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。     

甲真菌病患者甲微生物群分析

目的研究甲真菌病患者甲微生物群的构成,为进一步阐明甲真菌病的发病机制提供线索。方法本研究共纳入47例甲真菌病患者及7例健康志愿者。取患者病甲的甲屑进行真菌镜检及培养鉴定;提取患者病甲、患者对侧健甲及健康人甲的DNA,对真菌rDNA ITS区及细菌16S rDNA V3-V4区PCR扩增,分析微生物群构成,并进行α多样性、β多样性、Simper分析及Spearman相关性分析。结果甲真菌病患者病甲的微生物群构成与对侧健甲及健康人甲存在差异。患者病甲的真菌菌群的丰富度高于对侧健甲。患者对侧健甲细菌菌群的多样性高于病甲及健康人甲,且患者对侧健甲细菌菌群的构成与患甲和健康人甲均有部分重叠。结论患者对侧健甲的细菌菌群构成具有由健康人甲向患者病甲转变的趋势。且在患者病甲的微生物群中,某些真菌和细菌菌属可能具有相关性。     

Reconstruction of fingertip amputations with full-thickness perionychial grafts from the retained part and local flaps.

The treatment of fingertip amputations distal to the distal interphalangeal joint when the amputated part is saved is difficult and controversial. Both reattachment of the amputated portion as a composite graft and microvascular anastomosis are prone to failure in this distal location. The authors have evolved a reconstructive plan that uses the nail matrix, perionychium, and hyponychium of the amputated fingertip as a full-thickness graft when the amputation is between the midportion of the nail bed andjust proximal to the eponychial fold. Various flaps are used to lengthen and augment the finger pulp, and skeletal pinning is carried out as necessary. The charts of 15 patients who underwent this procedure over a 38 month period were evaluated retrospectively. Seven returned to the office for examination at least 1 year after the fingertip reconstruction described above; four others were interviewed by telephone. Nail deformity, fingertip sensation, and joint range of motion were evaluated, and the reconstructed fingertips were photographed in standardized views. In six of the seven patients seen in the office, aesthetic and functional results were judged as good by both patient and physician; one of the six had minimal nail curvature. The seventh patient had no nail growth, although finger length was retained and there was no functional disability. The four patients interviewed by phone reported normal fingertip use with no dysesthesias or cold intolerance; all had nail growth, although three patients described slight nail curvature that required care in trimming. The authors favor salvage of all perionychial parts when a distal fingertip amputation occurs. Reconstruction of the fingertip with grafting of the hyponychium, perionychium, and nail matrix from the amputated part combined with local flaps can provide a very satisfactory functional and aesthetic result.     

Digital glomus tumors: a 29-year experience with a lateral subperiosteal approach

The excision of distal digital glomus tumors has traditionally been performed directly over the involved nail bed. This can lead to nail deformities that are often unacceptable for the surgeon and the patient. The authors describe their experience with successful excision of digital glomus tumors using a lateral subperiosteal approach, which creates a dorsal flap. In 29 years, 19 patients were diagnosed with digital glomus tumors. All patients underwent excision using the lateral subperiosteal approach. The mean tumor size was 0.52 cm. The tumors were located on the pulp of the distal phalanx in two patients (10.5 percent) and subungually in 17 patients (89.5 percent). In all patients, preoperative clinical diagnosis was confirmed postoperatively with the biopsy result. Complications occurred in only two patients and included one paronychia and one temporary nail loss. The overall recurrence rate was 15.7 percent. All patients remained asymptomatic after surgery and regained full active and passive range of motion. There were no nail deformities by this approach. This technique represents a safe and effective approach to excising digital glomus tumors.     

