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Verrucous carcinoma is classically considered a variant of squamous cell carcinoma, most commonly occurring in the oral cavity in association with snuff and chewed tobacco. However, the association between verrucous carcinoma of the foot and diabetes is less well known. This study presents a systematic review of all articles containing the search term “verrucous carcinoma” and “diabetic foot ulcer” in the abstract or title that have been published in PubMed before September 2020. The requirement for inclusion in our report were that the patient data had been documented in a case‐related manner and the patient diagnosed with verrucous carcinoma secondary to diabetic foot lesion. Seven descriptions of verrucous carcinoma presenting in patients with diabetic foot ulcers were presented across six case reports, and clinical case descriptions are collected here along with treatment outcomes, where available, and discussion of common mimics of verrucous carcinoma of the foot. Due to treatability and potential for extensive invasion of local structures requiring resection with wide margins, verrucous carcinoma should be carefully considered in the differential diagnosis of a warty foot lesion in the setting of the diabetic foot.

Background/purpose The LFA REAL™ is a measurement system for evaluating lupus disease activity from both clinician and patient perspectives. Patients’ viewpoints are captured using a patient-reported outcome (PRO) questionnaire. A series of visual analog scales are designed to rate disease severity and progress over the past 4 weeks. Brief instructions guide the patient to distinguish between active, potentially reversible symptoms and chronic pain or discomfort that are more likely due to damage. Beyond its simplicity and efficiency, the PRO can provide versatile assessments from a global, organ-based, and symptom-specific level. This paper describes the patient-centered approach used to evaluate the content validity of the LFA-REAL PRO. Methods The PRO was developed in accordance with FDA guidance. A two-phase qualitative study was performed with 25 lupus patients, 10 who participated in concept elicitation (Phase 1) and 15 in cognitive debriefing interviews (Phase 2). Qualitative data were analyzed using ATLAS.ti software v7.5. Upon completion of the interviews, participants completed the draft PRO and additional measures to characterize the sample. Results The mean age of participants was 45.6 and 88% were female, as expected in a lupus population. The mean SF-36 physical component score was 29.8 and the mean mental component score was 46.4. Phase 1 elicited symptom saturation and mapping of the draft PRO. Fatigue was reported by 100% of patients, highlighting its importance as a measurable domain. Additionally, 100% of patients spontaneously mentioned arthritis, which may be more important to this group than previously estimated, substantiating the approach of this PRO to break down components of arthritis into joint pain, stiffness, and swelling. Shortness of breath and fever were reported more frequently than expected. Phase 2 data demonstrated that participants found the instrument easy to use and offered recommendations to improve clarity, leading to adjustments in wording and formatting. Conclusions Results suggest that the LFA-REAL PRO has content validity and, with some modifications suggested by participants, is ready for quantitative validation, including tests of reliability, validity, responsiveness to change, and performance relative to other PROs used in lupus trials. After validation, the LFA-REAL system is intended for use in clinical practice and research. Electronic supplementary material The online version of this article (10.1186/s12955-019-1151-8) contains supplementary material, which is available to authorized users.

Objectives Hydroxychloroquine (HCQ) is a key therapy in systemic lupus erythematosus (SLE). Medication non-adherence is reported in up to 80% of lupus patients and results in increased morbidity, mortality, and health care utilization. HCQ levels are a sensitive and reliable method to assess medication adherence. Our study evaluated the role of HCQ level measurement in routine clinical care and its association with disease activity in a predominantly Hispanic population. Methods SLE patients from the Columbia University Lupus cohort treated with HCQ for ≥ 6 months and reporting medication adherence were included. HCQ levels were measured by whole blood high performance liquid chromatography. Non-adherence was defined as an HCQ level Results One hundred and eight patients were enrolled; the median age was 38 years, 91% were female, and 63% were Hispanic. The median SLEDAI-2K was 4.3 (0–20). Forty-one percent of patients had an HCQ level Conclusion HCQ levels

