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Objective Most current wound size measurement devices or applications require manual wound tracing and reference markers. Chronic wound care usually relies on patients or caregivers who might have difficulties using these devices. Considering a more human-centered design, we propose an automatic wound size measurement system by combining three deep learning (DL) models and using fingernails as a reference. Materials and methods DL models (Mask R-CNN, Yolov5, U-net) were trained and tested using photographs of chronic wounds and fingernails. Nail width was obtained through using Mask R-CNN, Yolov5 to crop the wound from the background, and U-net to calculate the wound area. The system’s effectiveness and accuracy were evaluated with 248 images, and users’ experience analysis was conducted with 30 participants. Results Individual model training achieved a 0.939 Pearson correlation coefficient (PCC) for nail-width measurement. Yolov5 had the highest mean average precision (0.822) with an Intersection-over-Union threshold of 0.5. U-net achieved a mean pixel accuracy of 0.9523. The proposed system recognized 100% of fingernails and 97.76% of wounds in the test datasets. PCCs for converting nail width to measured and default widths were 0.875 and 0.759, respectively. Most inexperienced caregivers consider convenience is the most important factor when using a size-measuring tool. Our proposed system yielded 90% satisfaction in the convenience aspect as well as the overall evaluation. Conclusion The proposed system performs fast and easy-to-use wound size measurement with acceptable precision. Its novelty not only allows for conveniences and easy accessibility in homecare settings and for inexperienced caregivers; but also facilitates clinical treatments and documentation, and supports telemedicine.

We introduce a paradigm of completely non-invasive, on-demand diagnostics that may replace common blood-based laboratory tests using only a smartphone app and photos. We initially targeted anemia, a blood condition characterized by low blood hemoglobin levels that afflicts >2 billion people. Our app estimates hemoglobin levels by analyzing color and metadata of fingernail bed smartphone photos and detects anemia (hemoglobin levels <12.5 g dL −1 ) with an accuracy of ±2.4 g dL −1 and a sensitivity of 97% (95% CI, 89–100%) when compared with CBC hemoglobin levels ( n  = 100 subjects), indicating its viability to serve as a non-invasive anemia screening tool. Moreover, with personalized calibration, this system achieves an accuracy of ±0.92 g dL −1 of CBC hemoglobin levels ( n  = 16), empowering chronic anemia patients to serially monitor their hemoglobin levels instantaneously and remotely. Our on-demand system enables anyone with a smartphone to download an app and immediately detect anemia anywhere and anytime. Anemia has a global prevalence of over 2 billion people and is diagnosed via blood-based laboratory test. Here the authors describe a smartphone app that can estimate hemoglobin levels and detect anemia by analyzing pictures of fingernail beds taken with a smartphone and without the need of any external equipment.

DNA obtained from the crime scene or in the form of trace evidence is one of the most crucial pieces of evidence to individualize an assailant. During a violent physical assault, DNA, in the form of epithelial cells or blood due to violent scratching, is deposited in the hyponychium of the fingernail. This trace DNA is recovered and extracted from the fingernail debris by nail swabbing, and genetic profiling is done from the extracted DNA. The objective of the study is to evaluate the amount of exogenous DNA that persists in fingernail debris and the difference in recovery rate of the biological material under fingernails after specific time intervals while immersed in different water bodies. The study uses synthetic/prosthetic fingers that mimics the real-life drowned cases. Among the three different water bodies included in the study, samples recovered from tap water were highest in concentration; with a concentration of approximately 21 ng/µL even after 48 h of submersion. Whereas, the lowest concentrations of DNA, as low as 0.68 ng/µL, were observed in samples that were recovered from the sewage water after 48 h of submersion. The findings revealed that DNA yield varies significantly depending on the type of water body, with freshwater environments (tap water and canal water) showing higher recovery rates compared to polluted waters (sewage water). These results are pivotal in understanding the potential of fingernail debris as a forensic sample for DNA analysis, particularly in the cases of drowning. The use of prosthetic fingers in this study provides a controlled and ethical model that can simulate submersion scenarios and help inform forensic protocols for evidence collection in real-world drowning or submerged body cases. [Display omitted] •Fingernail debris retains DNA traceable to assailants after violent assaults.•This study simulates drowning cases using prosthetic fingers in various water bodies.•Tap water samples yielded highest DNA (∼21 ng/µL) after 48 h immersion.•Sewage water caused the greatest DNA degradation (as low as 0.68 ng/µL).•DNA recovery varies by water type, aiding forensic analysis in drowning cases.

