{"id":"https://openalex.org/W2957296158","doi":"https://doi.org/10.1093/mmy/myz075","title":"PAS stain based histological classification and severity grading of toenail onychomycosis","display_name":"PAS stain based histological classification and severity grading of toenail onychomycosis","publication_year":2019,"publication_date":"2019-06-12","ids":{"openalex":"https://openalex.org/W2957296158","doi":"https://doi.org/10.1093/mmy/myz075","mag":"2957296158","pmid":"https://pubmed.ncbi.nlm.nih.gov/31309228"},"language":"en","primary_location":{"id":"doi:10.1093/mmy/myz075","doi":"https://doi.org/10.1093/mmy/myz075","is_oa":false,"landing_page_url":"https://doi.org/10.1093/mmy/myz075","pdf_url":null,"source":{"id":"https://openalex.org/S93288122","display_name":"Medical Mycology","issn_l":"0268-1218","issn":["0268-1218","1365-280X","1369-3786","1460-2709"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-1"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical Mycology","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5044841181","display_name":"Xingpei Hao","orcid":"https://orcid.org/0000-0001-8661-2304","observed_orcids":["https://orcid.org/0000-0001-8661-2304"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Xingpei Hao","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5014981140","display_name":"Joon H. Yim","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Joon Yim","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":null,"display_name":"David Freedman","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"David Freedman","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5032395244","display_name":"Sarwat Siddiqui","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Sarwat Siddiqui","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":null,"display_name":"David Levine","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"David Levine","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5043524081","display_name":"Michael Tritto","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Michael Tritto","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5023533021","display_name":"Gina M Saffo","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Gina M Saffo","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5032213286","display_name":"Adam L. Isaac","orcid":"https://orcid.org/0000-0001-5338-3445","observed_orcids":["https://orcid.org/0000-0001-5338-3445"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Adam Isaac","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":"https://orcid.org/0000-0001-5338-3445","affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5033742004","display_name":"Gene S. Mirkin","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Gene Mirkin","raw_affiliation_strings":["Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Foot and Ankle Specialists of Mid-Atlantic, LLC. Rockville, Maryland, USA","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5033742004","https://openalex.org/A5044841181"],"corresponding_institution_ids":[],"apc_list":{"value":4889,"currency":"USD","value_usd":4889},"apc_paid":null,"fwci":0.5191,"has_fulltext":false,"cited_by_count":4,"citation_normalized_percentile":{"value":0.63410813,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":88,"max":95},"biblio":{"volume":"58","issue":"4","first_page":"453","last_page":"459"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11253","display_name":"Nail Diseases and Treatments","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2708","display_name":"Dermatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11253","display_name":"Nail Diseases and Treatments","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2708","display_name":"Dermatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11037","display_name":"Fungal Infections and Studies","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12317","display_name":"Actinomycetales infections and treatment","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2726","display_name":"Microbiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/onychomycosis","display_name":"onychomycosis","score":0.9940000176429749},{"id":"https://openalex.org/keywords/toenails","display_name":"toenails","score":0.5550000071525574},{"id":"https://openalex.org/keywords/periodic-acid-schiff-staining","display_name":"PAS staining","score":0.8009999990463257},{"id":"https://openalex.org/keywords/histological-classification","display_name":"histological classification","score":0.9769999980926514},{"id":"https://openalex.org/keywords/severity-grading","display_name":"severity classification","score":0.9409999847412109},{"id":"https://openalex.org/keywords/subungual-onychomycosis","display_name":"subungual onychomycosis","score":0.968999981880188},{"id":"https://openalex.org/keywords/fungal-density","display_name":"fungal density","score":0.7770000100135803},{"id":"https://openalex.org/keywords/treatment-response","display_name":"treatment response","score":0.6449999809265137},{"id":"https://openalex.org/keywords/treatment-guidelines","display_name":"treatment guidelines","score":0.414000004529953}],"concepts":[{"id":"https://openalex.org/C2777286243","wikidata":"https://www.wikidata.org/wiki/Q5591926","display_name":"Grading (engineering)","level":2,"score":0.6799122095108032},{"id":"https://openalex.org/C2781294515","wikidata":"https://www.wikidata.org/wiki/Q2733470","display_name":"Stain","level":3,"score":0.6760900616645813},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5741795301437378},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.45278024673461914},{"id":"https://openalex.org/C16005928","wikidata":"https://www.wikidata.org/wiki/Q171171","display_name":"Dermatology","level":1,"score":0.4094499945640564},{"id":"https://openalex.org/C74864618","wikidata":"https://www.wikidata.org/wiki/Q2332446","display_name":"Staining","level":2,"score":0.35195010900497437},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.12476864457130432},{"id":"https://openalex.org/C18903297","wikidata":"https://www.wikidata.org/wiki/Q7150","display_name":"Ecology","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D000293","descriptor_name":"Adolescent","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000369","descriptor_name":"Aged, 