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Anhydrous and water-assisted proton mobility in phosphotungstic acid.

Nonlocal gradient-corrected density functional theoretical calculations were used to determine the energetics associated with proton migration in phosphotungstic acid. The activation energy for anhydrous proton hopping between two oxygen atoms on the exterior of the molecular Keggin unit was calculated to be 103.3 kJ mol(-1). The quantum-tunneling effect on the rate of proton movement was determined using semiclassical transition-state theory and was found to be a major contributor to the overall rate of proton movement at temperatures below approximately 350 K. The adsorption of water on an acidic proton decreases the activation barrier for hopping to 11.2 kJ mol(-1) by facilitating proton transfer along hydrogen bonds. The overall rate constant for proton hopping was determined as a function of temperature and water partial pressure. Small amounts of water greatly enhance the overall rate of proton movement.

Journal Article↗

Dynamic NMR study of the mechanisms of double, triple, and quadruple proton and deuteron transfer in cyclic hydrogen bonded solids of pyrazole derivatives.

Using dynamic solid state (15)N CPMAS NMR spectroscopy (CP = cross polarization, MAS = magic angle spinning), the kinetics of the degenerate intermolecular double and quadruple proton and deuteron transfers in the cyclic dimer of (15)N labeled polycrystalline 3,5-diphenyl-4-bromopyrazole (DPBrP) and in the cyclic tetramer of (15)N labeled polycrystalline 3,5-diphenylpyrazole (DPP) have been studied in a wide temperature range at different deuterium fractions in the mobile proton sites. Rate constants were measured on a millisecond time scale by line shape analysis of the doubly (15)N labeled compounds, and by magnetization transfer experiments on a second timescale of the singly (15)N labeled compounds in order to minimize the effects of proton-driven (15)N spin diffusion. For DPBrP the multiple kinetic HH/HD/DD isotope effects could be directly obtained. By contrast, four rate constants k(1) to k(4) were obtained for DPP at different deuterium fractions. Whereas k(1) corresponds to the rate constant k(HHHH) of the HHHH isotopolog, an appropriate kinetic reaction model was needed for the kinetic assignment of the other rate constants. Using the model described by Limbach, H. H.; Klein, O.; Lopez Del Amo, J. M.; Elguero, J. Z. Phys. Chem. 2004,218, 17, a concerted quadruple proton-transfer mechanism as well as a stepwise consecutive single transfer mechanism could be excluded. By contrast, using the kinetic assignment k(2) approximately k(3) approximately k(HHHD) approximately k(HDHD) and k(3) approximately k(HDDD) approximately k(DDDD), the results could be explained in terms of a two-step process involving a zwitterionic intermediate. In this mechanism, each reaction step involves the concerted transfer of two hydrons, giving rise to primary kinetic HH/HD/DD isotope effects, whereas the nontransferred hydrons only contribute small secondary effects, which are not resolved experimentally. By contrast, the multiple kinetic isotope effects of the double proton transfer in DPBrP and of the triple proton proton transfer in cyclic pyrazole trimers studied previously indicate concerted transfer processes. Thus, between n = 3 and 4 a switch of the reaction mechanism takes place. This switch is rationalized in terms of hydrogen bond compression effects associated with the multiple proton transfers. The Arrhenius curves of all processes are nonlinear and indicate tunneling processes at low temperatures. In a preliminary analysis, they are modeled in terms of the Bell-Limbach tunneling model.

Journal Article↗

Location, acid strength, and mobility of the acidic protons in Keggin 12-H3PW12O40: a combined solid-state NMR spectroscopy and DFT quantum chemical calculation study.

Solid-state 13C NMR experiments and quantum chemical Density Functional Theory (DFT) calculations of acetone adsorption were used to study the location of protons in anhydrous 12-tungstophosphoric acid (HPW), the mobility of the isolated and hydrated acidic protons, and the acid strength heterogeneity of the anhydrous hydroxyl groups. This study presents the first direct NMR experimental evidence that there are two types of isolated protons with different acid strengths in the anhydrous Keggin HPW. Rotational Echo DOuble Resonance (REDOR) NMR experiments combined with quantum chemical DFT calculations demonstrated that acidic protons in anhydrous HPW are localized on both bridging (Oc) and terminal (Od) atoms of the Keggin unit. The CP/MAS NMR experiments revealed that the isolated acidic protons are immobile, but hydrated acidic protons are highly mobile at room temperature. The isotropic chemical shift of the adsorbed acetone suggested that the acid strength of the H(H2O)n+ species in partially hydrated HPW is comparable to that of a zeolite, while the acidity of an isolated proton is much stronger than that of a zeolite. Isolated protons on the bridging oxygen atoms of anhydrous HPW are nearly superacidic.

