Nail lichen planus: A review of clinical presentation, diagnosis and therapy

Lichen planus is a multifaceted disease of complex etiopathogenesis. Nails are involved in up to 10% of patients with lichen planus. Although most cases are mild, serious consequences may occur due to rapid progression of the disease, the high risk of scarring, and the resulting irreversible damage to the nail structure. Permanent damage of at least one nail occurs in approximately 4-12% of patients with nail lichen planus. In this narrative review, we emphasize the pathophysiology of nail lichen planus, the emergent nature of the disease, and the spectrum of different clinical manifestations. Diagnosis of nail disease in general, and of nail lichen planus in particular, is rapidly evolving. This review provides a comprehensive account of the non-invasive and invasive diagnostic techniques and treatment options reported in the literature, with emphasis on the efficacy and safety of the drugs used, the associated evidence, and the factors to be taken into account in planning and providing adequate treatment. The role of aesthetic and camouflage options is also summarized.

Web of microbes (WoM): a curated microbial exometabolomics database for linking chemistry and microbes

Background

As microbiome research becomes increasingly prevalent in the fields of human health, agriculture and biotechnology, there exists a need for a resource to better link organisms and environmental chemistries. Exometabolomics experiments now provide assertions of the metabolites present within specific environments and how the production and depletion of metabolites is linked to specific microbes. This information could be broadly useful, from comparing metabolites across environments, to predicting competition and exchange of metabolites between microbes, and to designing stable microbial consortia. Here, we introduce Web of Microbes (WoM; freely available at: http://webofmicrobes.org), the first exometabolomics data repository and visualization tool.

Description

WoM provides manually curated, direct biochemical observations on the changes to metabolites in an environment after exposure to microorganisms. The web interface displays a number of key features: (1) the metabolites present in a control environment prior to inoculation or microbial activation, (2) heatmap-like displays showing metabolite increases or decreases resulting from microbial activities, (3) a metabolic web displaying the actions of multiple organisms on a specified metabolite pool, (4) metabolite interaction scores indicating an organism’s interaction level with its environment, potential for metabolite exchange with other organisms and potential for competition with other organisms, and (5) downloadable datasets for integration with other types of -omics datasets.

Conclusion

We anticipate that Web of Microbes will be a useful tool for the greater research community by making available manually curated exometabolomics results that can be used to improve genome annotations and aid in the interpretation and construction of microbial communities.

Electronic supplementary material

The online version of this article (10.1186/s12866-018-1256-y) contains supplementary material, which is available to authorized users.

Photoonycholysis: new findings

First described in 1961, photoonycholysis (PO) is a rare nail alteration that may result from drug intake, from topical aminolevulinate photodynamic therapy or from photosensitive conditions such as porphyria or pseudoporphyria. Spontaneous PO is rare. This review updates the numerous causes of PO and highlights some new ways producing this condition. Four different types of PO are clearly recognized without relationship with the responsible drug. An updated list of potential inducing drug is provided. Some practical points on PO have been raised. The inability to reproduce photoonycholysis experimentally should be emphasized, and the pathogenesis of PO still needs to be clarified.

Influence of the nature and environment of manganese in Mn-BEA zeolites on NO conversion in selective catalytic reduction with ammonia

Manganese-containing BEA zeolites, Mn_xSiBEA (x = 1-4 wt%) and Mn_(I.E.)AlBEA, were prepared by a two-step post-synthesis method and a conventional wet ion-exchange, respectively, and applied as catalysts in the selective catalytic reduction of NO with ammonia (NH₃-SCR). The physicochemical analysis of zeolite properties by high-energy-resolution fluorescence-detected XANES (HERFD-XANES) and X-ray emission spectroscopy (XES) uncovered that the coordination, geometry and oxidation state of Mn species are strongly related to the preparation method. Additionally, the study of catalyst acidity by FTIR spectroscopy with CO and pyridine probe molecules provided important insight into the number and type of acidic centres present on the catalyst surface. The catalytic results revealed that NO conversion depended on the state and content of Mn. The zeolites obtained by the two-step post-synthesis method and with a low Mn content were very active in the medium temperature range (NO conversion ∼100%) with simultaneous high selectivity to N₂ due to the presence of isolated, framework Mn(iii) and Mn(ii) species. The N₂O formation was especially high in the case of catalysts containing extra-framework polynuclear Mn species and negligible in the case of Mn_(I.E.)AlBEA containing predominantly isolated, extra-framework Mn(ii) species.

