional poly(p-phenyl styrenesulfonate) and poly(p-phenyl styrene-sulfonate-co-styrene) were successfully synthesized by the atom transfer radical polymerization (ATRP) using CuBr/bpy(PMDETA) catalyst and 1-phenylethyl bromide (1-PEBr) as an ATRP initiator in diphenyl ether (DPE) or dimethyl formamide (DMF). In both homo- and copolymers, the CuBr/PMDETA catalytic system in DPE or DME showed higher yield than CuBr/bpy and the polydispersity index (PDI) of polymer was low. Using PMDETA or bpy as a ligand in DMF, the high yield with high PDI was obtained than in DPE. We found that the CuBr/PMDETA catalyzed ATRP of p-phenyl styrenesulfonate and copolymerization with styrene comonomer in DPE proceeded in a controlled manner. The polymers containing sulfonic acid were obtained by the chemical deprotection of protecting group, followed by acidification. The molecular structure, molecular weights and thermal properties of the copolymers were determined by nuclear magnetic resonance (1H NMR) spectroscopy, Fourier transform infrared (FT-IR) spectroscopy, size exclusion chromatography (SEC), differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA), respectively.

Supramalleolar Lateral Opening-Wedge Osteotomy in Conjunction With Progressive Collapsing Foot Deformity Reconstruction for PCFD With Ankle Instability.

BACKGROUND: Reconstruction of progressive collapsing foot deformity (PCFD) with ankle instability (PCFD class E) remains a substantial challenge to orthopaedic surgeons. We report the outcomes of PCFD class E treated by means of a relatively standard PCFD foot reconstruction approach with the addition of a supramalleolar lateral opening-wedge osteotomy. METHODS: We conducted a retrospective study of 13 patients (15 ankles) who underwent this procedure for PCFD class E between 2010 and 2021. Mean follow-up time was 3.8 (range, 2-6.3) years. Clinical assessment was based on the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale as well as a Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Radiographic assessments, including identification of the mechanical ankle joint axis point and a modified valgus Takakura-Tanaka osteoarthritis grade, were recorded. RESULTS: The mean JSSF score improved significantly from 45.2 preoperatively to 83.9 postoperatively (P < .001). SAFE-Q scores at the final follow-up were 70.1 for the pain and pain-related subscale, 75.4 for the physical functioning and daily living subscale, 83.0 for the social functioning subscale, 74.4 for the shoe-related subscale, and 78.1 for the general health and well-being subscale. Radiographic measurements showed improvement in the tibiotalar tilt angle (average improvement: 5.4 degrees); orientation of the talus joint line relative to the ground (average improvement: 14.0 degrees); anteroposterior talus-first metatarsal angle (average improvement: 11.2 degrees), talonavicular coverage angle (average improvement: 21.6 degrees), and lateral talus-first metatarsal angle (average improvement: 17.0 degrees). Postoperatively, the mechanical ankle joint axis point moved medially for all patients and into the medial half of the ankle joint for 7 patients. The modified osteoarthritis stage improved postoperatively in most cases. CONCLUSION: In this select and relatively small group of patients who had a supramalleolar lateral opening-wedge osteotomy combined with PCFD reconstruction, we measured general improvement in JSSF scores and radiographic variables. Long-term durability of the procedure remains unknown. This procedure may be an option for preserving the ankle joint in treatment of PCFD class E with osteoarthritis of the ankle. LEVEL OF EVIDENCE: Level IV, therapeutic.

Analysis of Whole Limb Alignment in Ankle Arthritis.

A full-length standing posteroanterior radiograph that includes the calcaneus (hip-to-calcaneus radiograph) is obtained for evaluation of the mechanical axis of the entire lower limb in patients with a lower limb condition involving malalignment. Such evaluation clarifies several pathomechanical aspects of hindfoot disorders, facilitates surgical planning, and elucidates factors contributing to unsatisfactory results of a particular operation. Whole limb alignment is influenced not only by the knee joint but also by the ankle joint; thus, knee realignment influences hindfoot alignment and vice versa. It is essential to analyze alignment of the whole limb in planning corrective lower limb surgery.

Mechanism of posterior malleolar fracture of the ankle: A cadaveric study.