Nail properties and appearances can indicate a person's underlying systemic diseases. Raman spectroscopy is an established laboratory technique and has been applied to nails, identifying spectral differences between healthy individuals and patient populations. We aim to explore the importance of potential spectral or chemical variations in nails between sexes, age groups, hands, and fingers. Twenty male and twenty female participants without known musculoskeletal or dermatological diseases donated nail clippings from each finger. The clippings were cleaned, and Raman spectra collected and analysed using a standardised protocol. In total 2000 spectra were collected. Females have higher intensities of disulphide, protein, and lipid bands, particularly in their 40s, than males. Age-related changes were prominent in female nails, especially in sulphur-related bands. No significant differences were observed between nails from the left and right hands or among different fingers. We did not control other factors such as diet, medication, or different occupation or sports participation. This is the first study to use Raman spectroscopy to compare nail composition across different ages and sexes in healthy adults. The findings provide a strong basis for further studies on nails at the population level for screening or monitoring diseases.

This study highlights the conservation problems faced by the tiny freshwater bivalves of the family Sphaeriidae, also known as pea, pill, or fingernail clams (or mussels) in Europe. Despite their global distribution, assumed ecological importance, and potential uses, basic knowledge about their taxonomy, biology, and ecology is very limited and much lower than for the larger freshwater bivalve taxa. Immediate scientific priorities are required to fill knowledge gaps regarding their taxonomy, genetic diversity, distribution, reproductive cycle, ecosystem functions, and population trends. Such fundamental knowledge is necessary to identify specific threats and develop appropriate conservation actions. Deploying environmental DNA analysis at a large scale could be a valuable way to fill gaps in distribution and strengthen monitoring in areas where local taxonomic knowledge is lacking. Until taxon-specific management plans can be developed, we recommend that efforts concentrate on the general protection and restoration of wetland habitats, implementing pollution control measures, and managing invasive species. These actions should be complemented by community engagement through citizen science initiatives. Additionally, prioritising data collection to fill existing knowledge gaps and updating conservation statuses (Red Lists) based on comprehensive assessments will be crucial. Implementing these actions will provide a starting point for the broader protection of freshwater ecosystems, thus benefiting pea clams and other interconnected species within these habitats.

Background Onychomycosis is commonly caused by dermatophytes, but nondermatophytic molds (NDMs) are increasingly recognized, even in immunocompetent individuals. These infections often present atypically, leading to delayed diagnosis. NDMs require accurate identification, as they may not respond to standard antifungal treatments used for dermatophyte infections. Case report An immunocompetent man in his 40s presented with discoloration of a single right index fingernail. He reported no trauma, systemic illness, or immunosuppressive therapy. Examination revealed brown-black nail discoloration with a milky-white base and mild nail dystrophy, without onycholysis or subungual debris. Other nails were unaffected. A provisional diagnosis of nondermatophytic mold onychomycosis was made. Nail clippings were sent for fungal culture showing growth of Aspergillus niger . Conclusion NDM onychomycosis should be considered in isolated nail discoloration, even in healthy individuals. Early laboratory evaluation is crucial for accurate diagnosis and effective, targeted antifungal therapy. Clinical trial Not applicable.

