Human nails as a biomarker of arsenic exposure from well water in Inner Mongolia: comparing atomic fluorescence spectrometry and neutron activation analysis

Abstract

Arsenic (As) is found naturally in the geological strata within the Ba Men Region of Inner Mongolia, China. A study was conducted to compare the total As measurements from two analytical techniques: instrumental neutron activation analysis (INAA) and atomic fluorescence spectrometry (AFS), and to verify nails as an exposure biomarker in this population. In 1999, nail and water samples were collected in a pilot study. Fingernails and toenails were pooled from 32 participants and analysed for total As by both INAA and AFS. Mean nail As values were 14.8±2.4 and 19.4±2.8 µg?g^?1 (±SEM) for INAA and AFS, respectively. Results from these two methods were significantly correlated (r=0.93, p<0.0001). In 2000, a second study was conducted and INAA was used to measure total As in toenails from 314 Ba Men residents. Well water samples were collected from 121 households and analysed by AFS. A significant correlation was observed between toenail and well water As (r=0.84, p<0.0001). Based on the results, INAA was significantly correlated with AFS and proved to be a reliable measure of nail As levels. In this population, toenail samples are a useful internal As exposure biomarker from drinking water sources.     

Toenail mercury concentration as a biomarker of methylmercury exposure

The aim of the study was to assess the value of toenail mercury as an alternative biomarker of methylmercury exposure compared with blood and hair. Blood, hair and toenail total mercury concentrations were determined simultaneously in a southern urban sea n = 35 and an eastern rural lake n = 37 group and separately in a central Finnish rural lake n = 39 group. A questionnaire based index was used for estimating frequency of exposure taking into account high vs low mercury fish. Total mercury concentration was determined by cold vapour atomic absorption spectrophotometry. The mean Fish Consumption Frequency Index varied from 4.7 to 9.9 on a scale of 1-20. The blood, hair and toenail mercury mean concentrations ranged from 2.9 to 14.6 g l-1, 0.45 to 1.57 mg kg-1 and 0.20 to 0.54 mg kg-1, respectively. In the combined southern and eastern groups n = 72 sampled simultaneously, the correlations between blood and hair mercury were r = 0.92 and that of blood and toenails r = 0.78 p 0.0001 . In the central Finnish group the correlations were more moderate. In the three groups all three biomarkers correlated highly with the fish consumption index, r = 0.43-0.76 p 0.0001 . Men consumed high mercury fish more frequently than women, 8.6 vs 6.6 n.s. . The mean mercury levels of blood and hair were two fold, but toenail mercury levels were only 30 higher in men compared with those of the women. The relative sensitivity slope of the sources decreased in the order, blood hair toenails. In conclusion, toenails, an easily accessible tissue for the estimation of methylmercury exposure, have been shown to be closely correlated with the well established samples for biomarkers, viz. blood and hair mercury.     

Toenail mercury concentration as a biomarker of methylmercury exposure

The aim of the study was to assess the value of toenail mercury as an alternative biomarker of methylmercury exposure compared with blood and hair. Blood, hair and toenail total mercury concentrations were determined simultaneously in a southern urban sea n = 35 and an eastern rural lake n = 37 group and separately in a central Finnish rural lake n = 39 group. A questionnaire based index was used for estimating frequency of exposure taking into account high vs low mercury fish. Total mercury concentration was determined by cold vapour atomic absorption spectrophotometry. The mean Fish Consumption Frequency Index varied from 4.7 to 9.9 on a scale of 1-20. The blood, hair and toenail mercury mean concentrations ranged from 2.9 to 14.6 g l-1, 0.45 to 1.57 mg kg-1 and 0.20 to 0.54 mg kg-1, respectively. In the combined southern and eastern groups n = 72 sampled simultaneously, the correlations between blood and hair mercury were r = 0.92 and that of blood and toenails r = 0.78 p 0.0001 . In the central Finnish group the correlations were more moderate. In the three groups all three biomarkers correlated highly with the fish consumption index, r = 0.43-0.76 p 0.0001 . Men consumed high mercury fish more frequently than women, 8.6 vs 6.6 n.s. The mean mercury levels of blood and hair were two fold, but toenail mercury levels were only 30 higher in men compared with those of the women. The relative sensitivity slope of the sources decreased in the order, blood hair toenails. In conclusion, toenails, an easily accessible tissue for the estimation of methylmercury exposure, have been shown to be closely correlated with the well established samples for biomarkers, viz. blood and hair mercury.     

