Human biomonitoring of toxic trace elements is of critical importance for public health protection. The current study aims to assess the levels of selected trace metals (Cd, Co, Cr, Cu, Mn, Ni, Pb, and Zn) into paired human nail and hair samples (n = 180 each) from different altitudinal setting along the Indus River, and which were measured by using inductively coupled plasma mass spectrometry (ICP-MS). The human samples (hair and nail) were collected from four different ecological zones of Pakistan which include frozen mountain zone (FMZ), wet mountain zone (WMZ), riverine delta zone (RDZ), and low-lying southern areas (LLZ). Our results showed the following occurrence trends into studied hair samples: higher values (ppm) of Zn (281), Co (0.136), and Mn (5.65) at FMZ; Cr (1.37), Mn (7.83), and Ni (1.22) at WMZ; Co (0.15), Mn (11.89), and Ni (0.99) at RDZ; and Mn (8.99) and Ni (0.90) at LLZ. While in the case of nails, the levels (ppm) of Mn (9.91) at FMZ and Mn (9.38, 24.1, and 12.5), Cr (1.84, 3.87, and 2.33), and Ni (10.69, 8.89, and 12.6) at WMZ, RDZ and LLZ, respectively, showed higher concentration. In general, among the studied trace elements, Mn and Ni in hair/nail samples were consistently higher and exceeded the WHO threshold/published reference values in most of the studied samples (> 50-60%) throughout the Indus basin. Similarly, hair/nail Pb values were also higher in few cases (2-10%) at all studied zones and exceeded the WHO threshold/published reference values. Our area-wise comparisons of studied metals exhibited altitudinal trends for Cd, Cr, Zn, and Mn (p < 0.05), and surprisingly, the values were increasing from south to north (at higher altitudes) and indicative of geogenic sources of the studied toxic elements, except Mn, which was higher at lower floodplain areas. Estimated daily intake (EDI) values showed that food and drinking water had the highest contribution towards Zn, Cu, Mn, and Ni and accumulation at all studied zones. Whereas, dust also acts as the main exposure route for Mn, Co, Cr, and Cd followed by the food, and water.

Very often, post-traumatic defects involve multiple tissues. Microsurgical techniques can reconstruct them with tissues taken from a toe: from the nail complex alone to compound osteo-onychocutaneous flaps. Several techniques have been reported since the 1980s. This paper describes techniques and indications for microsurgical nail reconstruction. Technique differs according to the deficit, and first and foremost whether only the nail complex is involved or whether other components of the fingertip important for the normal growth of the nail, such as the phalanx bone or the finger pad, are also missing (toenail flaps and the custom-made osteo-onychocutaneous flaps). For most patients the absence of a fingernail is an esthetic rather than functional concern, and the outcomes of microsurgical reconstruction are far from ideal in this regard. We prefer to reserve reconstruction for symptomatic patients with functional impairment.

Herein, 16 traditional and 13 novel organophosphate esters (OPEs) in skin wipes, personal PM2.5, sputum, and nails (fingernails and toenails) and 7 OPE metabolites in urine synchronously obtained from 64 college students were analyzed. Similar compositional profiles of the OPEs were found in skin wipes and nails and in personal PM2.5 and induced sputum. Significant correlations were observed between the concentrations of high-lipophilicity low-volatility OPEs in skin wipes and nails and between the concentrations of high-volatility low-lipophilicity OPEs in personal PM2.5 and sputum. These results imply that OPEs in fingernails and toenails may mainly come from external sources rather than internal exposure, and human nails and sputum can be used as indicators of human exposure to OPEs. A comparison between the daily exposure doses of the OPEs in personal PM2.5 and sputum shows that more volatile compounds may have higher inhalation bioavailability, which should be considered to improve the accuracy of inhalation exposure assessments. According to comprehensive external and internal exposure assessment, dermal absorption may be a more dominant pathway than inhalation, and skin wipes may be the best representative environmental matrix of human exposure to OPEs.