Abstract Introduction/Objective Nail apparatus tumors are rare and can pose diagnostic challenges. Onychomatricoma (also called onychomatrixoma) is a rare tumor first described in 1992. It is a benign biphasic fibroepithelial tumor of the nail. It has been reported in Caucasians, often in females with a peak incidence in the fifth decade of life. Rare cases are also reported in children. The common location is in the fingernail (75%), presenting with yellowing of the nail plate (xanthonychia) and thick longitudinal band. Cutaneous horn, melanonychia, nail bleeding, and nail deformity with or without bony extension can also be seen. Histologic findings show increased nail thickness surrounded by a layer of Malpighian epithelium. The fibroepithelial tumor shows hyperplasia of two components including onychogenic epithelium and mesenchymal stroma. Methods/Case Report A 65-year-old Vietnamese female presented with longstanding dark yellowish ridging discoloration, thickening and nail plate deformity of the left fourth fingernail with appearance of onychomycosis. However, KOH mount and fungal cultures of the nail plate were negative for fungal microorganisms. There was no history of pain, trauma, or prior treatment. Microscopic analysis of transverse and longitudinal sections of the nail shows a biphasic neoplasm that penetrates the nail plate with multiple digitations. There was deep finger-like epithelial cell strands that form anastomosis as well as invaginations into the dermis. Characteristic filiform projections are lined by onychogenic epithelium composed mostly of basal and supra-basal cells that lack granular and corneum layers. The stroma was hypercellular and fibrillary with spindle-shaped fibroblastic cells, and a deep layer with dense collagen. Immunohistochemical stains of the lesion show diffuse expression for CD10 and CD34 in the stroma and negativity for Periodic Acid Schiff staining. Results (if a Case Study enter NA) N/A Conclusion While most of the literature on onychomatricoma has been reported in Caucasian population, little is known about this tumor in non-Caucasians. This case report of onychomatricoma in a Vietnamese woman contributes to the emerging literature of this rare nail apparatus tumor in non-Caucasian population. Clinical and histopathologic correlation is important to achieve prompt and correct diagnosis since delay would result in nail dystrophy and deformity.

The effects of early-life metal exposure on neurodevelopment in very low birth weight preterm (VLBMP) children (with a birth weight of <1500 g and a gestational age of <37 weeks) have not been clearly established. We aimed to investigate associations of childhood exposure to multiple metals and preterm low birth weight with neurodevelopment among children at 24 months of corrected age. VLBWP children ( n = 65) and normal birth weight term (NBWT) children ( n = 87) were enrolled from Mackay Memorial Hospital in Taiwan between December 2011 and April 2015. Lead (Pb), cadmium (Cd), arsenic (As), methylmercury (MeHg), and selenium (Se) concentrations in the hair and fingernails were analyzed as biomarkers for metal exposure. The Bayley Scale of Infant and Toddler Development, Third Edition, was used to determine neurodevelopment levels. VLBWP children had significantly lower scores in all development domains compared to NBWT children. We also investigated preliminary exposure levels of VLBWP children to metals as reference values for future epidemiological and clinical survey. Fingernails are a useful biomarker for metal exposure to evaluate the effects on neurological development. A multivariable regression analysis revealed that fingernail Cd concentrations were significantly negatively associated with cognition ( β = −0.63, 95% confidence interval (CI): −1.17 to −0.08) and receptive language function ( β = −0.43, 95% CI: −0.82 to −0.04) among VLBWP children. VLBWP children with a 10-μg/g increase in the As concentration in their nails had a 8.67-point lower composite score in cognitive ability and a 1.82-point lower score in gross-motor functions. Effects of preterm birth and postnatal exposure to Cd and As were associated with poorer cognitive, receptive language, and gross-motor abilities. VLBWP children are at risk for neurodevelopmental impairments when exposed to metals. Further large-scale studies are needed assess to the risk of neurodevelopmental impairments when vulnerable children are exposed to metal mixtures.

