Observation using thermography of post-operative reaction after fascial manipulation®.

INTRODUCTION AND OBJECTIVE: Fascia Manipulation® is one of the methods focusing on the deep fascia. The assumption is that fascial manipulation is carried out on precisely determined points - coordination centres (cc), and on a limited area so as the friction occurring during manipulation would cause a local rise in temperature due to the inflammatory reaction. Rise in temperature influences modification in consistency of elementary matter in the manipulated area, and by the same token causing a decrease in the negative effects of fascia densification which stems from accumulation of hyaluronic acid. The purpose of the research is to prove the thesis that fascial manipulation causes local rise in temperature due to inflammatory reaction. MATERIAL AND METHODS: For the research, 25 individuals with densification in lower limb area were qualified. They were exposed to a single, 3-minute facial manipulation®. By means of a thermal-imaging camera, changes in the temperature of the body in the examined area were evaluated. The body's temperature evaluation was carried out 8 times: before the treatment, 5 minutes after the treatment, and, next, 6, 12, 18, 24, 36, 48 hours after the treatment. RESULTS: The average surface temperature of the treated area before mobilization was 33.4°C. A statistically relevant increase in temperature was already observed 5 minutes after the treatment (increase of 0.5°C; p<0.001). However, the highest temperature was observed 24 hours after mobilization (increase of 2.4°C). The difference between the first and 7 other measurements was statistically relevant (p<0.001). CONCLUSIONS: The statistically relevant increase in temperature under the influence of fascial manipulation® in the treatment area can confirm the occurrence of inflammatory reaction.

Functioning in the emotional sphere and ways of coping with chronic connective tissue disease.

Chronic illness is a strong stressor, and its occurrence in human life forces the individual to make adaptive changes. The aim of the study was to evaluate the reactions, behaviors, and emotional states of a person in the face of systemic connective tissue disease and ways of coping with this difficult situation. The method of choice was an individual case study. The subject was a 41-year-old patient, diagnosed with diffuse systemic sclerosis (dSSc) 8 years previously. The patient was characterized by lowered self-esteem, the presence of depressive symptoms, low level of hope for success, a reduced sense of competence, a tendency to use stress coping strategies focused on emotions and dominance of anxiety and tension. Emotional stress coping strategies, low level of hope for success, and non-acceptance attitude predispose the person suffering from systemic sclerosis (SSc) to exhibit depressive symptoms.

Process-related impurities of eplerenone: determination and characterisation by HPLC methods and Raman spectroscopy.

Two novel high-performance liquid chromatography methods for the determination of process-related impurities of eplerenone drug substance and the designated starting material were developed and validated. Process impurities, including stereoisomers of eplerenone and the intermediate, were controlled using a Kromasil C18 column (250 mm x 4.6 mm; particle size 5 µm), under gradient conditions. Simple mobile phases: water and acetonitrile, as well as a PDA detector set at 240 nm were used. In order to control the stereochemical purity of the starting material (SM) in the eplerenone synthesis the polysaccharide-based Kromasil 5-AmyCoat chiral stationary phase was applied. To confirm the identity of the process-related impurities (nine compounds) Raman Spectroscopy (RS), as a fast and convenient method, was applied. Differences in the wavenumbers of CC and CO stretching vibrations were the most distinctive features for the identification by means of RS. The bands assignment was supported by quantum mechanical computations. For one pair of the epimers containing the hydroxyl group the O-H…O bond geometry was correlated with the wavenumbers of stretching vibrations of this group. Wherever possible, experimental results were compared with literature data.

Synthesis and Physicochemical Characterization of the Process-Related Impurities of Olmesartan Medoxomil. Do 5-(Biphenyl-2-yl)-1-triphenylmethyltetrazole Intermediates in Sartan Syntheses Exist?

During the process development for multigram-scale synthesis of olmesartan medoxomil (OM), two principal regioisomeric process-related impurities were observed along with the final active pharmaceutical ingredient (API). The impurities were identified as N-1- and N-2-(5-methyl-2-oxo-1,3-dioxolen-4-yl)methyl derivatives of OM. Both compounds, of which N-2 isomer of olmesartan dimedoxomil is a novel impurity of OM, were synthesized and fully characterized by differential scanning calorimetry (DSC), infrared spectroscopy (IR), nuclear magnetic resonance spectroscopy (NMR) and high-resolution mass spectrometry/electrospray ionization (HRMS/ESI). Their ¹H, (13)C and (15)N nuclear magnetic resonance signals were fully assigned. The molecular structures of N-triphenylmethylolmesartan ethyl (N-tritylolmesartan ethyl) and N-tritylolmesartan medoxomil, the key intermediates in OM synthesis, were solved and refined using single-crystal X-ray diffraction (SCXRD). The SCXRD study revealed that N-tritylated intermediates of OM exist exclusively as one of the two possible regioisomers. In molecular structures of these regioisomers, the trityl substituent is attached to the N-2 nitrogen atom of the tetrazole ring, and not to the N-1 nitrogen, as has been widely reported up to the present. This finding indicates that the reported structural formula of N-tritylolmesartan ethyl and N-tritylolmesartan medoxomil, as well as their systematic chemical names, must be revised. The careful analysis of literature spectroscopic data for other sartan intermediates and their analogs with 5-(biphenyl-2-yl)tetrazole moiety showed that they also exist exclusively as N-2-trityl regioisomers.