Onychomycosis: Multicentre epidemiological, clinical and mycological study

BackgroundOnychomycosis accounts for up to 50% of all nail disorders. They can be caused by: yeasts, dermatophytes and non-dermatophyte moulds.Objectives and methodsA multicentre study designed to determine the prevalence, mycological test results, aetiological agents, and clinical presentation of onychomycosis was carried out. All fingernail and toenail samples taken during a one year period at 9 diagnostic centres were included.ResultsA total of 5,961 samples were analysed, of which 82.3% were from toenails and 17.7% from fingernails. The mean age of the patients was 49.7 years, and 66% were females. Direct microscopic examination was positive in 61% of the samples. In adults, 61.2% of toenails were positive using potassium hydroxide (KOH), and 43.7% were positive in cultures. The prevailing aetiological agents belong to the dermatophyte group (82.8%), and distal subungual was the most common clinical form. In fingernails, direct examination showed 59.8% positive samples, and cultures were positive in 52.9%. The prevailing agents were yeasts belonging to Candida species, and onycholysis was the most common lesion.ConclusionsDirect mycological examinations were positive in 61%, a higher value than that found in other series. Dermatophytes were prevalent in toenails of both sexes, and in finger nails yeast were prevalent in females, and dermatophytes in males. Non-dermatophyte moulds corresponded to 4.8% of toenail and 2.05% of fingernails isolates.     

甲板甲床部分切除联合苯酚烧灼术治疗嵌甲症的临床研究

目的:探讨甲板甲床部分切除联合苯酚烧灼术治疗嵌甲症的临床疗效。方法:选择武汉市中心医院2004年10月至2013年5月收治的115例148趾拇趾嵌甲进行研究。以2004年10月至2007年12月的患者53例(67趾)作为对照组行单纯甲板甲床部分切除术治疗,2008年1月至2013年5月的患者62例(81趾)作为观察组行甲板甲床部分切除联合苯酚烧灼术治疗。对比两组患者的出血、疼痛缓解和康复时间,了解一年后患者复发情况及满意度。结果:148趾手术伤口均一期愈合,观察组病例术后出血时间、疼痛缓解时间(1.85±0.42天、13.25±2.17小时)较对照组(2.69±0.53天、21.54±2.56小时)低,但术后恢复时间(11.32±2.37天)较对照组(8.93±2.06天)长,差异均有统计学意义(P0.05),观察组和对照组的复发率及总体满意率分别为6.15%、12.5%及97.06%、91.07%,两组差异并无统计学意义(P0.05)。结论:甲板甲床部分切除联合苯酚烧灼术治疗嵌甲症与单纯甲板甲床部分切除术的疗效相当,但可显著减少患者痛苦。     

Ingrowing toenails: an evaluation of two treatments.

Most of the procedures used for treating ingrowing toenails cause considerable discomfort and have high failure rates. This study evaluated two methods of treatment: (a) a simple procedure, and (b) angular phenolisation. Patients were seen in a special toenail clinic and were assessed for severity and duration of symptoms. Those with no permanent deformity of the nail fold and with only minor infection were treated by the simple procedure. The nail was nicked and torn down to expose the infected nail fold. The patients were then taught to clean the area, spray it with povidone-iodine dry powder, and pack the nail fold with a twist of cotton-wool. Patients with recurrent or severe ingrowing toenails were treated by angular phenolisation. One hundred patients were treated by the simple procedure and 61 of these had had no recurrence after six months. A total of 280 phenolisations were carried out over 18 months and 272 were successful. The treatments described are simple, effective, and well tolerated and should be considered as alternatives to traditional treatment.     

