Acrylates in artificial nails-Results of product analyses and glove penetration studies.

BACKGROUND: Artificial nail materials are mixtures that are prone to contain several sensitizing (meth)acrylates. It is not known whether the listing of (meth)acrylates is correct in these products' packages. Protective gloves suited for nail work are needed. OBJECTIVES: To analyse (meth)acrylates in gel nail and acrylic nail products chemically and to compare the results with the information in the product labels, and to study penetration of artificial nail materials through selected disposable gloves. METHODS: We analysed 31 gel nail products and 6 acrylic nail products for their (meth)acrylate content by gas chromatography-mass spectrometry (GC-MS). We tested the penetration of two nail products through three disposable gloves: nitrile rubber, neoprene rubber and polyvinyl chloride (PVC). RESULTS: Altogether 32/37 products contained (meth)acrylates. In all of them, there was discrepancy between the listed (meth)acrylates and those discovered in the analysis. The commonest (meth)acrylates were hydroxyethyl methacrylate (HEMA, 20/37 samples) and hydroxypropyl methacrylate (HPMA, 9/37 samples), but many of the product packages failed to declare them. Isobornyl acrylate (IBA) was discovered in nine gel nail products. The neoprene glove could withstand nail gel for 20 min and thin nitrile glove and PVC glove for 5 min. Acrylic nail liquid penetrated through disposable gloves quickly. CONCLUSIONS: Labelling of artificial nail products was notably incorrect on most products. Requirements for product labelling must be updated so that the risk of sensitization associated with artificial nail products is clearly indicated. Disposable gloves can probably be used short-term in gel nail work, whereas disposable gloves do not protect the user from acrylic nail liquids.

Fingernail form as a post-extraction guide for selecting the maxillary central incisor tooth form in the Saudi Arabian population: A novel application of CAD software.

Background: Human teeth and nails have demonstrated similar factors genetically, embryologically, and morphologically. The fingernail form may be used as a post-extraction guide for selecting the tooth form. Aim: To evaluate the correlation between the maxillary left central incisor tooth form with the left index, middle, and ring fingernails in the Saudi Arabian population. Materials and Methods: A descriptive cross-sectional study with purposive sampling was done among 200 Saudi participants. The maxillary left central incisor and the left index, middle, and ring fingernail were scanned using an intraoral scanner. The 3D digital images were converted to 3D models. The tooth form (tooth length, tooth width, and tooth shape) and nail form (nail length, nail width, and nail shape) were measured using the CAD software. Pearson's correlation coefficient and T-test were used for statistical analysis (P < 0.05). Result: A significant correlation exists between tooth length and nail length, with a maximum correlation toward index nail length (P = 0.015). A significant correlation exists between tooth width and nail width, with a maximum correlation toward ring nail width (P = 0.002). A significant correlation exists between tooth length and nail length in females with a maximum correlation toward index nail length in females (P = 0.001). The mean percentage of similarity between tooth and nail shape (index, middle, and ring) in males and females shows a highly significant difference between them (P = 0.001). The results indicate that the tooth and nail shape are similar (70 to 90%) based on the criteria set by the software. Conclusion: A definite correlation exists between maxillary central incisor tooth form and fingernail form. The fingernail form may be used as a post-extraction guide for selecting the maxillary central incisor tooth form in the Saudi Arabian population.

Biomarkers of environmental manganese exposure.