OBJECTIVES: Ankle fracture treatment involves reduction of the bone fragments and stabilization of the joint by reversing the mechanics of injury. For posterior malleolar fracture however, the true mechanism is not understood, leading to a lack of consistent guidance on how to best treat this injury. METHODS: Fifteen cadaver ankles were subjected to fracture loading that replicated the Lauge-Hansen pronation-external rotation mechanism. An axial load was applied to each specimen, which was mounted on a materials testing machine, and the foot was rotated externally to failure. Digital video cameras recorded the failure sequence of specific anatomic structures. RESULTS: Posterior malleolar fracture occurred in 7 specimens. Of these, 1 was an intra-articular fracture, another was a fracture involving the entire posterior tibial margin consisting of 2 fragments: that of the posterior tubercle and that of the posteromedial margin of the tibial plafond, with the former judged to be a consequence of avulsion by the posterior inferior tibiofibular ligament and the latter a consequence of axial loading from the talus. In the remaining 5 specimens, the posterior malleolar fracture was a small extra-articular avulsion fracture. CONCLUSIONS: Fractures at the posterolateral corner of the distal tibia were shown to be avulsion fractures attributed to the posterior inferior tibiofibular ligament and produced by external rotation of the talus. A fracture involving the entire posterior tibial margin consisting of 2 fragments can be produced by a combination of avulsion by the posterior inferior tibiofibular ligament and axial loading from the talus.

Fixation of the osteochondral talar fragment yields good results regardless of lesion size or chronicity.

PURPOSE: Osteochondral talar lesions, regardless of their size and/or chronicity, are, at our hospital, now treated by fixation of the fragment if the talar dome cartilage is judged to be healthy. The retrospective study described herein was conducted to assess clinical outcomes of this treatment strategy. METHODS: The study group comprised 44 patients (18 men and 26 women) with 45 such talar lesions. In all cases, the osteochondral fragment was reduced and fixed with bone harvested from the osteotomy site and shaped into peg(s) (one to four pegs per lesion). Median follow-up was 2.1 years (1-9 years). The lesion area was measured on computed tomography arthrographs, and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale was used to evaluate postoperative outcomes. Clinical failure was defined as a JSSF score < 80 points. RESULTS: The mean JSSF score improved significantly from 63.5 points preoperatively to 93.0 postoperatively (p < 0.001). Treatment failure occurred in only one ankle (0.02%). The mean lesion area was 51.2 mm2 (range 5-147 mm2). Correlation between lesion areas and the postoperative JSSF scores was weak (r = - 0.133). Correlation between the time of the trauma to the time of fixation surgery and the postoperative JSSF scores was also weak (r = 0.042). Radiographic outcomes were good for 28 ankles, fair for 10, and poor for 7. CONCLUSION: Fixation of the lesion fragment, regardless of size and/or chronicity, appears to be appropriate in cases of an osteochondral talar lesion. LEVEL OF EVIDENCE: IV.

Anatomical Pathology of Subtle Lisfranc Injury.

The extent and patterns of Lisfranc joint complex disruption in subtle Lisfranc injuries have not been well clarified. We reviewed the direct intraoperative findings for 87 patients, examined computed tomography images that had been obtained preoperatively for 73 of the patients, and classified the injuries according to the Kaar  et al. criteria as the transverse type (instability between the first cuneiform [C1] and the second metatarsal [M2] and between the second cuneiform [C2] and M2) or longitudinal type (instability between C1 and M2 and between C1 and C2). Our patients' injuries were classified as follows: longitudinal type (38%), transverse type (30%), transverse type and first tarsometatarsal (TMT) joint injury (20%), longitudinal type plus transverse type (7%), longitudinal type and first TMT joint injury (3%), and longitudinal type, transverse type, and first TMT joint injury (2%). In 11 patients, the longitudinal injury extended into the naviculo-first cuneiform joint. In 41 (56%) of the 73 patients for whom CT images were obtained, 1 or more fractures (not counting small avulsion fragments between C1 and M2) were found. Orthopedic surgeons should be aware of the various injury patterns possible in cases of subtle Lisfranc injury.

Study on the performance of methyl methacrylate polymerization: Comparison of partially oxidized tri-n-butylborane and benzoyl peroxide with aromatic tertiary amines.

In this study, we examined the polymerization performance of methyl methacrylate (MMA) initiated with partially oxidized tri-nbutylborane (TBBO) compared to that initiated with benzoyl peroxide and aromatic tertiary amine (BPO/amine) system. In the bulk polymerization of MMA at 37°C, conversion initiated with TBBO after 3 h was nearly quantitative, whereas the conversion with the BPO/amine system was low (~20%). The number-averaged and weight-averaged molecular weight of the TBBO-initiated polymer was more than twice as high as that of the BPO/amine-initiated polymer. Electron spin resonance (ESR) analysis of MMA polymerization indicated that the TBBO-initiated system maintained its radical intensities for a longer period than the BPO/amine-initiated system. Furthermore, the radical fragments in the TBBO-initiated PMMA after 72 h were still active as a polymerization initiator for MMA. These findings suggest that the polymerization mechanism of MMA initiated by TBBO functions as a living-like polymerization initiator.