Analysis of myosmine,cotinine and nicotine in human toenail,plasma and saliva

Myosmine is a minor tobacco alkaloid with widespread occurrence in the human diet. Myosmine is genotoxic in human cells and is readily nitrosated and peroxidated yielding reactive intermediates with carcinogenic potential. For biomonitoring of short-term and long-term exposure, analytical methods were established for determination of myosmine together with nicotine and cotinine in plasma, saliva and toenail by gas chromatography–mass spectrometry (GC/MS). Validation of the method with samples of 14 smokers and 10 non-smokers showed smoking-dependent differences of myosmine in toenails (66?±?56 vs 21?±?15?ng?g^?1, p?<0.01) as well as saliva (2.54?±?2.68 vs 0.73?±?0.65?ng ml^?1, p <0.01). However, these differences were much smaller than those with nicotine (1971?±?818 vs 132?±?82?ng g^?1, p <0.0001) and cotinine (1237?±?818 vs <35?ng?g^?1) in toenail and those of cotinine (97.43?±?84.54 vs 1.85?±?4.50?ng ml^?1, p <0.0001) in saliva. These results were confirmed in plasma samples from 84 patients undergoing gastro-oesophageal endoscopy. Differences between 25 smokers and 59 non-smokers are again much lower for myosmine (0.30?±?0.35 vs 0.16?±?0.18?ng?ml^?1, p <0.05) than for cotinine (54.67?±?29.63 vs 0.61?±?1.82?ng ml^?1, p <0.0001). In conclusion, sources other than tobacco contribute considerably to the human body burden of myosmine.     

Level of trace elements in serum and toenail samples of patients with onychocryptosis (ingrown toenail) and onychomycosis

BackgroundOnychocryptosis (ingrown toenail) and onychomycosis are common pathologies of the toenail and affecting many people. Since levels of trace elements have been shown to vary in certain diseases, in the presented work, chromium (Cr), copper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), selenium (Se), and zinc (Zn) levels of toenail and serum samples of healthy individuals and patients with onychocryptosis and onychomycosis were compared.MethodsSerum and toenail samples of 88 voluntary subjects (healthy n = 24; onychomycosis n = 24; onychocryptosis n = 40) aged between 19–80 years were collected. Levels of trace elements in the samples were analyzed by using an inductively coupled plasma-optical emission spectrophotometer (ICP-OES Thermo iCAP - 6000). The differences in medians between the groups for elements were evaluated with Kruskal -Wallis H test with post hoc for pairwise comparisons in SPSS 18.ResultsMg (p < 0.001) and Mn (p = 0.002) levels were significantly increased whereas Zn (p = 0.011) level was decreased in toenails of patients with onychomycosis compared to healthy subjects. Although Mg and Mn levels were higher in female subjects with onychomycosis (p = 0.001; p = 0.019), Mn was only increased in male subjects (p = 0.015). Mg was the only trace element found to be independent of sex, age, and smoking status in patients with onychomycosis. However, no significant difference has been found in serum trace element levels neither between any groups nor toenail trace element levels of patients with onychocryptosis and healthy subjects.ConclusionAs a response of the human body to pathogens like fungi in toenails, Mg, Mn and Zn levels vary. Especially the role of Mg ions in onychomycosis needs to be investigated more specifically.     

Determination of total arsenic concentrations in nails by inductively coupled plasma mass spectrometry

The analysis of trace elements in biological samples will extend our understanding of the impact that environmental exposure to these elements has on human health. Measuring arsenic content in nails has proven useful in studies evaluating the chronic body burden of arsenic. In this study, we developed methodology with inductively coupled plasma-mass spectrometry (ICP-MS) for the determination of total arsenic in nails. We assessed the utility of the washing procedures for removing surface contamination. Four types of preanalysis treatments (water bath, sonication, water bath plus sonication, and control) after sample decomposition by nitric acid were compared to evaluate the digestion efficiencies. In addition, we studied the stability of the solution over 1 wk and the effect of acidity on the arsenic signal. Arsenic content in the digested solution was analyzed by using Ar-N₂ plasma with Te as the internal standard. The results suggest that washing once with 1% Triton Χ-100 for 20 min for cleaning nail samples prior to ICP-MS analysis is satisfactory. Repeated measurement analysis of variance revealed that there was no significant difference among the various sample preparation techniques. Moreover, the measurements were reproducible within 1 wk, and acidity seemed to have no substantial influence on the arsenic signal. A limit of detection (on the basis of three times the standard deviation of the blank measurement) of 7 ng As/g toenail was achieved with this system, and arsenic recoveries from reference materials (human hair and nails) were in good agreement (95–106% recovery) with the certified/reference values of the standard reference materials. ICP-MS offers high accuracy and precision, as well as highthroughput capacity in the analysis of total arsenic in nail samples.     