We conducted a critical review on biomarkers of environmental manganese (Mn) exposure to answer the following questions: 1) are there reliable biomarkers of internal Mn exposure (Mn in biological matrices) associated with external metrics of Mn exposure (Mn in environmental media)? and 2) are there accurate reference values (RVs) for Mn in biological matrices? Three bibliographic databases were searched for relevant references and identified references were screened by two independent reviewers. Of the 6342 unique references identified, 86 articles were retained for data abstraction. Our analysis of currently available evidence suggests that Mn levels in blood and urine are not useful biomarkers of Mn exposure in non-occupational settings. The strength of the association between Mn in environmental media and saliva was variable. Findings regarding the utility of hair Mn as a biomarker of environmental Mn exposure are inconsistent. Measurements of Mn in teeth are technically challenging and findings on Mn in tooth components are scarce. In non-occupationally exposed individuals, bone Mn measurements using in vivo neutron activation analysis (IVNAA) are associated with large uncertainties. Findings suggest that Mn in nails may reflect Mn in environmental media and discriminate between groups of individuals exposed to different environmental Mn levels, although more research is needed. Currently, there is no strong evidence for any biological matrix as a valid biomarker of Mn exposure in non-occupational settings. Because of methodological limitations in studies aimed at derivation of RVs for Mn in biological materials, accurate RVs are scarce.

Evaluation of metal concentrations in hair and nails after dental implant placement.

STATEMENT OF PROBLEM: The accumulation of the elements contained in Ti6Al4V, the mostly used titanium alloy for dental implants, in epithelial extensions requires investigation. Studies evaluating the metals in dental implants in the hair and nails of patients with dental implants are lacking. PURPOSE: The purpose of this clinical research was to measure the levels of titanium (Ti), aluminum (Al), and vanadium (V) in the hair and nails of patients treated with grade 5 Ti alloy dental implants. MATERIAL AND METHODS: Ti, Al, and V elemental levels in the hair and nail samples of 33 participants treated with grade 5 Ti alloy dental implants were measured by using an inductively coupled plasma mass spectrometer. RESULTS: The results revealed a statistically significant increase in the amount of Ti in nail samples after implant surgery (P=.01), but no statistically significant increases in the amounts of Al or V in nail samples (P=.48, P=.645). In hair samples, the increase in Ti, Al, and V was not statistically significant (P=.728, P=.221, P=.376). The correlation between the amount of change in the elements in implants and the contact areas was weak for hair (Al, r=0.114; Ti, r=0.361; V, r=0.377) and for nails (Al, r=0.127; Ti, r=0.116; V, r=0.058). CONCLUSIONS: After the placement of dental implants made of grade 5 Ti alloy, minimal Al and V accumulated in hair and nails.

Biomechanical analysis of recently released cephalomedullary nails for trochanteric femoral fracture fixation in a human cadaveric model.

BACKGROUND: Recently, two novel concepts for intramedullary nailing of trochanteric fractures using a helical blade or interlocking dual screws have demonstrated advantages as compared to standard single-screw systems. However, these two concepts have not been subjected to a direct biomechanical comparison so far. The aims of this study were to investigate in a human cadaveric model with low bone quality (1) the biomechanical competence of nailing with the use of a helical blade versus interlocking screws, and (2) the effect of cement augmentation on the fixation strength of the helical blade. METHODS: Twelve osteoporotic and osteopenic human cadaveric femoral pairs were assigned for pairwise implantation using either a short TFN-ADVANCED Proximal Femoral Nailing System (TFNA) with a helical blade head element or a short TRIGEN INTERTAN Intertrochanteric Antegrade Nail (InterTAN) with interlocking screws. Six osteoporotic femora, implanted with TFNA, were augmented with bone cement. Four groups were created: group 1 (TFNA) paired with group 2 (InterTAN), both consisting of osteopenic specimens, and group 3 (TFNA augmented) paired with group 4 (InterTAN), both consisting of osteoporotic specimens. An unstable trochanteric AO/OTA 31-A2.2 fracture was simulated and all specimens were tested until failure under progressively increasing cyclic loading. RESULTS: Stiffness in group 3 was significantly higher versus group 4, p = 0.03. Varus (°) and femoral head rotation around the femoral neck axis (°) after 10,000 cycles were 1.9 ± 1.0/0.3 ± 0.2 in group 1, 2.2 ± 0.7/0.7 ± 0.4 in group 2, 1.5 ± 1.3/0.3 ± 0.2 in group 3 and 3.5 ± 2.8/0.9 ± 0.6 in group 4, being significantly different between groups 3 and 4, p = 0.04. Cycles to failure and failure load (N) at 5° varus or 10° femoral head rotation around the neck axis in groups 1-4 were 21,428 ± 6020/1571.4 ± 301.0, 20,611 ± 7453/1530.6 ± 372.7, 21,739 ± 4248/1587.0 ± 212.4 and 18,622 ± 6733/1431.1 ± 336.7, being significantly different between groups 3 and 4, p = 0.04. CONCLUSIONS: Nailing of trochanteric femoral fractures with use of helical blades is comparable to interlocking dual screws fixation in femoral head fragments with low bone quality. Bone cement augmentation of helical blades provides significantly greater fixation strength compared to interlocking screws constructs.