Incorporation of Mn into the vacant T-atom sites of a BEA zeolite as isolated, mononuclear Mn: FTIR, XPS, EPR and DR UV-Vis studies

A MnSiBEA zeolite has been prepared via a two-step postsynthesis procedure which consisted, in the first step, of the treatment of a tetraethylammonium BEA zeolite with nitric acid for the formation of vacant T-atom sites and then, in the second step, of the incorporation of Mn ions into the framework, resulting in a SiBEA zeolite, through their reaction with the silanol group of the vacant T-atom sites. The incorporation of Mn ions into the framework of the SiBEA zeolite has been evidenced using XRD. The formation of isolated mononuclear Mn(ii) and Mn(iii) in a MnSiBEA zeolite has been shown using FTIR, diffuse reflectance UV-Vis, EPR and XPS. The acidic properties of the mononuclear manganese species have been investigated via FTIR spectroscopy using pyridine as the probe molecule. The changes in the oxidation state of the Mn species under various treatments have been proven using EPR.

Extensive Turnover of Compatible Solutes in Cyanobacteria Revealed by Deuterium Oxide (D2O) Stable Isotope Probing

Cyanobacteria are important primary producers of organic matter in diverse environments on a global scale. While mechanisms of CO₂ fixation are well understood, the distribution of the flow of fixed organic carbon within individual cells and complex microbial communities is less well characterized. To obtain a general overview of metabolism, we describe the use of deuterium oxide (D₂O) to measure deuterium incorporation into the intracellular metabolites of two physiologically diverse cyanobacteria: a terrestrial filamentous strain (Microcoleus vaginatus PCC 9802) and a euryhaline unicellular strain (Synechococcus sp. PCC 7002). D₂O was added to the growth medium during different phases of the diel cycle. Incorporation of deuterium into metabolites at nonlabile positions, an indicator of metabolite turnover, was assessed using liquid chromatography mass spectrometry. Expectedly, large differences in turnover among metabolites were observed. Some metabolites, such as fatty acids, did not show significant turnover over 12-24 h time periods but did turn over during longer time periods. Unexpectedly, metabolites commonly regarded to act as compatible solutes, including glutamate, glucosylglycerol, and a dihexose, showed extensive turnover compared to most other metabolites already after 12 h, but only during the light phase in the cycle. The observed extensive turnover is surprising considering the conventional view on compatible solutes as biosynthetic end points given the relatively slow growth and constant osmotic conditions. This suggests the possibility of a metabolic sink for some compatible solutes (e.g., into glycogen) that allows for rapid modulation of intracellular osmolarity. To investigate this, uniformly ¹³C-labeled Synechococcus sp. PCC 7002 were exposed to ¹²C glucosylglycerol. Following metabolite extraction, amylase treatment of methanol-insoluble polymers revealed ¹²C labeling of glycogen. Overall, our work shows that D₂O probing is a powerful method for analysis of cyanobacterial metabolism including discovery of novel metabolic processes.

[Scabies of the nail unit in an infant]

BACKGROUND

There are no guidelines regarding the management of scabies in infants and recurrence is common at this age. We report the case of an infant with subungual hyperkeratosis and ungual lesions subsequent to classic scabies.

PATIENTS AND METHODS

A 7-month-girl, treated 6 weeks earlier with esdepallethrin for scabies, consulted for acquired lesions on 3 toe nails. These nails were thickened and displayed subungual hyperkeratosis. Physical examination of the skin, the finger nails and mucous membranes was otherwise normal. Fungal analyses were negative, but direct microscopic examination revealed numerous larvae of Sarcoptes scabiei as well as ovular debris. The child was treated with urea 40% to obtain chemical avulsion of the nails, and with topical esdepallethrin and a quarter tablet of ivermectin orally; there was no follow-up of the child.

DISCUSSION

Ungual scabies has already been reported in crusted scabies and very rarely in classic scabies. Subungual and ungual locations of S. scabiei may constitute a source of reinfestation with scabies in infants. Treatment is not well defined and currently involves chemical avulsion of the nails and the application of topical antiscabies treatment.

Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance

Koilonychia, a concave nail dystrophy, has multiple aetiologies and may be hereditary, acquired or idiopathic. Within dermatology, koilonychia is often a manifestation of an inflammatory dermatosis such as psoriasis or lichen planus, or a sign of onychomycosis. Other disease associations include iron store abnormalities, Plummer-Vinson Syndrome, nutritional deficiencies and occupational or traumatic aetiologies. In young children, koilonychia of the toenails is commonly transient and idiopathic, although familial and syndromic cases are reported. The dermatologist must be aware of the potential cutaneous and systemic associations with koilonychia in order to guide appropriate workup, treatment and/or referral. An algorithm for evaluation of koilonychia is presented along with discussion of common causes of koilonychia and a comprehensive list of all known associations.

Belowground Response to Drought in a Tropical Forest Soil. I. Changes in Microbial Functional Potential and Metabolism

Global climate models predict a future of increased severity of drought in many tropical forests. Soil microbes are central to the balance of these systems as sources or sinks of atmospheric carbon (C), yet how they respond metabolically to drought is not well-understood. We simulated drought in the typically aseasonal Luquillo Experimental Forest, Puerto Rico, by intercepting precipitation falling through the forest canopy. This approach reduced soil moisture by 13% and water potential by 0.14 MPa (from -0.2 to -0.34). Previous results from this experiment have demonstrated that the diversity and composition of these soil microbial communities are sensitive to even small changes in soil water. Here, we show prolonged drought significantly alters the functional potential of the community and provokes a clear osmotic stress response, including the production of compatible solutes that increase intracellular C demand. Subsequently, a microbial population emerges with a greater capacity for extracellular enzyme production targeting macromolecular carbon. Significantly, some of these drought-induced functional shifts in the soil microbiota are attenuated by prior exposure to a short-term drought suggesting that acclimation may occur despite a lack of longer-term drought history.

[Cosmetic nail products]

Cosmetic embellishment of fingernails involves the use of substance that harden either after the evaporation of solvents (varnishes) or after polymerisation (artificial acrylic nails, gel tips, glue-on artificial nails). Pathological reactions to cosmetics usually occur at a remote site for varnishes, and, most commonly, in situ with polymerising substances. Unvarnished artificial nails do not affect pulse oximetry readings, and in theory, patients are not required to remove them. However, a real problem of contamination via artificial nails exists. Increased carriage of pathological Gram-negative organisms and of Staphylococcus aureus and yeasts has been noted among nursing staff wearing artificial nails, both before and after fingernail cleaning. Fingernail fragility manifests itself through a number of different physical signs such as soft, breaking nails, with longitudinal or transverse fissures, showing distal doubling or friability. In some subjects, excessive manicuring with metal instruments or manicure sticks results in rolled onycholysis, of evocative appearance, or transverse onycholysis.

Belowground Response to Drought in a Tropical Forest Soil. II. Change in Microbial Function Impacts Carbon Composition

Climate model projections for tropical regions show clear perturbation of precipitation patterns leading to increased frequency and severity of drought in some regions. Previous work has shown declining soil moisture to be a strong driver of changes in microbial trait distribution, however, the feedback of any shift in functional potential on ecosystem properties related to carbon cycling are poorly understood. Here we show that drought-induced changes in microbial functional diversity and activity shape, and are in turn shaped by, the composition of dissolved and soil-associated carbon. We also demonstrate that a shift in microbial functional traits that favor the production of hygroscopic compounds alter the efflux of carbon dioxide following soil rewetting. Under drought the composition of the dissolved organic carbon pool changed in a manner consistent with a microbial metabolic response. We hypothesize that this microbial ecophysiological response to changing soil moisture elevates the intracellular carbon demand stimulating extracellular enzyme production, that prompts the observed decline in more complex carbon compounds (e.g., cellulose and lignin). Furthermore, a metabolic response to drought appeared to condition (biologically and physically) the soil, notably through the production of polysaccharides, particularly in experimental plots that had been pre-exposed to a short-term drought. This hysteretic response, in addition to an observed drought-related decline in phosphorus concentration, may have been responsible for a comparatively modest CO₂ efflux following wet-up in drought plots relative to control plots.