瓣状甲的类型、分布与遗传方式 --对陕西周至县某村的调查

瓣状甲是存在于我国北方许多汉族人群中的一种性状,其表现为小趾趾甲分瓣。我们通过对陕西省周至县某自然村的入户调查发现,瓣状甲的频率为79.17%,其中男性为81.48%,女性为76.67%,性别分布无统计学差异(χ2=1.09,P=0.295)。瓣状甲可为单侧或双侧发生,男性和女性的单、双侧瓣状甲频率无统计学差异(χ2=2.94,P=0.23)。13个年龄组间瓣状甲的频率差异有统计学意义。对2个完整的三代家系和51个核心家系的系谱分析,发现瓣状甲的遗传特点与常染色体单基因显性性状一致。因此,我们认为,瓣状甲是一种单基因显性性状,具有不同的表现类型,既可单侧发生,亦可双侧发生,其分布无性别差异,但有年龄差异。     

Concentration of arsenic in groundwater,vegetables, human hair and nails in mining site in the Northern Thai Nguyen province,Vietnam: human exposure and risks assessment

This study was aimed to examine the risk of chronic arsenic (As) exposure for the residents living in Nui Phao, Thai Nguyen in the northern Vietnam. Groundwater, vegetables, human hair, and nail samples were collected from volunteers living in Nui Phao. The results revealed that 75% of the groundwater samples had As exceeding the World Health Organization (WHO) drinking water guideline of 10 µg L^?1. The result of As concentration for most of the vegetable samples was greater than the WHO/FAO safe (0.1?mg kg^?1). The result of hair and nail samples in this study showed that 3.5 and 20% of the samples had As concentration exceeding the level of As toxicity in hair and nails, respectively. The result of health risks indicated that the potential health risk of As contamination is greater for groundwater than vegetables. The total hazard quotient (HQ) value through vegetables ingestion and drinking water exceeded 1.0 suggesting potential health risk for local residents. The calculation of potential carcinogenic risk through both consumption of vegetables and drinking water was low cancer risk in adults. Other food sources and the exposure pathways are needed to exactly assess health risks in this area.     

Lateral Drug Diffusion in Human Nails

The main objective of the current work is to demonstrate the process of passive lateral diffusion in the human nail plate and its effect on the passive transungual permeation of antifungal drug ciclopirox olamine (CPO). A water soluble dye, methyl red sodium salt (MR) was used to visualize the process of lateral diffusion using a novel suspended nail experiment. The decline in concentration of CPO correlates with that of concentration of MR from the proximal to the distal end of the nail in suspended nail study. Three toenails each were trimmed to 5 mm × 5 mm (25 mm²), 7 mm × 7 mm (49 mm²), and 9 mm × 9 mm (81 mm²) to study the extent and effect of lateral diffusion of the CPO on its in vitro transungual permeation. The permeation flux of CPO decreased as the surface area of the toenail increased. There was a positive correlation between the concentrations of CPO and MR in the area of application and in the peripheral area of the toenails of the three surface areas, confirming the findings in the suspended nail experiment. Profound lateral diffusion of CPO was demonstrated and shown to reduce the in vitro passive transungual drug permeation and prolong the lag-time in human toenails. The study data implies that during passive in vitro transungual permeation experiments, the peripheral nail around the area of drug application has to be kept to a minimum, in order to get reliable data which mimics the in vivo situation.KEY WORDS: ciclopirox olamine, lateral diffusion, passive, topical, transungual     

Comparison of hair, nails and urine for biological monitoring of low level inorganic mercury exposure in dental workers.