STRYDE versus PRECICE magnetic internal lengthening nail for femur lengthening.

INTRODUCTION: Magnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the MILN (PRECICE®) has been in use since 2011 but had limitations (50-75 lb) in post-operative weight bearing. A new stainless-steel version of the MILN (STRYDE®) allows 150-250 lb of post-operative weight bearing. The aim is to compare the outcomes of using these two different MILNs for both unilateral and bilateral femoral lengthening. METHODS: A single-center, retrospective cohort study was conducted in which patients' records were reviewed from the period from January 2017 to March 2020. A total of 66 femoral lengthening procedures were included in the study and were divided into two groups: STRYDE® group (30 femora) and PRECICE® group (36 femora). Outcomes assessed were the 6-months post-operative Limb Deformity-Scoliosis Research Society (LD-SRS) Score, adjacent joint range of motion (ROM), average distraction rate, bone healing index (BHI), and complications. RESULTS: No statistically significant difference was found between the two groups in regard to the (LD-SRS) score, hip ROM, or knee ROM. Statistically significant differences were found between the two groups in regard to BHI (average of 0.84 months/cm and 0.67 months/cm for STRYDE® and PRECICE®, respectively) and distraction rate (average of 0.6 mm/day and 0.9 mm/day for STRYDE® and PRECICE®, respectively). No mechanical nail complications were reported in the STRYDE® group compared to three events of nail failure in the PRECICE® group. One femur in the PRECICE® group needed BMAC injection for delayed healing compared to four femurs in the STRYDE® group. CONCLUSION: The STRYDE® MILN yields comparable functional results to those of PRECICE® MILN and shows fewer mechanical nail complications. However, STRYDE® MILN requires a slower distraction rate and yields slower healing (larger BHI). LEVEL OF EVIDENCE: Level III, Therapeutic study.

A validation study on fingernail cortisol: correlations with one-month cortisol levels estimated by hair and saliva samples.

Several studies have focused on the cortisol levels in fingernail samples as a possible index of cumulative hormone production; however, the biological validity of fingernail cortisol has not been fully established. We investigated the association between cortisol levels in fingernail samples and other biological specimens, including hair and saliva samples, in healthy young adults to determine whether fingernail cortisol was associated with past cumulative hormone production. Participants were 23 adults (14 men and 9 women; mean age = 22.7 ± 2.8 years). Saliva samples were collected three times per day for 30 days, and hair samples (1 cm) from participants' scalps were obtained. Fingernail samples were repeatedly collected for 8 months, considering growth rate of fingernail and time lag for fingernails to fully extend from the nail matrix. Cortisol levels in hair samples were significantly associated with the levels in fingernail samples that were obtained 3 months after hair collection (r = .48, p < .05). The 30-day integrated area under the curve, based on salivary cortisol levels at awakening and bedtime, were significantly associated with cortisol levels in fingernail samples that were collected 2-5 months after saliva collection. This finding was especially significant after adjusting for the awakening time when the saliva was collected. This study provided evidence that fingernail cortisol was associated with cumulative hormone levels measured several months before but not those in the present. The samples may be useful for endocrinological evaluation in the investigation of chronic stress, cortisol levels, and health; moreover, the use of fingernail samples would permit larger-scale studies.

Biomarkers for the Assessment of Exposure to Fluoride in Adults.