TREATMENT OF SUPERFICIAL FUNGOUS INFECTIONS—Value and Limitations of Systemic Administration of Griseofulvin

Comprehensive studies and numerous clinical reports have shown that griseofulvin orally in a dose of 1 gm. daily is an effective treatment for superficial fungous infections of the skin, hair and nails. The drug is not effective against yeast infections (moniliasis), bacterial infections or most of the deep fungous infections.Duration of treatment varies with the site of infection, glabrous skin, crotch and scalp responding within four to five weeks. Infections of palms, soles and nails require a considerably longer time, palms healing more quickly than soles and fingernails more quickly than toenails, which may require up to a year of continuous treatment.Auxiliary measures such as clipping hair, removing infected nail tissue and topical fungicides shorten the duration of treatment.No serious side effects have been reported. Minor discomforts such as headaches and mild rashes occur in some cases.Observations of a series of 49 patients with superficial fungous infections, especially hand, foot and nail infections due to Trichophyton rubrum, confirmed these reports taken from the literature. Attempts to use a reduced dosage schedule did not prove satisfactory.     

Human nail stem cells are retained but hypofunctional during aging

The nail is a continuous skin appendage. Cells located around the nails, which display coordinated homeostatic dynamics and release a flow of stem cells in response to regeneration, have been identified in mice. However, very few studies regarding human nail stem cells exist in the literature. Using specimens isolated from humans, we detected an unreported population of cells within the basal layer of postnatal human nail proximal folds (NPFs) and the nail matrix around the nail root. These cells were multi-expressing and expressed stem cell markers, such as keratin 15 (K15), keratin 14 (K14), keratin 19 (K19), CD29, CD34, and leucine-rich repeat-containing G protein-coupled receptor 6 (Lgr6). These cells were very similar to mouse nail stem cells in terms of cell marker expression and their location within the nail. We also found that the putative nail stem cells maintained their abundance with advancing age, but cell proliferation and nail growth rate were decreased on comparison of young and aged specimens. To summarize, we found a putative population of stem cells in postnatal human nails located at NPFs and the nail matrix. These cells may have potential for cell differentiation and be capable of responding to injury, and were retained, but may be hypofunctional during aging.     

Nail position has an influence on anterior knee pain after tibial intramedullary nailing

Our aim was to determine the possible relationship between anterior knee pain (AKP) and nail position marked as a distance from tip of nail to tibial plateau (NP) and to the tuberositas tibiae (NT). Nail position has an influence on anterior knee pain after tibial intramedullary nailing. We evaluated postoperative outcome results of 50 patients in the last 3 years with healed fractures initially treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws on both parts of the nail and with the use of medial paratendinous incision for nail entry portal. Patients marked a point on the visual analog scale (VAS) that corresponded to the level of postoperative AKP felt. Two groups of patients were formed on the basis of AKP (pain level was neglected): groups A and B, with and without pain, respectively. The difference between the two groups concerning NP measurements was statistically significant (p < 0.05), but not concerning NT measurements at the p < 0.05 level. Patients were classified by pain with high accuracy (98%) according to a classification tree. Symptoms of AKP did not appear if the tip of the nail position was more than 6.0 mm from the NP and more than 2.6 mm from the NT. However, for better evaluation of these results it will be necessary to examine a larger number of postoperative patients with AKP.     

新疆和田、哈密和阿勒泰市居民指甲中氢、氧稳定同位素的比较

在法庭科学研究领域,指甲作为一种新型生物信息载体,在物证信息挖掘方面具有重要的价值。人生命活动中摄入的氢、氧主要来源于饮用水、摄入的食物和空气等,其中的氢、氧稳定同位素比值信息会被指甲角蛋白记录并保存下来,这些信息可以用于推断人的生活地域变化情况,在个体身份的排查工作中具有重要的作用。本文借助元素分析-稳定同位素比质谱技术(EA-IRMS)对新疆和田、哈密和阿勒泰3个城市常住居民指甲中氢、氧稳定同位素比值进行了分析,并借助判别分析模型对指甲样本的氢、氧稳定同位素比值进行了模式识别。结果表明,3个不同城市常住居民指甲氢、氧稳定同位素比值存在一定的差异;和田指甲样本δ²H值与哈密、阿勒泰有明显差异;哈密指甲样本δ²H值与阿勒泰重叠范围宽,差异较小;3个城市δ¹⁸O值分布均有重叠,无明显的差异。在判别模型中,通过判别函数f(x,y)=0.992x+0.046y和判别函数f(x,y)=-0.198x+1.009y对3个市共计85份样本进行判别分析,总体分类准确率为95.29 %,9个验证样本均实现了准确的归类和判定。本文研究表明...     