To present a surgical technique of combining the on-top plasty with modified Bilhaut-Cloquet procedure for reconstructing a rare type of complicated radial polydactyly and evaluate the outcomes.
Fourteen complicated radial polydactyly in 13 patients were corrected by combining the on-top plasty with modified Bilhaut-Cloquet procedure. Osteotomies were performed as required, and the acral part of the ulnar thumb was transposed onto the proximal part of the radial thumb. The distal parts of the two thumbs were isolated as neurovascular pedicled composite tissue flaps, including part of the distal phalanx and nail bed, and were attached together in an extra-articular way. The tendons were rebalanced, and the nail bed was reconstructed. Objective and subjective outcomes were assessed.
The average follow-up time was 32.4 months (6-60 months). All reconstructed thumbs were rated as good in appearance and function. The mean Vancouver Scar Scale score was 1.3 (range 1-2) and the mean Wang-Gao score of the reconstructed thumbnail was 9.4 (range 8-11). The Tada score for the function of the reconstructed thumb was 5.5 (range 5-6). The main active range of motion (ROM) of the interphalangeal joint (IPJ) was 2.1-38.9°. All parents were satisfied with the outcomes.
Because of the diverse manifestations of thumb polydactyly, individualized surgical treatment is recommended, and careful preoperative planning should be made with the principle of combining the best parts of the two thumbs. By combining an on-top plasty with modified Bilhaut-Cloquet procedure, a satisfactory result can be achieved for treating complicated radial polydactyly.

UNASSIGNED: Nail psoriasis is a refractory disease that affects 50-79% skin psoriasis patients and up to 80% of patients with psoriatic arthritis (PsA). The pathogenesis of nail psoriasis is still not fully illuminated, although some peculiar inflammatory cytokines and chemokines seems to be the same as described in psoriatic skin lesions. Treatment of nail psoriasis still with challenge and should be individualized. Upadacitinib, an oral highly selective JAK1 inhibitor, has been approved for PsA treatment. Whether it has the therapeutic advantages for nail psoriasis.
UNASSIGNED: We report a case of a patient with nail psoriasis who responded well to upadacitinib therapy at a dose of 15mg once daily for 5 months. In addition, we reviewed the literature and compared the current treatment efficiency in the treatment of nail psoriasis. The therapeutic effects of JAK inhibitors for nail psoriasis may involve downstream cytokines, such as I IL-6, IL-10, and IL-23.
UNASSIGNED: Upadacitinib may be a promising therapeutic option for patients with severe nail psoriasis.

BACKGROUND: Onychomatricoma is a nail neoplasm that usually presents as longitudinal nail plate thickening, involving either the partial or whole nail. Histopathologically, it is characterized by deep invaginations of the proliferating nail matrix and proliferation of CD34+ and CD10+ spindle cells with collagenous to myxoid stroma. Onychomatricoma has been considered a fibroepithelial neoplasm. Recently, RB1 loss has been verified using array comparative genomic hybridization.
METHODS: This study investigated the RB1 status in onychomatricoma with morphological methods.
RESULTS: Six patients with onychomatricoma were included in the study. RB1 status was assessed using immunohistochemical staining and fluorescence in situ hybridization. Immunohistochemical staining showed that all six cases experienced RB1 loss in the mesenchymal component of onychomatricoma but not in the proliferated nail matrix. Fluorescence in situ hybridization in five cases showed a monoallelic deletion of the RB1 locus in the mesenchymal component but not in the proliferated nail matrix.
CONCLUSIONS: RB1 loss was observed only in the mesenchymal component of onychomatricoma. Our findings suggest that the proliferated nail matrix in onychomatricoma represents reactive hyperplasia of various degrees secondary to neoplastic mesenchymal proliferation. This indicates that onychomatricoma should be recognized as an RB1-deleted soft tissue neoplasm rather than a fibroepithelial neoplasm.