To monitor deficient or excessive intakes of biologically available fluoride (F), various biological samples have been tested for use as biomarkers of human exposure to F. Most such studies have concerned children and often have only involved measurement of F in 1 or 2 types of sample. The present study investigated the relationships of F concentrations in biomarkers of F exposure; including plasma, saliva, hair, finger- and toenails, and daily urinary F excretion (UFE) with the total daily F intake (TDFI) of adults. TDFI was assessed in 60 healthy adults, aged ≥20 years; 31 lived in a low-F water area (LFA, 0.04 mg F/L) and 29 in a high-F water area (HFA, 3.05 mg F/L) of Nigeria. All volunteers provided at least 1 biomarker sample from the above list and completed a questionnaire to evaluate F intake from the diet and toothpaste ingestion. TDFI, UFE and F concentrations of biomarkers were statistically significantly higher in the HFA than in the LFA. There were strong statistically significant positive correlations between TDFI and UFE (ρ = 0.730, p < 0.001); plasma F (ρ = 0.729, p < 0.001); fasting whole saliva F (ρ = 0.653, p < 0.001) and hair F (ρ = 0.603, p < 0.001). The statistically significant positive correlations between TDFI and fingernail F (ρ = 0.502, p < 0.001) and between TDFI and toenail F (ρ = 0.556, p < 0.001) were moderate. In conclusion, this study has indicated the usefulness of 24-h UFE as well as F concentration in plasma, fasting whole saliva and hair as biomarkers of contemporary or sub-chronic F exposure in groups of adults. However, they do not appear to have the necessary sensitivity to predict F exposure in individuals.

Dental Fluorosis according to Birth Cohort and Fluoride Markers in an Endemic Region of Colombia.

OBJECTIVES: To analyze changes in the dental fluorosis (DF) incidence according to a birth cohort and explore current exposure to DF in a case series. METHODS: Repeated cross-sectional study of two periods: 2015 and 2018. Two standardized examiners registered DF using the Thylstrup-Fejerskov index in permanent teeth of children aged 7-18 years. Period and birth cohort frequencies were estimated by a generalized linear model, binomial family, and logarithmic link function. Period estimates are presented as prevalence ratios (PR) and birth cohort estimates as cumulative incidence ratios (RR); 95% confidence intervals and P values are reported. In a subsample of 37 volunteers (12.29 ± 2.63 years), the fluoride (F) concentration in toenails was measured using the HMDS diffusion method and an ion-specific electrode. Other samples from the local environment such as food, soil, and coal were also collected. RESULTS: In 274 children, we found that nonsignificant increases between periods (PR = 1.17; 95% CI: 0.89-1.55) were not explained by birth cohort effects. A total of 37.8% of the subsample had a toenail F concentration ≥2 µg F/g. The salty snacks and seasoning had the highest F concentrations among local environmental samples. CONCLUSION: In this population with a high DF frequency according to birth cohort and the evaluated period, the study of soil, coal, and food samples indicated a continued F exposure. F concentration found in the toenails shows a moderate F exposure; nearly a third of the children and adolescents exceeded the adopted threshold of 2 µg F/g. It is important to monitor and explore changes in exposure in highly affected population.

Nails as a primary sample type for molecular genetic identification of highly decomposed human remains.

For identification of badly preserved cadavers, only a few tissues can be used as a source of DNA, mostly bones and teeth, from which sampling and DNA extraction are difficult and time-consuming. In most highly decomposed remains, the nails are preserved. The aim of this study was to evaluate nails as an alternative source of DNA instead of bones and teeth in demanding routine identification cases. An automated extraction method was optimized on nails obtained from 33 cadavers with a post-mortem interval (PMI) up to 5 years. The commercially available EZ1 Investigator Kit (Qiagen) was used for extraction, and the G2 buffer included in the kit was replaced with TNCa buffer, and DTT was added for digestion of 5 mg of nail. The DNA was purified in a Biorobot EZ1 device (Qiagen), quantified using the PowerQuant System (Promega), and STR typing was performed with the NGM kit (TFS). From 0.3 to 270 µg DNA/g of nail was obtained from the samples analyzed, with an average yield of 36 µg DNA/g of nail. Full STR profiles were obtained from all nails except one. The optimized extraction method proved to be fast and highly efficient in the removal of PCR inhibitors, and it yields high amounts of DNA for successful STR typing. Nails were implemented as the primary sample type for obtaining DNA from highly decomposed and partially skeletonized cadavers in routine forensic identification cases in our laboratory.

