Treatment of Dupuytren's contracture: a systematic review.

Aims: Dupuytren's contracture is a benign, myoproliferative condition affecting the palmar fascia that results in progressive contractures of the fingers. Despite increased knowledge of the cellular and connective tissue changes involved, neither a cure nor an optimum form of treatment exists. The aim of this systematic review was to summarize the best available evidence on the management of this condition. Materials and Methods: A comprehensive database search for randomized controlled trials (RCTs) was performed until August 2017. We studied RCTs comparing open fasciectomy with percutaneous needle aponeurotomy (PNA), collagenase clostridium histolyticum (CCH) with placebo, and CCH with PNA, in addition to adjuvant treatments aiming to improve the outcome of open fasciectomy. A total of 20 studies, involving 1584 patients, were included. Results: PNA tended to provide higher patient satisfaction with fewer adverse events, but had a higher rate of recurrence compared with limited fasciectomy. Although efficacious, treatment with CCH had notable recurrence rates and a high rate of transient adverse events. Recent comparative studies have shown no difference in clinical outcome between patients treated with PNA and those treated with CCH. Conclusion: Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. Cite this article: Bone Joint J 2018;100-B:1138-45.

Flyingfish feeding ecology in the eastern Pacific: prey partitioning within a speciose epipelagic community.

To test the hypothesis that prey partitioning contributes to community stability in flyingfish, the gut contents of 359 flyingfish specimens (representing five genera and eight species within Exocoetidae and Hemiramphidae) were collected at 50 dip-net stations during hour-long night-time fishing in oceanic waters of the eastern tropical Pacific Ocean between August and November 2007. Analyses using multidimensional scaling, and analysis of similarity revealed significant dietary differences among species, and similarity percentages tests helped identify the specific prey taxa responsible for these differences. Six species specialized on copepods (58·3-96·9% by number), but targeted different families. Specifically, the barbel flyingfish Exocoetus monocirrhus (n = 205) focused on euchaetids (51·6%), the banded flyingfish Hirundichthys marginatus (n = 24) fed on pontellids (21·8%), while the tropical two-wing flyingfish Exocoetus volitans (n = 11) and the bigwing halfbeak Oxyporhamphus micropterus (n = 34) ingested calanoids (54·6 and 17·0%). In contrast, the whitetip flyingfish Cheilopogon xenopterus (n = 73) and the mirrorwing flyingfish Hirundichthys speculiger (n = 4) had generalized diets comprising similar proportions of amphipod, copepod, mollusc and larval fish prey. Distinct differences in mean fullness, highly digested material, per cent empty guts and mean numbers of prey per gut were also synthesized, and uncovered a pattern of asynchronous feeding. Altogether, these findings provide valuable descriptive data on the diets of an understudied group of epipelagic teleosts, and, by extension, suggest that prey partitioning (taxa and feeding times) may influence flyingfish feeding ecology by reducing interspecific competition.