Journal Article↗

Modeling of protonation processes in acetohydroxamic acid

This work presents a theoretical study of acetohydroxamic acid and its protonation processes using ab initio methodology at the MP2(FC)/cc-pdVZ level. We find the amide form more stable than the imidic tautomer by less than 1.0 kcal mol(-)(1). For comparison with the experimental data, a three-dimensional conformational study is performed on the most stable tautomer (amide). From this study, the different barriers to rotation and inversion are determined and the intramolecular hydrogen bond between the OH group and the carbonyl oxygen is characterized. The electrostatic potential distribution shows three possible sites for electrophilic attack, but it is shown that only two of them, the carbonyl oxygen and the nitrogen atoms, are actual protonation sites. The protonation energy (proton affinity) is obtained from the results of the neutral and charged species. Proton affinities for the species charged on the carbonyl oxygen and the nitrogen atoms are estimated to be 203.4 and 194.5 kcal mol(-)(1), respectively. The development of a statistical model permits the quantification of DeltaG (gas-phase basicity) for the two protonation processes. In this way, the carbonyl oxygen protonated form is found to be more stable than that of the nitrogen atoms by 8.3 kcal mol(-)(1) at 1 atm and 298.15 K, due to the enthalpic contribution. As temperature increases, the proportion of the nitrogen protonated form increases slightly.

Journal Article↗

Effects of Gas-Phase Basicity on the Proton Transfer between Organic Bases and Trifluoroacetic Acid in the Gas Phase: Energetics of Charge Solvation and Salt Bridges.

The unimolecular dissociation pathways and kinetics of a series of protonated trimer ions consisting of two organic bases and trifluoroacetic acid were investigated using blackbody infrared radiative dissociation. Five bases with gas-phase basicities (GB) ranging from 238.4 to 246.2 kcal/mol were used. Both the dissociation pathways and the threshold dissociation energies depend on the GB of the base. Trimers consisting of the two most basic molecules dissociate to form protonated base monomers with an E(0) ~ 1.4 eV. Trimers consisting of the two least basic molecules dissociate to form protonated base dimers with an E(0) ~ 1.1-1.2 eV. These results indicate that the structures of the trimers change as a function of the GB of the basic molecule. The predominant structure of the protonated trimers consisting of the two most basic molecules is consistent with a salt bridge in which both of the basic molecules are protonated, and the trifluoroacetic acid molecule is deprotonated, whereas the predominant structure of the protonated trimers consisting of the two least basic molecules are consistent with charge-solvated complexes in which the proton is shared. The structure of the trimer consisting of the base of intermediate basicity is less clear; it dissociates to form primarily protonated base dimer, but has an E(0) ~ 1.2 eV. These results are consistent with the structure of this trimer as a salt bridge, but the resulting dissociation A(-). BH(+) product does not appear to be stable as an ion pair in the dissociative transition state.

Journal Article↗

Sensitivity of MRI to proteoglycan depletion in cartilage: comparison of sodium and proton MRI.

OBJECTIVE: The purpose of this work was to evaluate the results from sodium and proton magnetic resonance imaging (MRI) in detecting small changes in proteoglycan (PG) content in bovine articular cartilage specimens. DESIGN: Articular cartilage from 15 specimens of bovine patellae were subjected to partial PG depletion with different concentrations of trypsin for 30 min. Sodium and proton MR images of the intact specimen were obtained on a 4T GE clinical MRI system. Two custom-built 7 cm-diameter solenoid coils tuned to proton and sodium frequencies were employed. Fast gradient echo and spin echo imaging sequences were used to determine sodium density, proton density and proton relaxation times (T(1)and T(2)) of the specimens. Spectrophotometric assay was performed after MRI to determine PG concentrations of the cartilage specimens. RESULTS: The sodium signal change correlated well with the observed PG loss (R(2)=0.85, P< 0.01) whereas the proton signal change was inconsistent (R(2)=0.10, P< 0.8). The change in proton T(1)and T(2)between the two regions did not correlate with PG loss (R(2)=0. 07 and R(2)=0.06, respectively). CONCLUSIONS: Results from these studies demonstrate that sodium MRI is both sensitive and specific in detecting small changes in PG concentration, whereas proton density and relaxation properties are not sensitive to small changes in PG content.

