Dermatan sulfate (DS) widespread as a component of extracellular matrix proteoglycans, is characterized by great bio-reactivity and remarkable structural heterogeneity due to distinct degrees of sulfation and glucuronosyl epimerization and different polymerization degrees. However, DS metabolism under various biological conditions is poorly known. Dupuytren's contracture is a benign fibromatosis leading to complex remodeling of the palmar fascia structure and properties. However, it remains unclear whether the disease affects the structure of DS, which is the major tissue glycosaminoglycan. Thus the aim of the study was to examine the structure of the total DS in Dupuytren's fascia. DS chains were extracted from 5 samples of normal fascia and 7 specimens of Dupuytren's tissue by papain digestion followed by fractionation with cetylpyridinium chloride. Then, DS structure analysis was performed comprising the evaluation of its molecular masses and sensitivity to hyaluronidase and chondroitinase B. Dupuytren's contracture is associated with significant remodeling of DS chain structure revealed by (1) a distinct profile of chain molecular masses characterized by the appearance of long size components as well as the increase in the content of small size chains; (2) a different glucuronosyl epimerization pattern connected with the enhanced content of glucuronate disaccharide blocks; (3) chain oversulfation. These structural alterations in total DS may modify the GAG interactions especially affecting collagen fibrillogenesis and growth factor availability. Thus, Dupuytren's contracture associated DS remodeling may promote the phenomena typical for advanced disease: apoptosis and reduction in cell number as well as the appearance of dense pseudotendinous collagen matrix.
The purpose of this study was to evaluate the effect of physical exercise on limited locomotion in the hands of patients who underwent surgery to correct Dupuytren's contracture. We studied the hands of 84 patients with Dupuytren's contracture aged from 30 to 84 years. In all patients, the contracture was removed by performing a partial fasciectomy. Physical exercises were carried out a week prior to surgery and during the postoperative period. Patients were divided into group I, in which the exercise was carried out under the supervision of the authors of this study and group II, in which exercises were performed sporadically and without professional supervision. Measurements were performed on all patients one week before surgery (A), 1 week after surgery (B) and 6 weeks after (C). The range of movement of fingers was measured using a goniometer. The average total loss of finger extension was evaluated, taking due account of the extension loss in the MCP, PIP and DIP joints of all fingers of the treated hand. Rehabilitation treatment included active and passive exercises; in more severe cases the treatment of choice was massage and special equipment to help bear flexion contracture. Test results were statistically analyzed. In all patients, there was an increase in mobility of the fingers. Patients taking part in physical exercise had significantly greater range of finger movement.
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