Lineage-specific chromatin signatures reveal a regulator of lipid metabolism in microalgae

Alga-derived lipids represent an attractive potential source of biofuels. However, lipid accumulation in algae is a stress response tightly coupled to growth arrest, thereby imposing a major limitation on productivity. To identify transcriptional regulators of lipid accumulation, we performed an integrative chromatin signature and transcriptomic analysis to decipher the regulation of lipid biosynthesis in the alga Chlamydomonas reinhardtii. Genome-wide histone modification profiling revealed remarkable differences in functional chromatin states between the algae and higher eukaryotes and uncovered regulatory components at the core of lipid accumulation pathways. We identified the transcription factor, PSR1, as a pivotal switch that triggers cytosolic lipid accumulation. Dissection of the PSR1-induced lipid profiles corroborates its role in coordinating multiple lipid-inducing stress responses. The comprehensive maps of functional chromatin signatures in a major clade of eukaryotic life and the discovery of a transcriptional regulator of algal lipid metabolism will facilitate targeted engineering strategies to mediate high lipid production in microalgae.

Abundance of Cottus poecilopus is influenced by O2 saturation, food density and Salmo trutta in three tributaries of the Rožnovská Bečva River, Czech Republic

The distribution patterns of alpine bullhead Cottus poecilopus in three tributary streams of the Rožnovská Bečva River (Danube basin) were studied with respect to temperature, oxygen concentration and saturation, shading, current, conductivity, total organic carbon (TOC), nitrates and phosphates, biochemical oxygen demand (BOD₅ ), pH, redox potential, bottom grain structure, density of macroinvertebrates and the abundance of brown trout Salmo trutta. Sites with lower abundance per hectare of C. poecilopus differed significantly in dissolved oxygen saturation, density of macroinvertebrates during the autumn period (positive correlation with C. poecilopus) and in abundance per hectare of S. trutta (negative correlation). These results indicate that these factors significantly influence the distribution of this endangered species in the studied catchment and that stocking of S. trutta will impair its recovery.

Acroosteolysis presenting with brachyonychia following exposure to cold

BACKGROUND

A vast number of conditions ranging from simple trauma to hereditary and collagen vascular disease had been described in association with acroosteolysis.

OBJECTIVE

To demonstrate that severe cold exposure not mounting to frostbite may be associated with acroosteolysis.

METHODS

A 16-year-old girl with acroosteolysis presenting with brachyonychia was fully investigated for possible cause of her nail and bone deformity.

RESULTS

Lab investigations including Parathormone levels, Anti Scl 70, ANA, Anti-CCP and RF levels were all normal. X-ray imaging revealed resorption of the tufts of the terminal phalanges bilaterally. Disruption of nail fold capillaries with sluggish flow in capillary loops was evident on capillaroscopy.

CONCLUSION

It had been repeatedly reported that frostbite, Raynaud's disease and diseases associated with repeated chilblains may be associated with secondary cold-induced acroosteolysis. Here, we present a case of acroosteolysis associated with brachyonychia following exposure to severe cold not mounting to frostbite.

The prevalence of onychomycosis in the global population: a literature study

BACKGROUND

Onychomycosis is a common disorder, and high prevalence figures are commonly cited in the literature.

OBJECTIVES

Evaluate the prevalence of onychomycosis based on published studies.

METHODS

Relevant studies were identified in Medline by using specific search criteria.

RESULTS

Eleven population-based and 21 hospital-based studies were identified. The mean prevalence in Europe and North America was 4.3% [95% Confidence Interval (CI): 1.9-6.8] in the population-based studies, but it was 8.9% (95% CI: 4.3-13.6) for the hospital-based studies. Both population-based and hospital-based studies showed that onychomycosis is more common in toenails and is seen more frequently in males. The main causative agent was a dermatophyte in 65.0% (95% CI: 51.9-78.1) of the cases. Trichophyton rubrum was the single most common fungus and was cultured on average in 44.9% of the cases (95% CI: 33.8-56.0). Moulds were found on average in 13.3% (95% CI: 4.6-22.1) and yeasts in 21.1% (95% CI: 11.0-31.3).

LIMITATIONS

We may not have been able to locate all studies.