Growth and development of infant giant pandas (Ailuropoda melanoleuca) at the Wolong Reserve,China

From 1991 to 1993 inclusive, seven infant giant pandas (Ailuropoda melanoleuca) were born at the China Conservation and Research Center for the Giant Panda. Average daily weight gain in the first 6 months for mother-reared infants (n = 5) was 71.3 g/day; for one partially mother-reared and partially hand-reared infant, 41.5 g/day; and for one completely hand-reared infant, 50.3 g/day. There was a significant difference in growth rates across the first 6 months in all methods of rearing. In addition, a comparison of growth rates across the three rearing methods showed significant differences in the first, second, third, fifth, and sixth months. Average daily body length increase for mother-reared infants was 4.1 mm/day; for partially mother-reared/partially hand-reared infants, 4.0 mm/day; and for the completely hand-reared infant, 2.8 mm/day. In mother-reared infants, body length increase during the first month was significantly greater than during the following months, and was slowest during the sixth month. At birth, infants were all pink in color with a light white coat of lanugo. Black pigmentation was first noted at 7–10 days of age, which was also the time that initial hair coat growth was seen. Eyes opened at 35–48 days of age. Ears opened at 31–50 days of age. Deciduous dentition was first seen at 82–121 days of age, while permanent dentition began to erupt at 350 days of age. © 1996 Wiley-Liss, Inc.     

Biological monitoring of lead and cadmium in human hair and nail and their correlations with biopsy materials, age and exposure

Hair and fingernails of exposed and unexposed subjects were analyzed for their lead (Pb) and cadmium (Cd) contents by atomic absorption spectrophotometer with graphite furnace and air-acetylene flame. Hair and nail Pb concentrations in occupationally exposed subjects ranged between 1.020-409.726 and 8.130-765.306 microg/g and in environmentally unexposed subjects 0.123-25.160 and 1.076-65.613 microg/g, respectively. Similarly, hair and nail Cd concentrations in occupationally exposed subjects ranged between 0.014-22.086 and 0.214-35.714 microg/g and in environmentally unexposed subjects 0.113-1.627 and 0.028-8.108 microg/g, respectively. A significant correlation was observed between Pb hair and nail concentrations in exposed subjects at P < 0.05, as compared to unexposed subjects and Cd hair and nail in exposed, as well as unexposed subjects. With respect to exposure, levels of Pb in hair and nails were found to be significant in exposed subjects, compared to unexposed ones and levels of Cd were significant only in nails of exposed ones. With respect to age, no significant correlation was found between hair and nail Pb and Cd concentrations in both exposed and unexposed subjects.     

Trace element distribution in the hair of some sickle cell anemia patients and controls

Hair samples of some young sickle cell anemia (SCA) and control patients in Nigeria were analyzed for 12 elements, viz, Se, Hg, Cr, Fe, Zn, Co, Cu, Br, As, Sb, Na, and Sc, using Instrumental Neutron Activation Analysis (INAA).

With the exception of Cu, which was found to be significantly higher in the hair of SCA patients (at the 0.05 level of the t-test), there were generally no significant differences in elemental concentrations within the two groups. A preliminary study of the elemental contents of the fingernails of the same subjects showed a higher abundance of most of the elements in nail than in hair. These preliminary results were compared with similar studies from some other parts of the world.

     

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.     