Animals↗

Tritium exchange on transfer RNA: slowly exchanging protons sensitive to a change in the dihydrouridine stem.

Measurements of tritium exchange on tRNA were made for periods from 0.5 min to 8 hr after separation from labeled solvent. The exchange curve was analysed in terms of three kinetic classes of exchanging protons with half-lives of 5 hr (12 protons), 0.54 hr (37 protons) and about 3.5 min (58 protons) at 0 degrees C in 0.14 M K+/10 mM Mg2+. The behaviour under varying ionic conditions of protons in the slowest exchange class and of some protons in the intermediate class suggests that they are dependent on the tertiary structure of the molecule. Moreover, in the same range of exchange times characteristic of these latter protons, about 9 more protons were observed in the case of a mutant form of tRNA Trp, the UGA-suppressor species, than in the wild-type tRNATrp. These two species differ only in base 24 in the dihydrouridine stem. This dynamic difference between the wild-type and suppressor species may be related to a functionally important difference in coupling between the conformation of the molecule and interactions at the anticodon.

Escherichia coli↗

Unusual proton exchange properties of Z-form poly[d(G-C)].

Real-time solvent-exchange NMR has been used to study the proton exchange in Z-form poly[d(G-C)]. In 4.5 M NaCl the most slowly exchanging protons (about two orders of magnitude slower than in B-DNA) are identified as the guanine imino proton and the cytosine amino proton hydrogen bonded to the guanine carbonyl. Both protons exchange at the same rate and the exchange follows single-exponential kinetics and cannot be catalyzed, implying that the exchanges of the two protons both occur from the same transient solvent-exposed state. The exchange depends strongly on temperature and the activation energy for exchange ( approximately 22 kcal/mol) is the same as the activation energy for the B --> Z transition. The rate of proton exchange is identical with the B --> Z transition rate, both measured in 4.5 M NaCl. The correlation between the B --> Z kinetics and the proton exchange also extends to 3.25 M NaClO(4) solutions, in which both rates are 5 times faster. This unexpected parallelism between the B --> Z transition kinetics and the Z exchange kinetics indicates that the rate-limiting steps in the two processes are similar.

Journal Article↗

Simultaneous monitoring of light-induced changes in protein side-group protonation, chromophore isomerization, and backbone motion of bacteriorhodopsin by time-resolved Fourier-transform infrared spectroscopy.

Absorbance changes in the infrared and visible spectral range were measured in parallel during the photocycle of light-adapted bacteriorhodopsin, which is accompanied by a vectorial proton transfer. A global fit analysis yielded the same rate constants for the chromophore reactions, for protonation changes of protein side groups, and for the backbone motion. From this result we conclude that all reactions in various parts of the protein are synchronized to each other and that no independent cycles exist for different parts. The carbonyl vibration of Asp-85, indicating its protonation, appears with the same rate constant as the Schiff base deprotonation. The carbonyl vibration of Asp-96 disappears, indicating most likely its deprotonation, with the same rate constant as for the Schiff base reprotonation. This result supports the proposed mechanism in which the protonated Schiff base, a deprotonated aspartic acid (Asp-85) on the proton-release pathway, and a protonated aspartic acid (Asp-96) on the proton-uptake pathway act as internal catalytic proton-binding sites.

Journal Article↗

A proton magnetic resonance and a circular dichroism study of the solvent dependent conformation of the synthetic tubulin fragment Ac tubulin, alpha (430-441) amide and its interaction with substance-P.

Proton magnetic resonance techniques were used to study the conformation of the synthetic tubulin fragment Ac-tubulin (430-441) amide in H2O and 80% CD3OH/20% D2O solutions, using water suppression techniques. Proton assignments are based on two-dimensional COSY experiments combined with one-dimensional spin decoupling. A comparison of the NH proton shifts between the two solvents, namely delta(CD3OH/H2O-H2O) shows a small solvent effect for the Lys1 to Val6 region of the molecule, whereas for Gly7 to Glu12 the solvent effect is much larger. The smaller effects in the region of Lys1 to Val6 may be due to some hydrogen bonding as these protons are shielded from the solvent. These conclusions are in agreement with the circular dichroism results in 80% methanol/20% water where the alpha helix is present to the extent of 30%, whereas the peptide is completely unstructured in water with some aggregation. The temperature dependence of the NH proton shifts was also carried out. In water these shifts are of the order of 7-9 X 10(-3) ppm/K indicating that most of the protons are not involved in hydrogen bonding. In CD3OH/H2O, these values range from about 4-6 X 10(-3) ppm/K, which are compatible with the presence of hydrogen bonds. Finally, binding studies were carried out between the tubulin peptide and the undecapeptide neutrotransmitter substance P. The largest shifts are for the Tyr3 NH proton of the tubulin fragment, whereas for substance P it is for the Lys3, Gln5 and Leu10 NH protons, indicating a change in conformation of both peptides on interaction.