T1ρ mapping of articular cartilage grafts after autologous osteochondral transplantation for osteochondral lesions of the talus: A longitudinal evaluation.

BACKGROUND: Clinical results of autologous osteochondral transplantation (AOT) for treatment of osteochondral lesions of the talus have been mixed. T1ρ imaging can be used to noninvasively detect early cartilage degeneration. PURPOSE OR HYPOTHESIS: To quantitatively assess, by means of T1ρ imaging, changes over time in the biochemical health of grafted cartilage after AOT for osteochondral lesions of the talus. STUDY TYPE: Retrosepctive case series. POPULATION: The study group comprised nine patients who underwent AOT for an osteochondral lesion of the talus and in whom T1ρ mapping was performed 1 and 2 years postoperatively. FIELD STRENGTH/SEQUENCE: 3 Tesla. T1ρ-weighted turbo field echo. ASSESSMENT: The mean T1ρ value of full-thickness cartilage at the repair site and that of full-thickness cartilage elsewhere in the same image (far-field cartilage) were determined. Clinical assessment was based on the American Orthopaedic Foot & Ankle Society (AOFAS) scale. Correlation between the T1ρ ratios (grafted-to-far-field cartilage T1ρ values) and clinical outcomes was examined. STATISTICAL TESTS: Mixed effects model. Pearson correlation analysis. RESULTS: At 1 year, a significant difference existed between the mean T1ρ value of the grafted cartilage (57.0 ± 7.7 ms) and that of the far-field cartilage (41.8 ± 4.6 ms) (P < 0.001). At 2 years, the mean T1ρ value of the grafted cartilage (49.1 ± 6.4 ms) was significantly lower than that at 1 year (P = 0.011). Moderate negative correlation was found between the 1-year T1ρ ratio and 1-year AOFAS score (r = -0.60) and between the 2-year T1ρ ratio and 2-year AOFAS score (r = -0.50). DATA CONCLUSION: Our observation of substantial restoration of the proteoglycan content of the grafted cartilage approximately 2 years after AOT for osteochondral lesions of the talus indicates that the content changes gradually and that the cartilage reparation process is slower than previously believed. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2018;48:398-403.

Responsiveness of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) in patients with hallux valgus.

BACKGROUND: In this study, we investigated the responsiveness of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) for patient's assessment before and after hallux valgus surgery. METHODS: Patient-reported answers on the SAFE-Q and Short Form-36 (SF-36) before and at a mean of 3-4 and 9-12 months after hallux valgus surgery were analyzed. Data of 100 patients (92 women, eight men) from 36 institutions throughout Japan were used for analysis. RESULTS: In all subscales of the SAFE-Q, the trend of increased scores after surgery was statistically significant (P < 0.001). Among the patients with available scores both before and at 9-12 months after surgery (n = 66), the largest effect sizes (ESs) were observed for shoe-related (1.60), pain and pain-related (1.05), and general health and well-being (0.84) scales. In the SF-36 (n = 64), the largest ES was observed for the bodily pain scale (0.86). Less notable changes were observed for the remaining SF-36 domains. CONCLUSION: The SAFE-Q is the first patient-reported outcome measure which includes a quality of life assessment of shoes. In our cohort, the most remarkable responsiveness was observed for the shoe-related subscale. Based on its responsiveness, the SAFE-Q appears to be sufficient for evaluation of foot-related quality of life before and after surgery.

Design of peptide-containing N5-unmodified neutral flavins that catalyze aerobic oxygenations.

Simulation of the monooxygenation function of flavoenzyme (Fl-Enz) has been long-studied with N5-modified cationic flavins (FlEt+ ), but never with N5-unmodified neutral flavins (Fl) despite the fact that Fl is genuinely equal to the active center of Fl-Enz. This is because of the greater lability of 4a-hydroperoxy adduct of Fl, FlOOH , compared to those of FlEt+ , FlEtOOH , and Fl-Enz, FlOOH-Enz. In this study, Fl incorporated into a short peptide, flavopeptide (Fl-Pep), was designed by a rational top-down approach using a computational method, which could stabilize the corresponding 4a-hydroperoxy adduct (FlOOH-Pep) through intramolecular hydrogen bonds. We report catalytic chemoselective sulfoxidation as well as Baeyer-Villiger oxidation by means of Fl-Pep under light-shielding and aerobic conditions, which are the first Fl-Enz-mimetic aerobic oxygenation reactions catalyzed by Fl under non-enzymatic conditions.

Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle.