森林生态系统林木根系对优先流的影响

土壤水和溶质运移是土壤学和环境科学研究的难点和热点,优先流是一种常见的土壤溶质运移形式,绕过土壤基质而优先运移至地下水源,造成土壤养分的流失和水质的恶化。林木根系是土壤层的重要部分,其结构形态影响着优先流过程,为量化林木根系结构对土壤优先流的影响,以首都圈森林生态系统鹫峰定位监测站为研究区域,利用野外染色示踪与室内分析相结合的方法,定量分析根长密度和根系生物量在优先流区和基质流区的变化。结果表明:1)随着土层深度的增加,根长密度表现为减小的趋势,对径级d1 mm,1d3 mm和3d5 mm根系而言,根长密度在优先流区大于基质流区发生概率分别为66.7%,88.9%和83.3%;2)根系d1 mm对优先流贡献度最大,均值为94.8%,1d3 mm和3d5 mm根系对优先流贡献度较小,均值分别为4.3%和0.9%;3)研究点根系生物量进行统计,66.7%优先流区根系生物量大于基质流区根系生物量。开展根系对优先流的影响研究,有助于探明土壤水分运移规律,分析地表地下水质恶化根源,为生态环境安全提供理论指导和技术支持。     

Tensile and shear properties of fingernails as a function of a changing humidity environment

The mechanical properties of fingernails are important because of their impact in preventing damage and in maintaining their appearance. In particular, knowing the effect of local environmental conditions can tell us how they might best be protected. In order to better understand this, tensile tests were carried out to characterise the properties of fingernails at different relative humidities. Cyclic tests were also conducted to investigate the ability of the structure to recover deformation at different moisture contents. Torsional tests were performed to determine the shear modulus of the keratinous matrix material which binds together the fibrous components of the fingernails. This enabled an analysis of how the material may resist bending, torsion and permanent deformation in a natural environment. In particular, it is shown that at low relative humidity the nails are more brittle, and at high moisture contents they are more flexible. Increasing relative humidity lowers torsional stiffness much more than tensile stiffness, suggesting that moisture plasticises the matrix rather than affecting the fibres. The twist to bend ratio is minimised at 55% RH, close to the natural condition of nails which should minimise susceptibility to torsional damage due to plasticisation and a disruption of the matrix material binding the keratin fibres.     

Medium for Isolation and Growth of Bacteria Associated with Plum Leaf Scald and Phony Peach Diseases

Rickettsia-like bacteria associated with plum leaf scald and phony peach diseases were isolated from diseased but not from healthy tissues and cultured on charcoal-yeast extract medium (BCYE) buffered with ACES (2-[(2-amino-2-oxoethyl) amino]-ethanesulfonic acid). Optimum conditions for isolation and growth on BCYE medium were pH 6.5 to 6.9 at 20 and 25°C under normal atmosphere. Growth of primary colonies and first-passage subcultures was restricted, and colonies reached a maximum diameter of 0.6 mm in 60 days. After 12 passages, subcultures reached maximum growth in 21 days. The rickettsia-like bacteria from BCYE cultures were gram negative, serologically the same as those present in diseased peach and plum, and composed of rod-shaped cells measuring 0.35 by 5 μm (average diameter and maximum length) in a matrix of filamentous strands of similar width but of variable length.     

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 77 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference between the retroauricular angle in the surgical group and in controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.     

Extended upper blepharoplasty for lateral hooding of the upper eyelid using a scalpel-shaped excision: a 13-year experience