Skin and nails abnormalities in a patient with ZTTK syndrome and a de novo mutation in SON.

Zhu-Tokita-Takenouchi-Kim (ZTTK) syndrome is a rare, severe, and recently described multisystem developmental disorder characterized by delayed psychomotor development and intellectual disability, characteristic facial features, hypotonia, poor overall growth, and visual abnormalities. Mucocutaneous manifestations have not been reported so far among individuals with ZTTK syndrome. Herein, we present a patient with ZTTK syndrome due to a de novo mutation in SON gene, who has dental abnormalities and retronychia of the toenails. We suggest that mucocutaneous features may be a part of the phenotype.

BIO-NAIL: a bacterial cellulose dressing as a new alternative to preserve the nail bed after avulsion.

Avulsion of the nail plate is the most accomplished surgical procedure among the nail apparatus surgeries. Since it is not possible to use the removed nail to cover the nail bed, some materials have been suggested, however, they are generally not available for use and often at a high cost. To evaluate the use of Bacterial Cellulose (BC) dressing as a biological nail (Bio-Nail) after partial or total avulsion of the nail plate. Twenty-six candidates for nail avulsion, were randomized into two groups: Control, using Vaseline with gauze (11 patients) and Experimental group, BC group, using the Bio-Nail (15 patients). The patients were followed up during the 180-day period. The distribution of the patients in the groups was homogeneous for both sociodemographic and clinical data. The occurrence of infection (1 case in the control group) was not statistically relevant. The BC group had lower pain intensity (p = 0.011) with earlier temporal resolution when compared to the control group (p = 0.003). The BC group presented earlier reepithelization (p = 0.022) and better quantitative (p = 0.021) and qualitative conditions (p = 0.011) for the exudate. Regarding satisfaction, all the patients were satisfied. Good preservation of the nail plate area was observed in the BC group at the end of the 180-day period (p = 0.024). Average time of BC dressing permanence was 16.4 ± 7.1 days. BC showed to be appropriate as a dressing after partial or total avulsion of the nail plate. BC is a Bio-Nail promising for nail bed healing.

The Mind-Body Study: study design and reproducibility and interrelationships of psychosocial factors in the Nurses' Health Study II.

PURPOSE: Associations between psychosocial factors and biomarkers are increasingly investigated in studies of cancer incidence and mortality. Documenting optimal data/biospecimen collection protocols and scale properties are fundamental for elucidating the impact of psychosocial factors on biologic systems and ultimately cancer development/progression. METHODS: Between 2013 and 2014, 233 Nurses' Health Study II women (mean age: 60.6) participated in the Mind-Body Study. Participants completed a detailed online psychosocial assessment and provided hair, toenail, timed saliva over 1 day, urine and fasting blood twice, 1 year apart. Additionally, two separate microbiome collections for stool and saliva were conducted between the psychosocial assessments. We assessed correlations between various psychosocial measures and evaluated their 1-year reproducibility using intraclass correlations (ICC). RESULTS: Compliance with the protocols was high among participants. Psychosocial measures showed moderate-to-high reproducibility over 1 year (ICCs = 0.51-0.81). There was clear clustering of psychosocial factors according to whether they were querying positive (e.g., optimism, mastery, mindfulness) or negative (e.g., anxiety, depression, discrimination) emotion-related or social constructs. CONCLUSION: Results suggest feasibility for self-administered collection of various biospecimens and moderate-to-high reproducibility of psychosocial factors. The Mind-Body Study provides a unique resource for assessing inter-relationships between psychosocial factors and biological processes linked with long-term health outcomes, including carcinogenesis.

Incontinentia pigmenti in adults.

