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Dilated cardiomyopathy is a syndrome characterized by cardiac enlargement and impaired systolic function of the heart. Tumor necrosis factor (TNF)-alpha, a pleiotropic cytokine, seems to play a central role in the progression of dilated cardiomyopathy. Recent data suggest that ongoing inflammation in the myocardium may, in many cases, contribute to the development of disease. Chronic generation of autoantibodies to myocardial antigens or, in some cases, viral infection are pathobiologically involved. Although both antibodies and some viruses activate the complement system, the role of innate immunity in dilated cardiomyopathy has as yet not been investigated systematically. In this study we demonstrate by analysis of myocardial biopsies from 28 patients that C5b-9, the terminal membrane attack complex of complement, accumulates in human myocardium in dilated cardiomyopathy. C5b-9 significantly correlates with immunoglobulin deposition and myocardial expression of TNF-alpha. In vitro, C5b-9 attack on cardiac myocytes induces nuclear factor (NF)-kappaB activation as well as transcription, synthesis, and secretion of TNF-alpha. We conclude that chronic immunoglobulin-mediated complement activation in the myocardium may contribute in part to the progression of dilated cardiomyopathy via C5b-9-induced TNF-alpha expression in cardiac myocytes.

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Although pincer nail deformity (PND) treatment is time consuming independent of whether it is based on surgical or conservative procedures, long lasting beneficial results are found only after surgical intervention. Typically destruction of the lateral matrix horns either surgically or by phenol cauterization or even ablation of the matrix is performed. In the past these procedures mainly aimed at relief from pain; however, currently more patients ask for the preservation of the nail unit and a good cosmetic outcome. Today reconstructive results that meet the patient expectations are available. An adapted novel surgical method which will preserve the matrix horns while correcting the shape of the phalanx and preventing renewed adhesion of the nail bed to the phalanx is presented. Therefore the restoration of a normal width-to-length ratio of the nail plate with a cosmetically appealing result becomes possible. Surgical steps in an affected right toenail are presented.