CONCLUSIONS

Onychomycosis is a common disorder, but it may not be as common as cited in the literature, because hospital-based studies might overestimate the prevalence of onychomycosis. It is more frequent in males, and toenails are more commonly affected. Dermatophytes, particularly T. rubrum, are the main causative agents.

Functional genomics of novel secondary metabolites from diverse cyanobacteria using untargeted metabolomics

Mass spectrometry-based metabolomics has become a powerful tool for the detection of metabolites in complex biological systems and for the identification of novel metabolites. We previously identified a number of unexpected metabolites in the cyanobacterium Synechococcus sp. PCC 7002, such as histidine betaine, its derivatives and several unusual oligosaccharides. To test for the presence of these compounds and to assess the diversity of small polar metabolites in other cyanobacteria, we profiled cell extracts of nine strains representing much of the morphological and evolutionary diversification of this phylum. Spectral features in raw metabolite profiles obtained by normal phase liquid chromatography coupled to mass spectrometry (MS) were manually curated so that chemical formulae of metabolites could be assigned. For putative identification, retention times and MS/MS spectra were cross-referenced with those of standards or available sprectral library records. Overall, we detected 264 distinct metabolites. These included indeed different betaines, oligosaccharides as well as additional unidentified metabolites with chemical formulae not present in databases of metabolism. Some of these metabolites were detected only in a single strain, but some were present in more than one. Genomic interrogation of the strains revealed that generally, presence of a given metabolite corresponded well with the presence of its biosynthetic genes, if known. Our results show the potential of combining metabolite profiling and genomics for the identification of novel biosynthetic genes.

Robust automated mass spectra interpretation and chemical formula calculation using mixed integer linear programming

Untargeted metabolite profiling using liquid chromatography and mass spectrometry coupled via electrospray ionization is a powerful tool for the discovery of novel natural products, metabolic capabilities, and biomarkers. However, the elucidation of the identities of uncharacterized metabolites from spectral features remains challenging. A critical step in the metabolite identification workflow is the assignment of redundant spectral features (adducts, fragments, multimers) and calculation of the underlying chemical formula. Inspection of the data by experts using computational tools solving partial problems (e.g., chemical formula calculation for individual ions) can be performed to disambiguate alternative solutions and provide reliable results. However, manual curation is tedious and not readily scalable or standardized. Here we describe an automated procedure for the robust automated mass spectra interpretation and chemical formula calculation using mixed integer linear programming optimization (RAMSI). Chemical rules among related ions are expressed as linear constraints and both the spectra interpretation and chemical formula calculation are performed in a single optimization step. This approach is unbiased in that it does not require predefined sets of neutral losses and positive and negative polarity spectra can be combined in a single optimization. The procedure was evaluated with 30 experimental mass spectra and was found to effectively identify the protonated or deprotonated molecule ([M + H](+) or [M - H](-)) while being robust to the presence of background ions. RAMSI provides a much-needed standardized tool for interpreting ions for subsequent identification in untargeted metabolomics workflows.

[Nerve sheath myxoma of the hyponychium]

BACKGROUND

Nerve sheath myxoma is a rare benign tumour of the extremities that was long confounded with neurothekeoma. Herein, we describe a rare case of interest because of its site on the hyponychium.

PATIENTS AND METHODS

A 31-year-old woman presented with a painless distal tumour on the right ring finger that had been present for 3 to 4 years. It consisted of a firm, round nodule under the nail and spreading to the fingertip. Complete excision was carried out after cutting away the distal nail plate. Histological examination revealed a myxoid tumour comprising very clearly delineated lobules containing pale fusiform cells with small nuclear inclusions. These cells expressed S100 protein but no CD34 or epithelial membrane antigen (EMA). Complete excision was performed and a full recovery was made.

DISCUSSION

This type of tumour is characteristic of nerve sheath myxoma, and is almost certainly of Schwannian origin, although distinct from Schwannoma. It is rare, occurs after the age of 35 years and is preferentially located in the extremities of the limbs. There has only been one other description of its occurrence under the fingernail, in which it was described as neurothekeoma. However, neurothekeoma is entirely different, being more cellular, with no expression of protein S100, and marked by the NKIC3 antibody; it occurs in children or young adults, and is frequently found on the face. These two tumours were confused for some time, but today they must be completely distinguished from one another. These myxomas must be completely excised because of the risk of relapse. Finally, they should be distinguished from other myxoid tumours of the digits, certain of which can be malignant.