Creatinine-corrected urine mercury measurements in spot urine samples are routinely used in monitoring workers exposed to inorganic mercury. However, mercury measurement in other non-invasive biological material has been used in some epidemiological studies. Dentists and dental nurses remain a group of workers with potential exposure to inorganic mercury through their handling of mercury-containing amalgam, although changes in work practices have reduced the current, likely exposure to mercury. Therefore, dental workers remain an occupational cohort in whom the value of using different biological media to identify exposure to low level inorganic mercury can be investigated. Samples of head hair, pubic hair, fingernails, toenails and urine were analysed for mercury content from a cohort of UK dentists (n=167) and a socioeconomically similar reference population (n=68) in whom any mercury exposure was primarily through diet. The mercury content in all biological material was significantly higher in the dental workers than in the control population (p<0.0001). The geometric mean and 90th percentile mercury concentrations in the urine samples from dentists were 1.7 and 7.3 micromol mol(-1) creatinine, respectively, with only one sample having a value at around the UK's Health and Safety Executive biological monitoring health guidance level of 20 micromol mol(-1) creatinine. Receiver operator characteristic analyses suggested that the ability of the biological material to discriminate between dentists and referents were fingernails>urine approximately equal to toenails>pubic hair approximately equal to head hair. Further investigation is warranted as to why fingernails appear to be such a good discriminator, possibly reflecting some contribution of direct finger contact with amalgam or contaminated surfaces rather than systemic incorporation of mercury into growing nails. Good correlation between head hair and pubic hair mercury levels in all subjects was obtained (r=0.832), which was significantly improved when hair samples weighing <10 mg were excluded (r=0.868). Therefore, under these exposure conditions and using the described pre-analytical washing steps, there is little influence from atmospheric contamination on the level of mercury content of head hair. The choice of non-invasive biological materials for mercury analysis depends on a number of considerations. These include the toxicokinetics of urinary mercury excretion, the growth rates of hair and nail, the nature and time-frame of exposure, and the fact that urine mercury may not reflect the body burden level from dietary methyl mercury. However, the data from this study suggests that urine mercury remains the most practical and sensitive means of monitoring low level occupational exposure to inorganic mercury.     

Profiles of trace elements in toenails of Arab-Americans in the Detroit area, Michigan

Exposure to environmental contaminants is complicated by factors related to socioeconomic status, diet, and other culturally conditioned risk behaviors. Determination of a trace element profile in toenails can be used as a tool in biomonitoring the exposure history or assessing the deficiency of a particular element in a study population, which can lead to a better understanding of environmental and disease risks. Toenail clippings from 259 Arab Americans (163 adults, 96 children) residing in a highly industrialized area were analyzed for Al, V, Cr, Mn, Co, Ni, Cu, As, Se, Mo, Cd, Ba, Tl, and Pb using an inductively coupled plasma-mass spectrometer. Mean concentrations were compared with published values, and the influence of age, gender, and other demographic factors were explored. Elevated levels of Ni in this population warrant further investigation. Significant differences in the mean concentration of Al, V, Cr, Mn, Cd, Pb, and Se exist between toenails of adults and children. Pearson correlation coefficients reveal strong significant associations among Cd, Cr, and Tl (p<0.05), in addition to other elements. These investigations provide insight into exposures and factors influencing exposures in this population while adding to the growing fund of knowledge surrounding use of toenails as a marker of exposure.     

Portable X-ray fluorescence of zinc applied to human toenail clippings

Zinc is an essential trace element in humans. Zinc deficiency can result in a range of serious medical conditions which include effects on growth and development, the immune system, the central nervous system, and the gastrointestinal system. Diagnosis of zinc deficiency is often precluded by the lack of a noninvasive and reliable biomarker. Zinc concentration in nail is considered an emerging biomarker of zinc status in humans. Whether zinc in nail accurately reflects zinc status is beyond the scope of the current study, but is an important research question. The development of a portable method to quickly assess zinc concentration from a single nail clipping could be a useful advance. In this study, single toenail clippings from 60 individuals living in Atlantic Canada were measured for zinc using a portable X-ray fluorescence (XRF) technique. These samples were obtained from the Atlantic PATH cohort, part of the largest chronic disease study ever performed in Canada. Each toenail clipping was measured using three 300 s trials with a mono-energetic portable XRF system. Results were then assessed using two different approaches to the XRF analysis: (1) factory-calibrated zinc concentrations were output from each trial, and (2) energy spectra were analyzed for the characteristic X-rays resulting from zinc. Following the measurement of zinc using the non-destructive portable XRF method, the same clippings were measured for zinc concentration using the “gold standard” technique of inductively coupled plasma-mass spectrometry (ICP-MS). A linear equation of best fit was determined for the relationship between average XRF output zinc concentration and ICP-MS zinc concentration, with a correlation coefficient r = 0.60. Similarly, a linear equation of best fit was found for the relationship between a normalized XRF energy spectrum zinc signal and ICP-MS zinc concentration, with a correlation coefficient r = 0.68. Individual ICP-MS zinc concentrations ranged from 32 μg/g to 140 μg/g, with a population average of 85 μg/g. The results of this study indicate that portable XRF is a sensitive method for the measurement of zinc in a single nail clipping, and provides a reasonable estimation of zinc concentration. Further method development is required before portable XRF be considered a routine alternative to ICP-MS for the assessment of zinc in nail clippings.     