Circular Dichroism↗

Modification of Sulfhydryl Groups in the [gamma]-Subunit of Chloroplast-Coupling Factor 1 Affects the Proton Slip through the ATP Synthase.

A large proton leak not coupled to ATP synthesis (slip) occurs at alkaline pH through the chloroplast ATP synthase (Y. Evron, M. Avron [1990] Biochim Biophys Acta 1019: 115-120). The involvement of the ATP synthase [gamma]-subunit in the regulation of proton conductance was analyzed by measuring the effect of thiolalkylating agents on proton slip. Alkylation by N-ethylmaleimide of [gamma]-cysteine (Cys)-89, which is exposed upon energization of thylakoids, increases the slip only at alkaline pH. The slip is partially suppressed by low concentrations of adenine nucleotides and is completely eliminated by venturicidin, a blocker of the hydrophobic polypeptide complex of the chloroplast ATP synthase (CF0). Conversely, cross-linking of [gamma]-Cys-89 with [gamma]-Cys-322 renders the ATP synthase leaky to protons and insensitive to ATP also at neutral pH. The accessibility of [gamma]-Cys-89 to alkylation by fluorescein maleimide is completely suppressed by N,N-dicyclohexylcarbodiimide and by venturicidin, which block proton conductance through CF0 and increase the pH gradient. These results suggest that the [gamma]-subunit has a dominant role in proton gating through the ATP synthase and responds to changes in pH and ligands taking place on either side of the thylakoid membrane. It is proposed that the conformational changes that induce the proton slip and the exposure of [gamma]-Cys-89 reflect the conversion of the enzyme from a catalytically latent to an active state, and depend on the deprotonation of a stromal site at alkaline pH and on protonation of an intrathylakoid inner site upon energization. Therefore, conditions that induce the conformational activation also provide the driving force for ATP synthesis.

Journal Article↗

Localization of the proton pump of corn coleoptile microsomal membranes by density gradient centrifugation.

Previous studies characterizing an ATP-dependent proton pump in microsomal membrane vesicles of corn coleoptiles led to the conclusion that the proton pump was neither mitochondrial nor plasma membrane in origin (Mettler, Mandala, Taiz 1982 Plant Physiol 70: 1738-1742). To facilitate positive identification of the vesicles, corn coleoptile microsomal membranes were fractionated on linear sucrose and dextran gradients, with ATP-dependent [(14)C]methylamine uptake as a probe for proton pumping. On sucrose gradients, proton pumping activity exhibited a density of 1.11 grams/cubic centimeter and was coincident with the endoplasmic reticulum (ER). In the presence of high magnesium, the ER shifted to a heavier density, while proton pumping activity showed no density shift. On linear dextran gradients, proton pumping activity peaked at a lighter density than the ER. The proton pump appears to be electrogenic since both [(14)C]SCN(-) uptake and (36)Cl(-) uptake activities coincided with [(14)C] methylamine uptake on dextran gradients. On the basis of density and transport properties, we conclude that the proton pumping vesicles are probably derived from the tonoplast. Nigericin-stimulated ATPase activity showed a broad distribution which did not coincide with any one membrane marker.

Journal Article↗

Kinetic analysis of proton transport by the vanadate-sensitive ATPase from maize root microsomes.

Proton transport by the nitrate-insensitive, vanadate-sensitive ATPase in Kl-washed microsomes and reconstituted vesicles from maize (Zea mays L.) roots was followed by changes in acridine orange absorbance in the presence of either KNO(3) or KCl. Data from such studies obeyed a kinetic model in which net proton transport by the pump is the difference between the rate of proton transport by the action of the ATPase and the leak of protons from the vesicles in the direction opposite from the pump. After establishing the steady state proton gradient, the rate of return of transported protons was found to obey first-order kinetics when the activity of the ATPase was completely and rapidly stopped. The rate of return of these protons varied with the quencher used. When the substrate Mg:ATP was depleted by the addition of either EDTA or hexokinase, the rate at which the proton gradient collapsed was faster than when vanadate was used as the quencher. These trends were independent of the anion accompanying the K and the transport assay used.