80 and over","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002648","descriptor_name":"Child","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002675","descriptor_name":"Child, Preschool","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005533","descriptor_name":"Foot Dermatoses","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D005533","descriptor_name":"Foot Dermatoses","qualifier_ui":"Q000382","qualifier_name":"microbiology","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010503","descriptor_name":"Periodic Acid-Schiff Reaction","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D012720","descriptor_name":"Severity of Illness Index","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D014009","descriptor_name":"Onychomycosis","qualifier_ui":"Q000145","qualifier_name":"classification","is_major_topic":true},{"descriptor_ui":"D014009","descriptor_name":"Onychomycosis","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D014009","descriptor_name":"Onychomycosis","qualifier_ui":"Q000473","qualifier_name":"pathology","is_major_topic":false},{"descriptor_ui":"D055815","descriptor_name":"Young Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1093/mmy/myz075","doi":"https://doi.org/10.1093/mmy/myz075","is_oa":false,"landing_page_url":"https://doi.org/10.1093/mmy/myz075","pdf_url":null,"source":{"id":"https://openalex.org/S93288122","display_name":"Medical Mycology","issn_l":"0268-1218","issn":["0268-1218","1365-280X","1369-3786","1460-2709"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-1"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical Mycology","raw_type":"journal-article"},{"id":"pmid:31309228","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/31309228","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical mycology","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9391000270843506,"display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":22,"referenced_works":["https://openalex.org/W57803676","https://openalex.org/W163655423","https://openalex.org/W1950078727","https://openalex.org/W1968089704","https://openalex.org/W2014489968","https://openalex.org/W2017263357","https://openalex.org/W2037147326","https://openalex.org/W2072500262","https://openalex.org/W2073148029","https://openalex.org/W2077956529","https://openalex.org/W2081793374","https://openalex.org/W2109533181","https://openalex.org/W2152784305","https://openalex.org/W2589164862","https://openalex.org/W2637073256","https://openalex.org/W2725535854","https://openalex.org/W2789816728","https://openalex.org/W2809639793","https://openalex.org/W2810533515","https://openalex.org/W2811270246","https://openalex.org/W2991051170","https://openalex.org/W4245953518"],"related_works":["https://openalex.org/W2964830252","https://openalex.org/W1968089704","https://openalex.org/W4206682951","https://openalex.org/W4309407796","https://openalex.org/W2077868973","https://openalex.org/W2046461011","https://openalex.org/W3095859591","https://openalex.org/W1994872394","https://openalex.org/W4413792225","https://openalex.org/W2081793374"],"abstract_inverted_index":{"Onychomycosis":[0],"is":[1,9,25],"a":[2,57,77,99,232],"common":[3],"world-wide":[4],"health":[5],"issue.":[6],"Accurate":[7],"detection":[8,59],"essential":[10],"for":[11,71,234],"treatment.":[12,228],"Multiple":[13],"studies":[14],"have":[15],"shown":[16],"that":[17,168,191,209],"PAS-stain":[18],"based":[19,41,63,103,238],"histological":[20,42,104,212,241],"visualization":[21],"of":[22,47,61,67,85,146,179,194,219,236],"fungal":[23,36,58,86,221],"elements":[24],"superior":[26],"to":[27,107,201,227],"either":[28],"direct":[29],"microscopy":[30],"with":[31],"20%":[32],"potassium":[33],"hydroxide,":[34],"or":[35,115,120,123,128,131,138],"culture.":[37],"However,":[38],"PAS":[39,74,101,172],"stain":[40,102],"classification":[43,105,213,242],"and":[44,73,89,134,140,149,156,161,185,203,243],"severity":[45,193,218],"grading":[46],"onychomycosis":[48,109,112,118,126,136,142,237],"are":[49],"lacking":[50],"in":[51,93],"the":[52,83,192,210,217,220,225,240],"literature.":[53],"Here":[54],"we":[55,97],"reported":[56],"rate":[60],"47.87%":[62],"on":[64,82,239],"an":[65],"analysis":[66,84],"13,805":[68],"toenails":[69,174,182],"processed":[70],"H&E":[72],"stains":[75],"over":[76],"three":[78],"year":[79],"period.":[80],"Based":[81],"density,":[87],"distribution":[88],"infiltrating":[90],"depth":[91],"level":[92],"858":[94],"PAS-positive":[95],"toenails,":[96],"created":[98],"novel":[100],"system":[106],"classify":[108],"as":[110,153,158,163],"occult":[111],"(OO),":[113],"focal":[114,122,130],"diffuse":[116,124,132],"subungual":[117,133],"(FSO":[119],"DSO),":[121],"plate":[125,135],"(FPO":[127],"DPO),":[129],"(FSPO":[137],"DSPO)":[139],"superficial":[141],"(SO).":[143],"The":[144],"severities":[145],"OO,":[147],"FSO":[148],"FPO":[150],"were":[151,175],"graded":[152],"mild,":[154],"DSO":[155],"DPO":[157],"moderate,":[159],"FSPO":[160],"DSPO":[162],"severe":[164,176,200],"infections,":[165],"which":[166],"revealed":[167],"more":[169],"than":[170],"75%":[171],"positive":[173],"infections.":[177],"Evaluation":[178],"97":[180],"paired":[181],"biopsied":[183],"pre-":[184],"post-treatment":[186],"from":[187,199],"47":[188],"patients":[189],"demonstrated":[190],"infection":[195,222],"was":[196],"significantly":[197],"reduced":[198],"mild":[202],"moderate":[204],"levels.":[205],"These":[206],"data":[207],"indicate":[208],"current":[211],"evaluates":[214],"not":[215],"only":[216],"but":[223],"also":[224],"response":[226],"We":[229],"further":[230],"propose":[231],"guideline":[233],"treatment":[235],"severity.":[244]},"counts_by_year":[{"year":2025,"cited_by_count":2},{"year":2022,"cited_by_count":1},{"year":2020,"cited_by_count":1}],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2019-07-23T00:00:00"}