BACKGROUND: We determined the preoperative and postoperative passing points of the mechanical axis of the lower limb at the level of the tibial plafond using a new method involving a full-length standing posteroanterior radiograph that includes the calcaneus (a hip-to-calcaneus radiograph) and correlated them to the clinical results after supramalleolar osteotomy for ankle osteoarthritis. METHODS: We reviewed the hip-to-calcaneus radiographs of fifty lower limbs of forty-one patients treated for lower limb malalignment at our institution. The mechanical axis point of the ankle was the point at which the mechanical axis divides the coronal length of the plafond, expressed as a percentage. Four independent observers performed all measurements twice. Supramalleolar tibial osteotomy was performed in twenty-seven ankles (twenty-four patients) to treat moderate varus-type osteoarthritis of the ankle. The mean follow-up period was 2.8 years (range, two to 5.3 years). Clinical assessment was based on the American Orthopaedic Foot & Ankle Society (AOFAS) scale. RESULTS: Interobserver and intraobserver reliability in identifying the mechanical ankle joint axis point were very high. The mean postoperative mechanical axis point was 50% (range, 13% to 70%) in ankles for which the preoperative point was ≤0%, whereas the mean postoperative point was 81% (range, 48% to 113%) in ankles for which the preoperative point was >0%. The mean change in AOFAS score was significantly less for patients with a preoperative point of ≤0% than for those with a preoperative point of >0% (p=0.004). Improvement was significantly greater in ankles with a postoperative mechanical ankle joint axis point of ≥80% than in ankles with a postoperative mechanical ankle joint axis point of <60% (p=0.030). CONCLUSIONS: Traditional tibial correction resulted in great variation in the locations of the postoperative mechanical ankle joint axis point. In ankles with the preoperative point more medial than the tibial plafond, the point was insufficiently moved to the lateral side, and the clinical outcomes were less satisfactory.

Validity and reliability of a self-administered foot evaluation questionnaire (SAFE-Q).

BACKGROUND: The Japanese Society for Surgery of the Foot (JSSF) is developing a QOL questionnaire instrument for use in pathological conditions related to the foot and ankle. The main body of the outcome instrument (the Self-Administered Foot Evaluation Questionnaire, SAFE-Q version 2) consists of 34 questionnaire items, which provide five subscale scores (1: Pain and Pain-Related; 2: Physical Functioning and Daily Living; 3: Social Functioning; 4: Shoe-Related; and 5: General Health and Well-Being). In addition, the instrument has nine optional questionnaire items that provide a Sports Activity subscale score. The purpose of this study was to evaluate the test-retest reliability of the SAFE-Q. PATIENTS AND METHODS: Version 2 of the SAFE-Q was administered to 876 patients and 491 non-patients, and the test-retest reliability was evaluated for 131 patients. In addition, the SF-36 questionnaire and the JSSF Scale scoring form were administered to all of the participants. Subscale scores were scaled such that the final sum of scores ranged between zero (least healthy) to 100 (healthiest). RESULTS: The intraclass correlation coefficients were larger than 0.7 for all of the scores. The means of the five subscale scores were between 60 and 75. The five subscales easily separated patients from non-patients. The coefficients for the correlations of the subscale scores with the scores on the JSSF Scale and the SF-36 subscales were all highly statistically significantly greater than zero (p < 0.001). The means for the five JSSF Scale classification groups fell within a relatively narrow range, indicating that the SAFE-Q labels are sufficiently similar to permit their use for all of the JSSF Scale classifications. CONCLUSION: The present study revealed that the test-retest reliability is high for each subscale. Consequently, the SAFE-Q is valid and reliable. In the future, it will be beneficial to test the responsiveness of the SAFE-Q.

Synthesis of main-chain chiral quaternary ammonium polymers for asymmetric catalysis using quaternization polymerization.

Main-chain chiral quaternary ammonium polymers were successfully synthesized by the quaternization polymerization of cinchonidine dimer with dihalides. The polymerization occurred smoothly under optimized conditions to give novel type of main-chain chiral quaternary ammonium polymers. The catalytic activity of the polymeric chiral organocatalysts was investigated on the asymmetric benzylation of N-(diphenylmethylidene)glycine tert-butyl ester.

Design of main-chain polymers of chiral imidazolidinone for asymmetric organocatalysis application.

Main-chain polymers of chiral imidazolidinone were successfully synthesized by reaction of chiral imidazolidinone dimers with disulfonic acid. Chiral imidazolidinones were incorporated into the main-chain of the polymer by ionic bonding. These polymers could be used as polymeric chiral organocatalysts for asymmetric Diels-Alder reactions.

Molecular design of chiral quaternary ammonium polymers for asymmetric catalysis applications.

Repeated reaction between a chiral quaternary ammonium dimer and disodium disulfonate gave a chiral ionic polymer, which showed excellent catalytic activity in the asymmetric benzylation of N-diphenylmethylene glycine tert-butyl ester.