Light treatments of nail fungal infections

Nail fungal infections are notoriously persistent and difficult to treat which can lead to severe health impacts, particularly in the immunocompromized. Current antifungal treatments, including systemic and topical drugs, are prolonged and do not effectively provide a complete cure. Severe side effects are also associated with systemic antifungals, such as hepatotoxicity. Light treatments of onychomycosis are an emerging therapy that has localized photodynamic, photothermal or photoablative action. These treatments have shown to be an effective alternative to traditional antifungal remedies with comparable or better cure rates achieved in shorter times and without systemic side effects. This report reviews significant clinical and experimental studies in the field, highlighting mechanisms of action and major effects related to light therapy; in particular, the impact of light on fungal genetics.      

Proteomic analysis of human nail plate

Shotgun proteomic analysis of the human nail plate identified 144 proteins in samples from Causcasian volunteers. The 30 identified proteins solubilized by detergent and reducing agent, 90% of the total nail plate mass, were primarily keratins and keratin associated proteins. Keratins comprised a majority of the detergent-insoluble fraction as well, but numerous cytoplasmic, membrane, and junctional proteins and histones were also identified, indicating broad use by transglutaminases of available proteins as substrates for cross-linking. Two novel membrane proteins were identified, also found in the hair shaft, for which mRNAs were detected only at very low levels by real-time polymerase chain reaction in other tissues. Parallel analyses of nail samples from volunteers from Inner Mongolia, China gave essentially the same protein profiles. Comparison of the profiles of nail plate and hair shaft from the latter volunteers revealed extensive overlap of protein constituents. Analyses of samples from an arsenic-exposed population revealed few proteins whose levels were altered substantially but raised the possibility of detecting sensitive individuals in this way.     

Delayed primary reconstruction of subtotal nail bed loss using a split-thickness nail bed graft on decorticated bone

Split-thickness nail bed grafting is the accepted method of treatment for injuries involving loss of nail bed tissue. The nail bed of the great toe may be used without donor-site morbidity, and nail bed grafting may be combined with other procedures for fingertip reconstruction. A case of fingertip avulsion injury with loss of the nail plate, nail bed, and periosteum over the exposed distal phalanx of the thumb was reconstructed by a split-thickness nail bed graft placed directly on granulating decorticated bone. The length, appearance, and function of the injured dominant thumb were preserved.     

Does the nail bed really regenerate?

From observations of nail bed injuries, the regeneration of the nail bed seemed evident. The nail bed regenerated well in the presence of the nail matrix and poorly in its absence, suggesting that the nail bed regenerated from the nail matrix. Full-thickness skin graft or flap coverage of nail bed defects resulted in the good nail bed regeneration. The nail bed grew back, pushing the graft or the flap distally. The regenerated nail beds were about 70 percent of normal size in guillotine-type amputations and about 90 percent in the presence of an intact distal phalanx. The difference between full- and split-thickness skin grafts seemed to be adherence to the phalangeal bone, the former giving way to the advancing nail bed and the latter staying in the way. In addition, the destination of the moving nail bed cells was discussed.     

Congenital curved nail of the fourth toe

Five cases of congenital curved nail of the fourth toe are reported. Patients included four males and one female; four cases were bilateral, and one was unilateral. There were no other significant associated anomalies of the extremities, and only the fourth toes were affected. The features of the deformity are a curved nail and hypoplasia of the soft tissue and bone of the distal phalanx of the fourth toe. This anomaly may be transmitted autosomally and is unique in that it may be of mesodermic origin.     

Derby intramedullary nail: Further biomechanical comparison

This paper is the second part of a study into the mechanical effectiveness of a new intramedullary femoral nail (the Derby nail). The results of three point bending tests have shown that the Derby nail is stronger and stiffer than both the K and Zickel nails and offers advantages over the AO plate, despite the lattcr's higher load carrying ability when used on the compressively loaded bone face. Previous work by the authors has shown the Derby nail to be superior in torsional loading and it is felt that this intramedullary device offers sound clinical advantages over the other designs, this being confirmed by extensive clinical trials.