In this study, the distribution of nineteen ingredients of personal care product (PCPs), including seven metabolites of phthalates (mPAEs), five benzophenone-type ultraviolet filters (BPs), and seven antimicrobial agents (AAs), were investigated in paired human hair, nail and urine samples. The median concentrations of ΣmPAEs, ΣBPs and ΣAAs were 135, 2.76 and 179 ng/g in hair, 37.3, 2.95 and 297 ng/g in nails, and 345, 4.03 and 50.1 ng/mL in urine, respectively. Mono-methyl phthalate (49%), 2,4-dihydroxybenzophenone (45%) and triclosan (71%) were the most abundant mPAE, BP and AA in hair samples, respectively, and had similar abundance in nail samples. In contrast, mono-n-butyl phthalate (45%), 4-hydroxy benzophenone (29%) and methyl paraben (54%) were the predominant mPAE, BP and AA in urine samples, respectively. Significant differences in the concentrations of some target compounds were observed between male and female but inconsistent across different matrices. Moreover, most compounds with significant correlations had quite different correlation coefficients in each matrix. No significant correlations were found between hair, nail and urine samples for most of the target analytes. These results suggest these analytes have matrix-specific distribution, and it is necessary to use multiple matrices to comprehensively assess the risk of ingredients of PCPs to human health.

BACKGROUND: The measurements of width index, height index, and curvature index were used for assessment of the curvature severity. Nevertheless, both sides of the nail root are buried subcutaneously, impossibility in measuring the width index correctly.
METHODS: We developed a technique to measure the index under high-frequency ultrasonography (HF-USG).
RESULTS: There was good agreement between the HF-USG index and the result examined after surgery.
CONCLUSIONS: The observation on HF-USG helps to distinguish between ingrown nail and pincer nail. The HF-USG index will be useful in the examination and measurement of nail roots buried subcutaneously or nail penetration under the hypertrophic lateral nail fold, and comparing the effectiveness among treatments for pincer nail objectively.

UNASSIGNED: Onychopapilloma is generally recognized as a benign tumor of the nail bed and distal matrix. However, the origin of onychopapilloma has not been explained yet.
UNASSIGNED: To clarify the origin of onychopapilloma, we detected the expression patterns of hair-related keratins and epithelial keratins, which are expressed specifically in the nail unit.
UNASSIGNED: The clinical and histopathologic features of 11 patients with onychopapilloma were analyzed, and the expression patterns of hair-related and epithelial keratins were detected.
UNASSIGNED: Histologically, all subjects showed acanthosis, papillomatosis and matrix metaplasia within the nail bed. Immunohistochemically, the expression pattern of keratins in our standard nail unit was consistent with previous reports. \"Nail matrix-related keratins\" HK31, HK34, HK85, and HK86 were only expressed in the nail matrix, and \"Nail bed-related keratins\" HK75 and K6/K16 were only expressed in the nail bed. However, in onychopapilloma, whether adjacent to the matrix or in the distal nail bed, all cases were positive for nail bed-related keratins and HK31 but negative for other nail matrix-related keratins.
UNASSIGNED: Our study suggests that onychopapilloma may originate from the nail bed rather than the nail matrix. Furthermore, the expression of nail bed-related keratins and HK31 could be used as diagnostic markers of onychopapilloma.

BACKGROUND: Internal fixation of complex proximal humeral fractures (PHF) with osteoporosis is associated with a high incidence of complications. This study introduces the technique and clinical results of a novel intramedullary support nail and plate system (ISNPs) for the internal fixation of 3- or 4- part PHF in older adults. The ISNPs combines the concept of intramedullary support and dynamic fixation into a locking plate fixation system that can be applied using a minimally invasive surgical approach.
METHODS: A total of 46 consecutive patients diagnosed with 3- or 4-part PHF that met the criteria were included in this study, including 18 in the ISNPs group and 28 in the conventional locking plate (LP) group. Clinical results, including operative time, intraoperative bleeding, reduction quality, subjective outcome ratings, and complications, were compared between the two groups. Functional outcomes were evaluated using the Constant score and disability of the arm, shoulder, and hand (DASH) questionnaire at 1-year follow-up.
RESULTS: There were no significant differences in age, sex, local bone quality, Neer-fracture type, and follow-up time between the ISNPs and LP groups. For clinical analysis, there were no significant differences in intraoperative bleeding and operation time between the ISNPs and LP groups. Significant differences were observed in the percentage of the malreduced cases, Constant and DASH score analysis, and the patients\' subjective evaluation (\'excellent\' and \'good\' %) between the two groups.
CONCLUSIONS: The ISNPs technique proposed in this study provides a novel hybrid internal fixation model for complex PHF with osteoporosis. The clinical results at 1-year follow-up confirmed the advantage of applying it to 3- or 4- part PHF in older patients. Further studies are required to optimize its design and explore its optimal indications.