Incontinentia Pigmenti (IP; MIM 308300) is an X-linked dominant genodermatosis caused by pathogenic variant in IKBKG. The phenotype in adults is poorly described compared to that in children. Questionnaire survey of 99 affected women showed an age at diagnosis from newborn to 41 years, with 53 diagnosed by 6 months of age and 30 as adults. Stage I, II, and III lesions persisted in 16%, 17%, and 71%, respectively, of those who had ever had them. IP is allelic to two forms of ectodermal dysplasia. Many survey respondents reported hypohidrosis and/or heat intolerance and most had Stage IV findings. This suggests that "Stage IV" may be congenitally dysplastic skin that becomes more noticeable with maturity. Fifty-one had dentures or implants with 26 having more invasive jaw or dental surgery. Half had wiry or uncombable hair. Seventy-three reported abnormal nails with 27 having long-term problems. Cataracts and retinal detachment were the reported causes of vision loss. Four had microphthalmia. Respondents without genetic confirmation of IP volunteered information suggesting more involved phenotype or possibly misassigned diagnosis. Ascertainment bias likely accounts for the low prevalence of neurocognitive problems in the respondents.

Ingrown Toenail Management.

Ingrown toenails account for approximately 20% of foot problems in primary care. The great toe is most often affected. Ingrown toenails occur most commonly in young men, and nail care habits and footwear are most often contributory factors. No consensus has been reached for the best treatment approach, but ingrown nails may be nonsurgically or surgically treated. Nonsurgical treatments are typically used for mild to moderate ingrown nails, whereas surgical approaches are used in moderate and severe cases. Simple nonsurgical palliative measures include correcting inappropriate footwear, managing hyperhidrosis and onychomycosis, soaking the affected toe followed by applying a mid- to high-potency topical steroid, and placing wisps of cotton or dental floss under the ingrown lateral nail edge. Application of a gutter splint to the ingrown nail edge to separate it from the lateral fold provides immediate pain relief. A cotton nail cast made from cotton and cyanoacrylate adhesive, taping the lateral nail fold, or orthonyxia may also alleviate mild to moderate ingrown toenail. Surgical approaches seek to remove the interaction between the nail plate and the nail fold to eliminate local trauma and inflammatory reaction. These approaches are superior to nonsurgical ones for preventing recurrence. The most common surgical approach is partial avulsion of the lateral edge of the nail plate. Matrixectomy further prevents recurrence and can be performed through surgical, chemical, or electrosurgical means.

Is Fixing Pediatric Nail Bed Injuries With Medical Adhesives as Effective as Suturing?: A Review of the Literature.

OBJECTIVES: Nail bed injuries are common in children, with nail bed damage accounting for 15% to 24% of fingertip injuries. Our objective was to see whether medical adhesives, the cyanoacrylates including Histoacryl and Dermabond, could be used to fix nail bed lacerations as opposed to doing a primary repair with sutures, thus potentially being a quicker method for repair in the emergency department for these injuries. METHODS: We conducted a literature review using the search engines MEDLINE, PubMed, Web of Science, and Google Scholar, and the references within these articles were also integrated. All articles in English were searched. Search terms included "nail bed repair," "nail bed laceration repair," and "cyanoacrylate." RESULTS: A total of 6 articles were found using the previously mentioned search terms. Four articles using 2-octyl cyanoacrylate or Dermabond for the repair of nail bed injuries were found, with 2 additional articles describing the use of Histoacryl-n-butyl-2-cyanoacrylate-for nail injury repairs. CONCLUSIONS: The 6 articles discussed in this article include approximately 118 patients' worth of data including a mix of adult and pediatric patients. Despite the small numbers and variety of types of study, it is encouraging that there are so many positive results. Cryoacrylates such as Dermabond or Histoacryl maybe useful to assist with nail injuries in children. Therefore, we feel that using a medical adhesive is as effective as suturing nail bed injuries in children.

Fingernail and toenail clippings as a non-invasive measure of chronic cortisol levels in adult cancer survivors.