Journal Article↗

Protons suppress the dark current of frog retinal rods.

Outer segments of rod photoreceptors with the attached ellipsoid region of the inner segment were isolated from Rana pipiens retinae, and their membrane photocurrents measured with the suction electrode technique in the 'ellipsoid-in' configuration. Under dark adapted conditions in standard Ringer solution, isolated rod outer segments with ellipsoids exhibited maximal photocurrents of 10-30 pA, and light sensitivities of 0.2-1.0 pA/isomerization. A local perfusion technique was employed to change rapidly the solution bathing the outer segment. Rods were tested for their sensitivity to protons by perfusion with Ringer solution of altered pH. The dark current was reversibly suppressed by low pH: in Ringer solution with Calcium activity aCa = 10(-3)M dark current suppression obeyed a hyperbolic saturation law with apparent dissociation constant, pKa = 4.8. The decay of dark current of rods following poisoning with ouabain was retarded by low pH perfusion, as it was by light. Protons thus act to suppress the outer segment Na+ conductance. Three experiments support the hypothesis that protons act interior to the plasma membrane in suppressing the dark current. (1) Perfusion of rods at constant pH with Ringer solution having increased CO2 suppressed the dark current. (2) Removal of perfusate containing 50 mM-NH4Cl causes transient dark current suppression. (3) Acetate, which acts as a neutral proton carrier, when added to Ringer solution, shifts the apparent pKa of dark current suppression to a higher pH. Dark current suppression by protons and recovery occurred with a time constant of ca. 1 s. Low pH perfusion retarded the recovery of the dark current from a saturating flash, slowed the light response in its linear range, and increased light sensitivity. Perfusion at pH = 10.5 caused a slight increase in dark current, sped up the recovery of the rod from a saturating flash, accelerated the linear response and decreased the light sensitivity. Lowering aCa of the Ringer solution caused the proton sensitivity of the dark current to drop. At aCa = 5 X 10(-6) M the apparent pKa of dark current suppression was shifted about 0.8 pH units to pH = 4.0. Cells at aCa = 10(-9) M were insensitive to pH = 3.5, which completely suppressed the dark current at normal aCa. Lowered aCa decreased light sensitivity. Both proton sensitivity and light sensitivity of dark current suppression were estimated for each member of a population of rods in various aCaS:proton sensitivity and light sensitivity were found to be linearly correlated over a range of 3 log units.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

Contribution of mitochondrial proton leak to skeletal muscle respiration and to standard metabolic rate.

We have tested the hypothesis that the leak of protons across the mitochondrial inner membrane (proton leak) is a significant contributor to standard metabolic rate (SMR). We found that proton leak accounts for around one-half of the resting respiration rate of perfused rat skeletal muscle. Proton leak is known to make a significant (26%) contribution to the resting respiration rate of isolated rat hepatocytes (M. D. Brand, L.-F. Chien, E. K. Ainscow, D. F. S. Rolfe, and R. K. Porter. Biochim. Biophys. Acta 1187: 132-139, 1994). If the importance of proton leak in these isolated and perfused systems is similar to its importance in vivo, then using literature values for the contribution of liver and skeletal muscle to SMR, we can calculate that proton leak in liver and skeletal muscle alone accounts for 11-26% (mean 20%) of the SMR of the rat. If proton leak activity in the other tissues of the rat is similar to that in liver cells, then the contribution of proton leak to rat SMR would be 16-31% (mean 25%).

Adenosine Triphosphate↗

Strategy for structure elucidation of drug metabolites derived from protonated molecules and (MS)n fragmentation of zotepine, tiaramide and their metabolites.