Metabolites associated with adaptation of microorganisms to an acidophilic, metal-rich environment identified by stable-isotope-enabled metabolomics

Microorganisms grow under a remarkable range of extreme conditions. Environmental transcriptomic and proteomic studies have highlighted metabolic pathways active in extremophilic communities. However, metabolites directly linked to their physiology are less well defined because metabolomics methods lag behind other omics technologies due to a wide range of experimental complexities often associated with the environmental matrix. We identified key metabolites associated with acidophilic and metal-tolerant microorganisms using stable isotope labeling coupled with untargeted, high-resolution mass spectrometry. We observed >3,500 metabolic features in biofilms growing in pH ~0.9 acid mine drainage solutions containing millimolar concentrations of iron, sulfate, zinc, copper, and arsenic. Stable isotope labeling improved chemical formula prediction by >50% for larger metabolites (>250 atomic mass units), many of which were unrepresented in metabolic databases and may represent novel compounds. Taurine and hydroxyectoine were identified and likely provide protection from osmotic stress in the biofilms. Community genomic, transcriptomic, and proteomic data implicate fungi in taurine metabolism. Leptospirillum group II bacteria decrease production of ectoine and hydroxyectoine as biofilms mature, suggesting that biofilm structure provides some resistance to high metal and proton concentrations. The combination of taurine, ectoine, and hydroxyectoine may also constitute a sulfur, nitrogen, and carbon currency in the communities.

IMPORTANCE

Microbial communities are central to many critical global processes and yet remain enigmatic largely due to their complex and distributed metabolic interactions. Metabolomics has the possibility of providing mechanistic insights into the function and ecology of microbial communities. However, our limited knowledge of microbial metabolites, the difficulty of identifying metabolites from complex samples, and the inability to link metabolites directly to community members have proven to be major limitations in developing advances in systems interactions. Here, we show that combining stable-isotope-enabled metabolomics with genomics, transcriptomics, and proteomics can illuminate the ecology of microorganisms at the community scale.

Metabolic footprinting of mutant libraries to map metabolite utilization to genotype

The discrepancy between the pace of sequencing and functional characterization of genomes is a major challenge in understanding complex microbial metabolic processes and metabolic interactions in the environment. Here, we identified and validated genes related to the utilization of specific metabolites in bacteria by profiling metabolite utilization in libraries of mutant strains. Untargeted mass spectrometry based metabolomics was used to identify metabolites utilized by Escherichia coli and Shewanella oneidensis MR-1. Targeted high-throughput metabolite profiling of spent media of 8042 individual mutant strains was performed to link utilization to specific genes. Using this approach we identified genes of known function as well as novel transport proteins and enzymes required for the utilization of tested metabolites. Specific examples include two subunits of a predicted ABC transporter encoded by the genes SO1043 and SO1044 required for the utilization of citrulline and a predicted histidase encoded by the gene SO3057 required for the utilization of ergothioneine by S. oneidensis. In vitro assays with purified proteins showed substrate specificity of SO3057 toward ergothioneine and histidine betaine in contrast to substrate specificity of a paralogous histidase SO0098 toward histidine. This generally applicable, high-throughput workflow has the potential both to discover novel metabolic capabilities of microorganisms and to identify the corresponding genes.

Bronchoscopy as an indicator of tracheobronchial fungal infection in non-neutropenic intensive-care unit patients

