[Chronic low back pain: exercise therapy, multidisciplinary programs, NSAID's, back schools and behavioral therapy effective; traction not effective; results of systematic reviews]. / Chronische lage rugpijn: oefentherapie, multidisciplinaire programma's, NSAID's, rugscholing en gedragstherapie effectief en tractie niet effectief; resultaten van systematische reviews.

OBJECTIVE: To inventory the current state of the art regarding the effectiveness of conservative treatment of chronic low back pain. DESIGN: Systematic reviews. METHOD: The relevant literature from the period January 1966-September 1999 was retrieved via Medline, Embase, PsychLit and the Cochrane Library and via reference lists in the articles found. The methodological quality of the studies was assessed using criteria for internal validity. On the basis of the number of examinations, their quality and the consistency of the findings, conclusions were subdivided into four levels of strength of scientific evidence. RESULTS: There was strong evidence that exercise therapy and multidisciplinary treatment programmes were effective in chronic low back pain, and moderate evidence that non-steroidal anti-inflammatory drugs (NSAIDs), back schools and behavioural therapy were effective in chronic low back pain. There was also strong evidence that traction was not effective in chronic low back pain. Strong evidence for effectiveness of many other commonly used interventions was lacking.

High-performance liquid-chromatographic-atmospheric-pressure chemical-ionization ion-trap mass-spectrometric identification of isomeric C6-hydroxy and C20-hydroxy metabolites of methylprednisolone in the urine of patients receiving high-dose pulse therapy.

Fourteen metabolites of methylprednisolone have been analysed by gradient-elution high-performance liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS). The compounds were separated on a Cp Spherisorb 5 microm ODS column connected to a guard column packed with pellicular reversed phase. The mobile phase was an acetonitrile- 1.0% aqueous acetic acid gradient at a flow rate of 1.5 mL min(-1) The analysis gave a complete picture of parent drug, prodrugs and metabolites, and the alpha/beta stereochemistry was resolved. The short (1-2 h) elimination half-life of methylprednisolone is explained by extensive metabolism. The overall picture of the metabolic pathways of methylprednisolone is apparently simple-reduction of the C20 carbonyl group and further oxidation of the C20,C21 side chain (into C21COOH and C20COOH), in competition with or in addition to oxidation at the C6 position.

Separation and characterisation of bovine histone H1 subtypes by combined ion-exchange and reversed-phase chromatography and mass spectrometry.

In order to separate and identify histone H1 subtypes from calf thymus we used both electrospray mass spectrometry (ES-MS) and matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF-MS) after a three-step chromatographic procedure consisting of reversed-phase high-performance liquid chromatography (RP-HPLC), size-exclusion chromatography (SEC) and ion-exchange chromatography (IEC). Under the RP-HPLC conditions described, we obtained two baseline-separated H1-fractions which were characterised by MALDI-TOF-MS. The determined masses ranged from 22,850 to 22,590 for the first fraction and from 22,070 to 21,250 for the second fraction. Further, it was shown that the first fraction contained at least four and the second one at least five subtypes of the histone class H1. Four homogeneous pure H1 subtypes were obtained by a combination of IEC followed by SEC and RP-HPLC. The molecular masses of these four subtypes determined by ES-MS were 22,606, 22,761, 21,347 and 21,263. We obtained six additional molecular masses of histone H1 subtypes from three heterogeneous fractions, namely 22,066, 21,802, 20,586 and 19,817 by ES-MS and 22,800 and 22,675 by MALDI-TOF-MS. The retention times of these fractions and the molecular masses were in agreement with the data obtained from RP-HPLC fractions by MALDI-TOF-MS.