Angiotensin receptors in Dupuytren's disease: a target for pharmacological treatment?

BACKGROUND: Attempts at the pharmacological treatment of Dupuytren's disease have so far been unsuccessful, and the disease is not yet fully understood on a cellular level. The Renin-Angiotensin System has long been understood to play a circulating hormonal role. However, there is much evidence showing Angiotensin II to play a local role in wound healing and fibrosis, with ACE inhibitors being widely used as an anti-fibrotic agent in renal and cardiac disease. METHODS: This study was designed to investigate the presence of Angiotensin II receptors 1 (AT1) and 2 (AT2) in Dupuytren's tissue to form a basis for further study into the pharmacological treatment of this condition. Tissue was harvested from 11 patients undergoing surgery for Dupuytren's disease. Each specimen was processed into frozen sections and immunostaining was employed to identify AT1 and AT2 receptors. RESULTS: Immunostaining for AT1 receptors was mildly positive in one patient and negative in all the remaining patients. However, all specimens stained extensively for AT2 receptors. This suggests that the expression of AT2 receptors is more prominent than AT1 receptors in Dupuytren's disease. CONCLUSION: These findings have opened a new avenue for future research involving ACE inhibitors, AT2 agonists, and AT2 antagonists in Dupuytren's disease.

Postsurgical Pyoderma Gangrenosum Versus Necrotizing Fasciitis: Can We Spot the Difference?

BACKGROUND: Pyoderma gangrenosum is a rare noninfectious cutaneous disease characterized by expanding areas of skin ulceration around necrotic centers with purulent debris. Exceptionally, it can be precipitated by surgery alone, and this entity has been described as postsurgical pyoderma gangrenosum (PSPG). Cases of PSPG in the literature are rare. METHODS: We performed a retrospective review of the current literature on PSPG and highlight some observed differences between these conditions. We also present our experience of PSPG imitating an infectious process post reduction mammoplasty. RESULTS: Although PSPG can demonstrate fever, malaise, systemic signs, and serology that mimic the sepsis of necrotizing fasciitis, we identify some features that can aid diagnosis of pyoderma gangrenosum in the absence of pathergy (which is pathognomonic). These include premorbid inflammatory bowel disease, hematological malignancy, or inflammatory polyarthritis; the exquisite and disproportionate pain associated (in particular within surrounding normal skin); symmetrical changes on both breasts; specific histopathological changes with absence of microorganisms; cutaneous wounds demonstrating an ulcerated, violaceous, and undermined edge; and, in this case, bilaterally spared nipple-areola complexes suggesting progression within continuous skin up to but not across incision lines. CONCLUSIONS: We hope that, in encouraging a higher index of suspicion, prompt diagnosis, and accurate treatment, a better outcome for both patient and surgeon can be achieved in future cases.

Autologous fat grafting for scars, healing and pain: a review.

INTRODUCTION: Current guidelines suggest a multimodal approach to treating scars but there is no gold standard for treatment; however, there is exciting therapeutic potential for the use of autologous fat grafting (AFG). Functional and aesthetic improvements have been reported, including pain relief and scar quality improvement. AIMS: To explore the current evidence regarding the use of AFG in hypertrophic and painful scars. METHODS: A systematic review of the literature was conducted using 11 MeSH terms in PubMed, Medline and EMBASE. English studies that used AFG to treat scars in human participants were included. RESULTS: A total of 746 studies were found and 23 studies (from 2008 to 2016) were included: five studies were evidence level V; nine studies were evidence level IV; eight were evidence level III; and one study was evidence level II. A total of 1158 patients were assessed for improvement in scar characteristics including colour, thickness, volume, pain and restoration of function at affected sites, following treatment. Positive outcomes were noted for all parameters and a significant improvement in AFG's analgesic effect was recorded in 567 out of 966 patients, P < 0.05. DISCUSSION: AFG is a minimally invasive and safe approach to treating scars, a promising alternative to surgical excision. The technique of blunt cannula insertion optimises the release of scar retraction, which contributes to the analgesic effect of this treatment method. The evidence supports current theories of mesenchymal stem cell's regenerative and anti-inflammatory properties responsible for scar healing. There are limited high quality studies to support its use and future randomised controlled trials should be conducted.

Managing the child with a diagnosis of Moebius syndrome: more than meets the eye.

Moebius syndrome (MBS) is a congenital, non-progressive facial and abducens nerve palsy in the presence of full vertical gaze and may be associated with limb abnormalities and craniofacial dysmorphisms. MBS is now defined as a disorder of rhombencephalic maldevelopment and recent gene discoveries have shown this to be a dominant disorder in a subset of patients. Accurate diagnosis and management by a multidisciplinary team with expertise in congenital facial palsy is paramount.

Co-expression of tonoplast Cation/H(+) antiporter and H(+)-pyrophosphatase from xerophyte Zygophyllum xanthoxylum improves alfalfa plant growth under salinity, drought and field conditions.

Salinity and drought are major environmental factors limiting the growth and productivity of alfalfa worldwide as this economically important legume forage is sensitive to these kinds of abiotic stress. In this study, transgenic alfalfa lines expressing both tonoplast NXH and H(+)-PPase genes, ZxNHX and ZxVP1-1 from the xerophyte Zygophyllum xanthoxylum L., were produced via Agrobacterium tumefaciens-mediated transformation. Compared with wild-type (WT) plants, transgenic alfalfa plants co-expressing ZxNHX and ZxVP1-1 grew better with greater plant height and dry mass under normal or stress conditions (NaCl or water-deficit) in the greenhouse. The growth performance of transgenic alfalfa plants was associated with more Na(+), K(+) and Ca(2+) accumulation in leaves and roots, as a result of co-expression of ZxNHX and ZxVP1-1. Cation accumulation contributed to maintaining intracellular ions homoeostasis and osmoregulation of plants and thus conferred higher leaf relative water content and greater photosynthesis capacity in transgenic plants compared to WT when subjected to NaCl or water-deficit stress. Furthermore, the transgenic alfalfa co-expressing ZxNHX and ZxVP1-1 also grew faster than WT plants under field conditions, and most importantly, exhibited enhanced photosynthesis capacity by maintaining higher net photosynthetic rate, stomatal conductance, and water-use efficiency than WT plants. Our results indicate that co-expression of tonoplast NHX and H(+)-PPase genes from a xerophyte significantly improved the growth of alfalfa, and enhanced its tolerance to high salinity and drought. This study laid a solid basis for reclaiming and restoring saline and arid marginal lands as well as improving forage yield in northern China.

Vertebral artery dissection: an unusual cause of transient ataxia, vertigo, and sensorineural hearing loss.

We present the case of a 33-year-old man who was admitted with intermittent ataxia, vertigo, and sensorineural hearing loss as a result of a vertebral artery dissection following minor neck trauma. Our aim is to highlight the importance of obtaining magnetic resonance imaging, magnetic resonance angiography, and/or duplex color-flow imaging when presented with a case of fluctuating vertigo and sensorineural hearing loss with side-specific ataxia. Likewise, it is important to obtain the input of neurologists to optimize a patient's prognosis and minimize long-term sequelae.