We aimed to establish that a bronchoscopic view can be as reliable as microbiology, and support an empirical tracheobronchial fungal infection (TBFI) treatment decision. We retrospectively studied 95 respiratory failure patients with suspected TBFI admitted to the intensive-care unit (ICU) in 2008 with sticky secretions, hyperaemic mucosa, and whitish plaques on bronchoscopic view. Patients not suspected of having TBFI were chosen as a control group (n = 151). Broncheoalveolar lavage (BAL) fluid was cultured, and biopsy samples were taken from the lesions. Biopsy samples positive for fungi were defined as 'proven', only BAL-positive (+ fungi) cases were 'probable TBFI', and BAL-negative (- fungi) cases were 'possible TBFI'. BAL (+ fungi) and BAL (- fungi) in the control group were defined as 'colonization' and 'no TBFI', respectively. The sensitivity, specificity and positive and negative predictive values of BAL (+ fungi) were 85.1% (63/74), 81.4% (140/172), 66.3% (63/95), and 92.7% (140/151), respectively. Biopsies were performed in 78 of 95 patients, and 28 were proven TBFI with fungal elements, and 100% were BAL (+ fungi). Probable TBFI was seen in 30 of 95 patients with BAL (+ fungi), and possible TBFI (BAL(- fungi)) in 25 of 95. Among the 95 patients, microbiology revealed fungi (90.5% Candida species; 9.5% Aspergillus) in 63 (66.3%). In the controls, the colonization and no TBFI rates were 11 of 151 and 140 of 151, respectively. Observing sticky secretions, hyperaemic mucosa and whitish plaques by bronchoscopy is faster than and may be as reliable as microbiology for diagnosing TBFI. These findings are relevant for empirical antifungal therapy in suspected TBFI patients in the ICU.

Improved genome annotation through untargeted detection of pathway-specific metabolites

BACKGROUND

Mass spectrometry-based metabolomics analyses have the potential to complement sequence-based methods of genome annotation, but only if raw mass spectral data can be linked to specific metabolic pathways. In untargeted metabolomics, the measured mass of a detected compound is used to define the location of the compound in chemical space, but uncertainties in mass measurements lead to "degeneracies" in chemical space since multiple chemical formulae correspond to the same measured mass. We compare two methods to eliminate these degeneracies. One method relies on natural isotopic abundances, and the other relies on the use of stable-isotope labeling (SIL) to directly determine C and N atom counts. Both depend on combinatorial explorations of the "chemical space" comprised of all possible chemical formulae comprised of biologically relevant chemical elements.

RESULTS

Of 1532 metabolic pathways curated in the MetaCyc database, 412 contain a metabolite having a chemical formula unique to that metabolic pathway. Thus, chemical formulae alone can suffice to infer the presence of some metabolic pathways. Of 248,928 unique chemical formulae selected from the PubChem database, more than 95% had at least one degeneracy on the basis of accurate mass information alone. Consideration of natural isotopic abundance reduced degeneracy to 64%, but mainly for formulae less than 500 Da in molecular weight, and only if the error in the relative isotopic peak intensity was less than 10%. Knowledge of exact C and N atom counts as determined by SIL enabled reduced degeneracy, allowing for determination of unique chemical formula for 55% of the PubChem formulae.

CONCLUSIONS

To facilitate the assignment of chemical formulae to unknown mass-spectral features, profiling can be performed on cultures uniformly labeled with stable isotopes of nitrogen (15N) or carbon (13C). This makes it possible to accurately count the number of carbon and nitrogen atoms in each molecule, providing a robust means for reducing the degeneracy of chemical space and thus obtaining unique chemical formulae for features measured in untargeted metabolomics having a mass greater than 500 Da, with relative errors in measured isotopic peak intensity greater than 10%, and without the use of a chemical formula generator dependent on heuristic filtering. These chemical formulae can serve as indicators for the presence of particular metabolic pathways.

Finger retronychias detected early by 3D ultrasound examination

BACKGROUND

A new pattern of ingrown nail, called retronychia is involved in the posterior translation of the whole nail unit producing paronychia.

OBJECTIVE

To demonstrate an unusual case of paronychia that affected three of the fingers on the right hand.

METHODS

We used 3D ultrasound to study the whole nail unit in the fingers of both the affected (right) and non affected (left) hand.

RESULTS

Backward motion of the nail unit with decreased distance between the origin of the nail plates and the distal interphalangeal joint was clearly demonstrated by 3D ultrasound in the affected fingers.

CONCLUSION

3D ultrasound provides non invasive and more understandable information about the physiopathological changes in retronychia.