Excess skin of the upper lids is often accompanied by lateral overlap of skin with crow's feet because of the absence of fixation to the tarsal plate, giving the eye a sad, heavy look that often disturbs the lateral visual field. The accepted crescent-shaped blepharoplasty is somewhat convex, which is widest at the center of the lid with or without a lateral extension. However, in patients who have normal brow position or minimal eyebrow ptosis and whose main concern is the excess upper eyelid skin and lateral hooding, such a crescent excision may not suffice. A scalpel-shaped excision that is widest laterally and that tapers to a point medially will extirpate the maximal skin where it is most needed and overcome the skin excess in the lateral aspect of the upper lid. Between 1990 and 2002, 301 white patients (275 women and 26 men) between the ages of 33 and 79 years were operated on using the extended scalpel-shaped upper blepharoplasty technique. The follow-up period was more than 1 year. The lower margin of the incision is along the supratarsal crease, about 10 mm above the ciliary line. It begins medially about 1 cm above and lateral to the medial canthus. Above the lateral canthus, the skin marking is gently curved upward and outward, often within a natural skin crease or crow's feet to reach a little below and slightly beyond the lateral extremity of the eyebrow. The upper border of the incision joins the two extremities of the skin outline in a gentle convex curve. The general outline of the incision takes on the shape of a number 20 scalpel blade in which the maximal width is located laterally. Following excision of the excess skin and removal of protuberant fat pads if needed, suturing is executed from lateral to medial. The final suture line is in the form of an oblique flattened lazy S. Following the removal of the stitches on the fifth postoperative day, no wound dehiscence was noticed at the lateral scar zone. In the older individuals, due to the lax skin, the scar becomes scarcely noticeable with time and often falls within a pre-existent crow's feet crease. Elimination of some of the crow's feet was also demonstrated. In patients with visual field impairment, significant functional and visual improvement was achieved. Most patients mentioned a pleasing postoperative open "Oriental" look of the eyes. The extended scalpel-shaped upper blepharoplasty adequately deals with the hooding of the skin laterally. This technique overcomes the excess of skin in both vertical and horizontal directions, since in suturing the lateral part of the skin defect in an oblique plane, slack skin is taken up transversely, and the technique provides some indirect upward support to the lateral eyebrow. In the absence of crow's feet in the younger person, this technique is not recommended because the lateral part of this suture line is visible, especially if the scar widens.     

Anthropometric study of male external genitalia of 320 healthy Nigerian adults

Five basic measurements of the male external genitalia were studied in 320 healthy male medical students belonging to the various parts of Nigeria (West Africa). Their ages range from 17 to 23 years. The measurements were as follows: average length of the penis (81.6 +/- 0.94 mm); circumference of the penis (88.3 +/- 0.02 mm); circumference of the scrotum (212.6 +/- 2.48 mm); length of right testis (46.8 +/- 0.54 mm); width of right testis (32.4 +/- 0.37 mm); length of left testis (46.0 +/- 0.53 mm); and width of left testis (31.4 +/- 0.36 mm). The size of the genitalia increases with the increase in age in younger year groups. The adult stages of genitalia development are reached at the age of 21 years in 89.0% of the individuals. The growth of the genitalia is continued with the increasing height and weight, but this growth slows down after attaining a definite height and weight.     

Correlative Growth in Young Terminalia superba in a Controlled Environment: Effect of the Leaves on Internode Elongation

Young Terminalia superba plants were cultivated in a controlledenvironment at the Phytotron. Effects of the excision of a youngleaf at definite elongation stages and at two given levels ofthe main axis were studied on the elongation of internodes inthese plants. Effects of the leaf did not seem to depend onits nodal position on the main axis but predominantly occurredon the immediate surrounding internodes. The excision of a youngleaf enhanced the growth rate of the internode located belowit and markedly decreased the elongation of the internode aboveit but slightly affected internode growth duration. This excisionenhanced the final length of the internode located below theleaf and decreased the final length of the internode locatedabove the removed leaf. Significant linear regressions werefound between the length of the excised leaf and the internodefinal lengths. Microscopic examination of epidermal cells ofcontrol and disrupted internodes revealed that the decreasedelongation after leaf excision could be attributed to reductionof cell divisions. The increased elongation after leaf excisioncould be attributed both to slight increase in the length ofcells (significant negative correlation was found with the lengthof the removed leaf) and to increase of cell divisions. Terminalia superba, leaf excision, cell division, internode elongation, correlative growth