Nα-Fmoc-Nù,ù-dimethyl-L-arginine (symmetrical) hydrochloride

The title compound, C(23)H(23)NO, is the product of a tandem transformation of the double Mannich base bis-(1-oxo-1,2,3,4-tertrahydro-2-naphtho-ylmeth-yl)amine hydro-chloride in HBr solution upon heating. The tetra-hydro-pyridine ring has a non-symmetrical half-chair conformation, whereas the cyclo-hexa-diene and cyclo-hexene rings adopt non-symmetrical half-boat conformations. The dihedral angle between the planes of the terminal benzene rings is 62.85 (6)°. The N atom has a trigonal-pyramidal geometry [sum of the bond angles = 332.4 (3)°]. In the crystal, mol-ecules form [001] chains via weak non-classical C-H⋯N hydrogen bonds. The chains are stacked along the b axis.

Prurigo pigmentosa (PP) is an inflammatory dermatosis with unknown etiology. The clinical presentations of PP varies according to the stages of the disease. Rarely, the formation of numerous vesicles and bullae upon erythematous infiltrative plaques can be found during the entire clinical course. In the present case, a 29-year-old Chinese woman presented with a 6-year history of relapsing pruritic erythematous plaques and bulla on her neck, chest and back. Physical examination revealed multiple erythematous plaques and vesicles in combination with mottled pigmentation in a symmetrical distribution and reticular pattern on the nape of her neck, chest and back. Histological examination of the biopsy specimen collected from the bullous area of her chest indicated a lichenoid reaction with intraepidermal bulla. This inflammatory region is characterized by recruitment of lymphocytes, spongiosis, and a perivascular lymphohistiocytic infiltrate in the upper dermis. Direct immunofluorescence analysis for IgG, IgA, IgM and C3 was negative. The diagnosis of bullous prurigo pigmentosa was verified based on the clinical manifestation and pathological findings. Minocycline hydrochloride therapy (100mg/d) was initiated, and 3 weeks later the rash had completely disappeared, which resulted in pigmentation of the entire area. No recurrence was observed during the 4 years follow-up.

Diabetic neuropathy is a neurodegenerative disorder that may alter both the somatic and autonomic peripheral nervous systems in the context of diabetes mellitus (DM). It is a prevalent and burdensome chronic complication of DM, that requires timely management. Optimized glycemic control (mainly for type 1 DM), multifactorial intervention (mainly for type 2 DM), with lifestyle intervention/physical exercise, and weight loss represent the basis of management for diabetic distal symmetrical polyneuropathy, and should be implemented early in the disease course. Despite better understanding of the pathogenetic mechanisms of diabetic peripheral neuropathy, there is still a stringent need for more pathogenetic-based agents that would significantly modify the natural history of the disease. The paper reviews the available drugs and current recommendations for the management of distal symmetrical polyneuropathy, including pain management, and for diabetic autonomic neuropathy. Evaluation of drug combinations that would perhaps be more efficient in slowing the progression of the disease or even reversing it, and that would provide a better pain management is still needed.