PURPOSE: Cancer survivors are at greater risk of comorbidities and functional decline due to physiological and psychological stress which can be measured by salivary cortisol. If saliva is used, multiple samples must be collected to accurately quantify long-term stress; however, fingernail (FN) and toenail (TN) clippings offer an opportunity to measure retrospective cortisol levels in a non-invasive manner. METHODS: Three sets of FN and TN clippings were collected at 12-month intervals in conjunction with saliva samples from cancer survivors (n = 109) participating in two clinical trials. FN and TN samples were stored at room temperature (RT); a subset underwent additional processing and freezing before analysis. Cortisol levels were determined via enzyme immunoassay, and correlation coefficients were generated to determine overall correspondence of the individual measures. RESULTS: Matched RT and frozen samples were highly correlated for TN (r = 0.950, p = 5.44 × 10-37) and FN (r = 0.784, p = 1.05 × 10-10). Correlations between RT FN and TN were statistically significant (r = 0.621, p = 3.61 × 10- 17), as were frozen FN and TN (r = 0.310, p = 0.0283). RT, but not frozen TN and FN correlated with salivary cortisol (r = 0.580, p = 1.65 × 10- 16 and r = 0.287, p = 0.00042 for TN and FN, respectively). CONCLUSIONS: FN and TN cortisol levels correlate with salivary cortisol in adult cancer survivors and may offer a less invasive and convenient means for measuring chronic cortisol levels.

Physiological stress measures in preschool children and their relationship with body composition and behavioral problems.

BACKGROUND: The relationship between physiological stress measures and body composition or behavioral problems in older children remains controversial, and data in young children are lacking. The aim of the study was to investigate this relationship in predominantly healthy preschool children. METHOD: Physiological stress measures were assessed using diurnal salivary alpha-amylase (sAA) and salivary cortisol, nail cortisol and parasympathetic activation (PNS) by overnight heart rate variability, and body composition (body mass index, skinfold thickness) and behavior problems (using the Strengths and Difficulties Questionnaire) in 324 children aged 2-6 years of the SPLASHY study. RESULTS: Parasympathetic nervous system was inversely related to body fat, to emotional, and to peer problems. Diurnal sAA was related to hyperactivity problems and moderated the relationship of cortisol and hyperactivity problems. Cortisol was not related to any other health problems. DISCUSSION: The relationship of PNS with body composition and behavioral problems might highlight the protective role of the parasympathetic system early in life.

Enhanced Ungual Permeation of Terbinafine HCl Delivered Through Liposome-Loaded Nail Lacquer Formulation Optimized by QbD Approach.

The present investigation focused on developing, optimizing, and evaluating a novel liposome-loaded nail lacquer formulation for increasing the transungual permeation flux of terbinafine HCl for efficient treatment of onychomycosis. A three-factor, three-level, Box-Behnken design was employed for optimizing process and formulation parameters of liposomal formulation. Liposomes were formulated by thin film hydration technique followed by sonication. Drug to lipid ratio, sonication amplitude, and sonication time were screened as independent variables while particle size, PDI, entrapment efficiency, and zeta potential were selected as quality attributes for liposomal formulation. Multiple regression analysis was employed to construct a second-order quadratic polynomial equation and contour plots. Design space (overlay plot) was generated to optimize a liposomal system, with software-suggested levels of independent variables that could be transformed to desired responses. The optimized liposome formulation was characterized and dispersed in nail lacquer which was further evaluated for different parameters. Results depicted that the optimized terbinafine HCl-loaded liposome formulation exhibited particle size of 182 nm, PDI of 0.175, zeta potential of -26.8 mV, and entrapment efficiency of 80%. Transungual permeability flux of terbinafine HCl through liposome-dispersed nail lacquer formulation was observed to be significantly higher in comparison to nail lacquer with a permeation enhancer. The developed formulation was also observed to be as efficient as pure drug dispersion in its antifungal activity. Thus, it was concluded that the developed formulation can serve as an efficient tool for enhancing the permeability of terbinafine HCl across human nail plate thereby improving its therapeutic efficiency.