TSQ ESI MS/MS and ion trap ESI MS(2) cleave protonated molecules. MS(2) at m/z 332 of zotepine cleaved m/z 245 (10%), m/z 287 (5%) and m/z 315 (100%) fragment ions at protonated positions. MS(2) at m/z 356 of tiaramide cleaved m/z 338 (18%), 313 (10%), 226 (100%), 198 (78%) and 131 (60%) fragment ions at protonated positions. The ESI ion trap MS produced new internal protonated molecules in an ion trap, such as m/z 113 and m/z 88 from m/z 131 protonated piperazinonium, and m/z 245 protonated 8-chloro dibenzo[b,f]thiepin. ESI ion trap (MS)(n) (n>or=3) cleaved new internal protonated molecules. It also causes carbocation cleavage, alpha cleavage, onium cleavage and McLafferty cleavage. We can easily elucidate the structure of metabolites from the difference in m/z of corresponding fragments between unchanged compound and its metabolite. Reactive oxygen diradicals involved in cytochrome P-450 cycles react with electron rich groups and reactive C-H bonds of zotepine and tiaramide to produce metabolites of 2-hydroxyzotepine, 3-hydroxyzotepine, norzotepine, zotepine-N-oxide, zotepine-S-oxide, Tiaramide carboxylic acid, dehydroxyethyltiaramide and tiaramide-N-oxide. The strategy for structure elucidation of drug metabolites was established on the basis of the reactivity of unchanged drug with reactive oxygen diradicals involved in cytochrome P-450 cycles and theory associated with protonated molecules and (MS)(n) fragmentation of drug metabolites.

Journal Article↗

Effectiveness of revascularization surgery evaluated by proton magnetic resonance spectroscopy and single photon emission computed tomography.

Proton magnetic resonance spectroscopy (MRS) and single photon emission computed tomography (SPECT) were used to evaluate chronic ischemic regions in 26 stroke patients before and 1, 3, and 6 months after revascularization surgery. The volume of interest for proton MRS was placed in an area including part of the frontal and temporal opercula, insular cortex, and basal ganglia. Twenty healthy volunteers served as controls for proton MRS. Patients were divided into three groups according to the preoperative proton MRS. Group A (n = 12) had significantly lower N-acetylaspartate/choline (NAA/Cho) and N-acetylaspartate/creatine (NAA/Cr) ratios on the operative side compared to those on the contralateral side, and also lower than those in normal subjects. In seven patients in Group A, postoperative serial proton MRS demonstrated no recovery of these ratios on the operative side. However, proton MRS of the other five patients indicated gradual improvement in these ratios on the operative side at 3 to 6 months after surgery, and SPECT indicated an increase in cerebral blood flow on the operative side in four of these five patients. In Group B (n = 9), proton MRS and SPECT showed no laterality before revascularization and no remarkable change during the postoperative course. In Group C (n = 5), NAA/Cho or NAA/Cr decreased on the contralateral side preoperatively. Two patients showed fluctuating values of NAA/Cho or NAA/Cr during the postoperative period. Serial proton MRS and SPECT studies may be useful for the evaluation of revascularization surgery on ischemic regions. The efficacy of revascularization surgery on the metabolism may appear gradually within 3-6 months.

Adolescent↗

The addition of the Protonics brace system to a rehabilitation protocol to address patellofemoral joint syndrome.

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To investigate the clinical efficacy of the addition of the Protonics system to a standard exercise-based patellofemoral rehabilitation protocol. BACKGROUND: The Protonics system has been suggested as an intervention for patients with patellofemoral pain syndrome (PFPS). However, the effects of this system have not been compared to the effects associated with traditional exercise-based rehabilitation alone. METHODS AND MEASURES: Seventeen of 34 females (mean age, 28 years; range, 13-55 years) diagnosed with PFPS were randomly assigned to wear the Protonics system while participating in a conventional exercise-based rehabilitation program. Functional and patient-reported outcome measures were evaluated, including Kujala score and the lateral step-up test. In addition, measurements of hip internal and external rotation, hip extension, and iliotibial band muscle length were compared between groups. RESULTS: Patients in both groups demonstrated improvement in Kujala score (P<.001), performance on the lateral step-up test (P<.001), and pain during the step-up test (P<.001) at the conclusion of the study. However, there was no difference between groups with respect to improvement in Kujala score (P = .33), step-up test performance (P = .47), or pain during the step-up test (P = .24). Patients using the Protonics system demonstrated greater gain in passive hip extension (P = .023) and increased hip external rotation motion (P = .017) at discharge versus patients treated with exercise alone. However, there was no difference in iliotibial band flexibility (P = .80) or hip internal rotation motion (P = .09) between groups. A greater proportion of patients in the Protonics group reported no pain with step-up testing at each 2-week interval. However, the 2.2 fewer visits required by patients in the Protonics group to meet discharge criteria did not achieve statistical significance (P = .08). CONCLUSIONS: Patients using the Protonics system demonstrated a shift in available hip rotation and increased passive hip extension flexibility. However, these changes were not outside the bounds of potential measurement error and did not translate into significant functional differences from a similar group treated with exercise alone. The economic implications of an average 2.2-visit decrease in treatment sessions per patient using the Protonics system are uncertain.

Adolescent↗