Nail biology and nail science

The nail plate is the permanent product of the nail matrix. Its normal appearance and growth depend on the integrity of several components: the surrounding tissues or perionychium and the bony phalanx that are contributing to the nail apparatus or nail unit. The nail is inserted proximally in an invagination practically parallel to the upper surface of the skin and laterally in the lateral nail grooves. This pocket-like invagination has a roof, the proximal nail fold and a floor, the matrix from which the nail is derived. The germinal matrix forms the bulk of the nail plate. The proximal element forms the superficial third of the nail whereas the distal element provides its inferior two-thirds. The ventral surface of the proximal nail fold adheres closely to the nail for a short distance and forms a gradually desquamating tissue, the cuticle, made of the stratum corneum of both the dorsal and the ventral side of the proximal nail fold. The cuticle seals and therefore protects the ungual cul-de-sac. The nail plate is bordered by the proximal nail fold which is continuous with the similarly structured lateral nail fold on each side. The nail bed extends from the lunula to the hyponychium. It presents with parallel longitudinal rete ridges. This area, by contrast to the matrix has a firm attachment to the nail plate and nail avulsion produces a denudation of the nail bed. Colourless, but translucent, the highly vascular connective tissue containing glomus organs transmits a pink colour through the nail. Among its multiple functions, the nail provides counterpressure to the pulp that is essential to the tactile sensation involving the fingers and to the prevention of the hypertrophy of the distal wall tissue, produced after nail loss of the great toe nail.

Development and validation of nail psoriasis quality of life scale (NPQ10)

BACKGROUND

The chronic and treatment-resistant nature of nail psoriasis affects patients' lives not only physically but also psychologically. Although there are scoring systems available for disease severity, there is as yet no scale to evaluate the impact of this condition upon the patients' quality of life.

OBJECTIVES

This study aims to develop and validate a quality of life scale specifically for nail psoriasis.

METHODS

A questionnaire was developed during a study conducted in France between 2004 and 2005. With the cooperation of l'Association Pour la Lutte Contre le Psoriasis, the questionnaire was sent to a random sample of 4000 of its 17,000 members.

RESULTS

The response rate was 33%. Of the 1309 questionnaires returned, 795 showed the presence of nail psoriasis and these were eligible. The scale score is obtained by adding together the responses to the 10 questionnaire items and the result is expressed as a percentage. The value of the score obtained is proportional to the functional difficulty experienced. The determination of Cronbach's a coefficient and a Principal Component Factor Analysis show, respectively, very good internal consistency and the unidimensional nature of the scale. Test-retest results on 15 patients showed good reproducibility. Results were validated with reference to the Dermatology Life Quality Index. In this study, the NPQ10 score is significantly influenced by gender (women have a higher score) and by the duration of psoriasis (recent onset implies greater functional difficulty). Finally, the score is much higher when the nail psoriasis affects both the hands and the feet.

CONCLUSION

This study confirms a change in the quality of life of patients who have nail psoriasis. The NPQ10 scale, specific to this condition, is simple to use and has the attributes needed in a quality of life scale. The scale must now be tested in longitudinal studies (such as clinical trials) to confirm its ability to measure a change in status.

Chemical avulsion with urea nail lacquer

BACKGROUND

Among the therapeutic possibilities for onychomycosis, chemicalnail avulsion is a logical approach to the eradication of the pathogen.

METHODS

A new formulation was used as a nail lacquer containing 40% urea in a film-forming solution in 10 patients presenting with onychomycosis. The urea nail lacquer was applied with a brush twice a day for 1 week by the patient and for a further week in two patients presenting total dystrophic onychomycosis.

RESULTS

This transungual delivery system weakens the nail plate/nail bed attachment in the diseased area.

CONCLUSION

The urea nail lacquer is comfortable for the patient and allows easy removal of the affected part of the fungal nail plate.

Three cases of intrathoracic gossypiboma with varying morbidities depending on the time of detection

An intrathoracic gossypiboma (surgical sponge retained within the thoracic cavity during surgery) is rare but causes serious surgical complications and presents with difficulties in the differential diagnosis. In this article, we describe three cases of intrathoracic gossypiboma identified with the help of exploratory surgery 22, 10 and 3 years after they had been retained after surgery. The radiological findings varied in these cases and were insufficient for an accurate preoperative diagnosis. Marked deterioration in the neighboring lung tissue was observed over time, and the patients who had gossypibomas for 22, 10 and 3 years required pneumonectomy, lobectomy and partial decortication, respectively.