BackgroundThe distal interphalangeal joint (DIP), the extensor tendon enthesis and fingernail, in psoriatic arthritis (PsA) represent a very interesting site where the dermatologic, synovial, and entheseal features of the disease merge. The nail-enthesis complex (NEC) can be well analysed with ultrasound (US), and the nailfold is the ideal site to assess angiogenesis, another typical feature of psoriatic synovitis, with both power Doppler (PD) and nailfold videocapillaroscopy (NVC). Studies have shown that PsA patients may have differences in the structure of the nail complex and capillaries compared with healthy individuals. No study has combined the two techniques.ObjectivesTo evaluate the ability of combined US examination of the NEC and NVC to differentiate PsA from psoriasis (PSO), rheumatoid arthritis (RA), and healthy subjects (HC).MethodsTwenty age- and sex-matched subjects per group were consecutively enrolled. Each subject was blindly assessed and underwent US of the NEC, NVC, and clinical examination. For the US examination, the nail plate, matrix, and bed were assessed in grayscale (GS) and with PD according to the Brown University Nail Enthesis Scale (BUNES)[1]. For the nail plate, the Wortsman[2] classification was also evaluated. The thickness of the nail plate, matrix, and nail bed were measured. Mean values of 10 digits were used for the analysis. Capillary density, number of microhaemorrhages, tortuous capillaries, ectasia, and ramified capillaries were assessed at NVC. Mean values were calculated for II-V digits in both hands. After excluding subjects with missing values, differences among groups were analysed with Kruskal-Wallis test. US and NVC variables were then included in a K-Means clustering model. The number of clusters was determined using the elbow method. Factor analysis was performed to explain the clustering results. The number of factors was selected using the Scree plot method.ResultsThe BUNES GS total score, the BUNES GS score for the plate, and the Wortsman score were significantly lower in HC compared to all other groups. BUNES GS for the plate was higher in PSO than in HC. The number of tortuous capillaries was higher in PsA than in PSO and HC, but not in RA. The clustering model identified five clusters (Figure 1A), showing good separation of PsA and HC. PSO were distributed from cluster 2 to cluster 5 and RA among all clusters. At factor analysis (Figure 1B), all US GS variables loaded on factor 1, US PD variables loaded on factor 2, matrix and bed thickness loaded on factor 3, and number of tortuous capillaries and ectasias loaded on factor 4. Loadings of Factor 5 and 6 were below 0.5.ConclusionThe results of this pilot study confirm that PsA patients have significant changes in the structure of the NEC compared with healthy subjects. However, most of these changes do not appear to be specific to PsA, as they are also found in PSO and, most surprisingly, in RA where DIP joint involvement is not present. Interestingly, PsA patients appear to have higher numbers of tortuous capillaries compared with PSO and HC, consistent with increased angiogenesis in the synovium. The combined evaluation seems to provide a good distinction between PsA and HC. Not surprisingly, PSO patients clustered closer to PsA (although with significant overlap with HC), which may be due to subclinical involvement. RA patients are distributed among all clusters and have alterations similar to those of PsA. This study does not provide a clear explanation for this phenomenon, and further studies are needed. This pilot study allowed us to identify US and NVC features that can be selected and applied in a prospective study that includes early undifferentiated arthritides and new-onset PSO, to understand whether the observed differences occur early in the disease and whether changes occur during the course of the disease. A larger sample size could also improve the accuracy of the clustering model.References[1]Cunha JS et al. doi:10.3899/jrheum.170146[2]Wortsman X et al. doi:10.1016/j.det.2006.03.014Figure 1.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Excessive use of alcohol increases the risk to be involved in a road traffic accident. According to many legislations, certain maximal blood-alcohol-concentrations (BAC) have to be respected to be allowed to drive on public roads. Acute alcohol intoxication is evaluated by blood analysis or analysis of the exhaled alveolar air. In many cases, evaluation of the alcohol consumption during the past months can be useful. In this light, ethyl glucuronide (EtG), a direct alcohol biomarker which can be found in keratinized matrices (hair, nails) is valuable and can be used for the long-term follow-up of alcohol consumption. To compare the EtG concentration in hair and fingernails from teetotalers, and to propose a cut-off value for EtG in fingernails for alcohol abstinence. Paired samples of hair and nails were collected from participants, with a minimum age of 18 years. They all stated alcohol abstinence for at least 6 months. Participants were asked to complete a questionnaire about age, gender and the use of hair care products and nail polish. Analysis of EtG in the nail and hair samples were conducted following a validated analytical method. From 126 participants a hair and nail sample were collected. Of this group, 15 participants were finally not included in the study because of insufficient amount of hair or nails collected. There were more female participants (65%) and the average age of participants was 39 years. The EtG concentration in hair was below the limit of detection of 2.1 pg/mg in all but 4 samples (2.1, 2.1, 2.9, and 3.5 pg/mg). The EtG concentration in nails was below the limit of detection in 97 of the 111 samples. The concentrations in nails ranged between 2.3 and 23 pg/mg. In a population of 111 teetotalers, the 97.5% percentile of EtG concentrations in fingernails is 7.6 pg/mg. The highest EtG concentration observed was 23 pg/mg. These results suggest that the cut-off value for alcohol abstinence may be lower than the previous suggested 59 pg/mg and 37 pg/mg. •Low concentration ethyl glucuronide in fingernails does not contradict teetotaling.•Ethyl glucuronide can be detected in fingernails when undetectable in hair.•Ethyl glucuronide in fingernails was below 7.6 pg/mg in 97.5% of teetotalers (n = 111).