Exposure assessment of benzene in Thai workers, DNA-repair capacity and influence of genetic polymorphisms

Exposure to benzene can cause DNA damage and the subsequent development of cancer. In this study, study subjects were 31 laboratory workers at a petrochemical factory and 31 gasoline service attendants. Control subjects were 34 workers from a mail sorting service center. Occupational exposures to benzene were assessed using biomarkers of exposure in blood and urine. Induction of DNA-repair capacity was assessed as a biomarker of early effect. The effects of polymorphisms in a metabolizing gene (CYP2E1), in detoxification genes (NQO1 and GSTT1), and in a DNA-repair gene (XRCC1, codon 399) on biomarker levels were evaluated. The mean individual benzene exposure of laboratory workers (24.40+/-5.82 ppb) and that of gasoline service attendants (112.41+/-13.92 ppb) were significantly higher than in controls (1.39+/-0.17 ppb, p<0.001). Blood benzene levels of laboratory workers (169.12+/-30.60 ppt) and gasoline service attendants (483.46+/-59.62 ppt) were significantly higher than those of the controls (43.30+/-4.89 ppt, p<0.001). Trans,trans-muconic acid levels in post-shift urine samples collected from laboratory workers (0.14+/-0.02 mg/g creatinine) and gasoline service attendants (0.20+/-0.02 mg/g creatinine) were significantly higher than in urine samples of controls (0.04+/-0.01 mg/g creatinine, p<0.001). The level of benzene exposure was correlated with blood benzene levels (R2=0.65, p<0.01) and post-shift urinary trans,trans-muconic acid concentrations (R2=0.49, p<0.01). As a biomarker of early effect, DNA-repair capacity was assessed by use of the cytogenetic challenge assay, i.e., chromosomal aberrations in peripheral lymphocytes were assessed after challenging blood cultures with 1 Gy gamma radiation. A significantly lower DNA-repair capacity--determined as dicentrics in laboratory workers (0.17 per metaphase cell) and in gasoline service attendants (0.19 per metaphase cell) compared with controls (0.12 per metaphase cell, p<0.001)--was observed. The frequency of deletions in laboratory workers (0.22 per metaphase cell) and gasoline service attendants (0.39 per metaphase cell) were significantly higher than in control workers (0.16 per metaphase cell, p<0.01 and p<0.001, respectively). An increase in radiation-induced dicentrics and deletions indicate a lower DNA-repair capacity in benzene-exposed workers. The influence of genetic polymorphisms on the biomarkers was assessed. Benzene-exposed workers who carried CYP2E1*1/*5 or *5/*5 genotypes excreted slightly higher levels of trans,trans-muconic acid than workers who carried the CYP2E1*1/*1 genotype. In this study, NQO1 and GSTT1 genotypes did not have any effect on the levels of trans,trans-muconic acid. In the case of XRCC1, laboratory workers with 399Arg/Gln or Gln/Gln had a lower DNA-repair capacity--measured as radiation-induced frequency of dicentrics and deletions--than those with the 399Arg/Arg genotype (p<0.01). Our results show that biomarkers of internal dose and early biological effect in people occupationally exposed to benzene are influenced by genetic polymorphisms in susceptibility genes.     

Low- and moderate- levels of arsenic exposure in young adulthood and incidence of chronic kidney disease: Findings from the CARDIA Trace Element Study

BackgroundIt is unclear whether arsenic exerts adverse health effects on the kidney at low- and moderate- levels of exposure. We prospectively examined toenail arsenic concentrations measured during young adulthood in relation to incidence of chronic kidney disease (CKD) in midlife.MethodsA total of 3768 participants (53 % female and 48 % blacks) in the Coronary Artery Risk Development in Young Adults (CARDIA) study were included. Arsenic concentration in toenail clippings was assessed by using inductively coupled plasma mass spectrometry at CARDIA exam year 2. Incident CKD was identified if having estimated glomerular filtration rate <60 mL/min per 1.73 m² or albuminuria >30 mg/g. The association between toenail arsenic levels and CKD incidence over a mean of 24 years of follow-up was examined using multivariable-adjusted Cox proportional hazards models.ResultsAfter controlling for potential confounders, including demographics, socioeconomics, lifestyle factors, clinical measurements of blood pressure, lipids, and glucose, and medical history, arsenic exposure measured in toenails was not associated with CKD incidence (quintile 5 versus quintile 1: hazard ratio = 1.04, 95 % confidence interval = 0.78–1.40, P for trend = 0.38).ConclusionThis longitudinal study does not support the hypothesis that low- and moderate- levels of arsenic exposure are associated with elevated incidence of CKD in the US general population. Further studies are need to investigate species of arsenic biomarkers in relation to nephrotoxicity.     

Microsurgical toenail transfer to the hand

Free nonvascularized toenail grafts have been used to reconstruct congenital or traumatic nail defects of the thumb or finger. Unfortunately, these transfers often result in deformity or atrophy. To avoid these undesirable results, microsurgical free vascularized toenail transfer was performed in 10 patients, 3 for congenital nail absence and 7 for traumatic nail defects. Patient age averaged 17 years (range 2 to 32 years). In contrast with previous reports, the whole big or second toenail complex without pulp was used in reconstruction. All 10 nails were successfully transferred with complete survival. No digits required reexploration. There were no donor- or recipient-site problems. Follow-up averaged 3 years, with a range of 14 months to 5 years and 4 months. Appropriate nail growth occurred in the congenital patients. No atrophy of the nail complex was found as long as sufficient bony support was present (9 of 10 cases). Whole free vascularized toenail transfers for reconstruction of congenital and traumatic nailbed defects achieve excellent aesthetic results while maintaining normal hand function.     

Quantification of manganese and mercury in toenail in vivo using portable X-ray fluorescence (XRF)

Background and objective: Toenail is an advantageous biomarker to assess exposure to metals such as manganese and mercury. Toenail Mn and Hg are in general analyzed by chemical methods such as inductively coupled plasma mass spectrometry and atomic absorption spectrophotometry. In this project, a practical and convenient technology—portable X-ray florescence (XRF)—is studied for the noninvasive in vivo quantification of manganese and mercury in toenail.

Material and methods: The portable XRF method has advantages in that it does not require toenail clipping and it can be done in 3?min, which will greatly benefit human studies involving the assessment of manganese and mercury exposures. This study mainly focused on the methodology development and validation which includes spectral analysis, system calibration, the effect of toenail thickness, and the detection limit of the system. Manganese- and mercury-doped toenail phantoms were made. Calibration lines were established for these measurements.

Results: The results show that the detection limit for manganese is 3.65?μg/g (ppm) and for mercury is 0.55?μg/g (ppm) using 1?mm thick nail phantoms with 10?mm soft tissue underneath.

Discussion and conclusion: We conclude that portable XRF is a valuable and sensitive technology to quantify toenail manganese and mercury in vivo.     

Differences in the frequency of micronucleated erythrocytes in humans in relation to consumption of fried carbohydrate-rich food

The aim of this study was to investigate if consumption of ordinary carbohydrate-rich food prepared in different ways has an impact on chromosome stability, i.e., on the formation of micronucleated young erythrocytes in humans. Twenty-four persons, divided into two groups, participated during 4 days in a semi-controlled food-consumption study. One group (low-heated-food-group, LowHF-group) consumed only food boiled in water (max 100 degrees C) and the other group (high-heated-food-group, HighHF-group) consumed preferentially strongly heated (fried) food. From each of the subjects, blood samples were drawn, before and after 4 days. The frequency (f) of micronucleated (MN) very young erythrocytes (transferrin-positive reticulocytes, Trf-Ret), fMNTrf-Ret, was determined, and the difference in the frequency, before and after the eating period, was calculated. The obtained mean differences for the two groups were compared. As an indicator of highly heated food the acrylamide (AA) content in part of the consumed foodstuffs was analysed by use of LC/MS-MS and the AA intake estimated. In the blood samples the hemoglobin-adduct levels from AA were analysed as a measure of the internal AA dose. The differences between the mean fMNTrf-Ret, before and after the eating period, were -0.15 per thousand for the LowHF-group and +0.17 per thousand for the HighHF-group, p<0.005 (t-test, one-tailed). The mean total AA intake in the HighHF-group during 4 days was estimated to about 3000+/-450microg per person. For the LowHF-group, the mean AA intake was low, 20+/-10microg per person. The lowest dose of AA that caused a significant increase of micronucleated erythrocytes in mice is more than a hundred times higher than the AA level in this study. Thus, it is unlikely that the exposure to AA is the major cause behind the observed difference. The answer is probably to be found in other compounds produced at the same time during heating of the food.