In response to loosened telehealth regulations and local restrictions on elective procedures during the coronavirus disease 2019 (COVID-19) pandemic, telemedicine use has dramatically increased. The goal of this study was to analyze patterns in telemedicine use among podiatric physicians during the COVID-19 crisis on a national level. Anonymous responses to a survey of practice metrics as well as subjective impressions of telemedicine efficacy were collected from 246 respondents, representing >1% of practicing podiatrists in the United States. Linear regression was performed to identify variables associated with COVID-19 prevalence and variables associated with higher self-reported likelihood of offering telemedicine visits post-COVID-19. Physicians in areas of lower COVID-19 prevalence were found to dispense durable medical equipment more frequently in-office and conduct more post-op telemedicine visits, with fewer visits for infections and trauma. Podiatrists in these regions also rated telemedicine more effective for medical and musculoskeletal pathologies. Additionally, fewer of their practices had modified office hours, and more of them advertised telemedicine services. Physicians more likely to offer telemedicine post-COVID-19 had significantly higher new patient volume and increased acuity of cases, with patient admission to the hospital after telemedicine visits. These physicians ranked the effectiveness of telemedicine more highly for every pathology surveyed. Of note, American College of Foot and Ankle Surgeons region and years in clinical practice were not statistically associated with likelihood of offering telemedicine visits post-COVID-19. This study represents the first systematic national assessment of telemedicine use in podiatry and highlights clinically relevant changes in practice and perception of telemedicine in response to the COVID-19 pandemic.

Patients with systemic lupus erythematosus (SLE) face lifelong challenges from chronic and disabling symptoms. The toolkit for assessing patient progress lacks a simple, scalable index that includes both physician assessments and patient experiences. Clinician and patient reported outcomes (ClinROs and PROs) were developed in isolation and discrepancies in their results promote confusion. The Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL™) was designed as a simple, versatile instrument of simple additive scales. Dual physician and patient components allow for a complete evaluation of disease activity. This report presents the early development of the LFA-REAL™ PRO.An initial focus group was conducted consisting of 10 SLE patients who ranked 32 areas of health and identified additional domains that are important to people with lupus. Subsequently, 19 domains were ranked by 100 consecutive patients with SLE from New York and Oklahoma City.The 10 focus group participants were female and had a mean age of 38.6. The dimensions they identified were generally in two categories: symptoms and impacts. The main symptoms were fatigue, joint and muscle pain, and general pain. The main impacts were sleep, drug side effects, and physical well-being. The 100 patients with SLE (90% female, mean age 37.5 years) ranked the 19 fields of health in order of importance. The top eight domains ranked were joint and muscle pain, fatigue, experience of quality of life, general pain, physical well-being, emotional well-being, organ involvement, and family life. Clinicians reviewed the data and decided on an instrument that would differentiate between lupus related symptoms and impact on quality of life as well as differentiate active symptoms from chronic damage. The disease activity instrument draft included all the identified symptoms: rash, joint symptoms (pains, stiffness, and swelling), muscle pain, fatigue, organ involvement symptoms (fever, chest pain, shortness of breath, leg swelling, and other), and hair loss.The PRO derived here is a composite disease activity instrument to accompany the physician reported assessment. The ClinRO and the PRO will provide the spectrum of lupus disease activity and bring the patient's experience and provide essential quantitative data to the evaluation of lupus in routine clinical care and clinical research.

Background SLE arthritis is difficult to evaluate because of the sometimes-evanescent nature of the symptoms and limitations of physical exams and imaging studies. Dynamic diffuse optical spectroscopy (dDOS) can be used to assess changes in light absorption through tissues during transient venous occlusion. The optical signal reflects changes in blood perfusion and has diagnostic value in rheumatoid arthritis. The current study explored the use of dDOS in SLE arthritis. Methods 12 SLE patients (ACR criteria) with active arthritis and 5 controls were evaluated. A dDOS sensor module was developed (figure 1a). Hemodynamic effects were obtained by inflating a BP cuff to 40 mmHg ×60 s. Light at 3 wavelengths (lambda=530, 655, 940 nm) was used to illuminate joints at 8 different points. Transmitted light intensities were measured with Si-photodetectors at 8 other positions (total 8×8×3=192 signal traces). Swollen, tender and healthy joints were examined by the same assessor. Results SLE patients and normal controls dDOS data were available for analysis from 66 and 24 proximal interphalangeal (PIP) joints, respectively (PIPs 2–4). Best results were obtained at 530 nm with cuff inflation at 40 mmHg. A representative measurement of 3 SLE arthritis and 3 normal joints is shown in figure 1b, highlighting differences in rise and plateau time. Given the pronounced effects at lambda=530 nm, we speculate that altered vessel physiology paired with already-increased blood pooling in the affected inflamed joints resulted in quicker increase in light absorption (rise time) that is maintained longer (plateau time) compared to normal joints. The AUC for dDOS was consistent with excellent discrimination, AUC=0.8639, sensitivity=76.19, specificity=88.57 (figure 1c). Conclusions dDOS can evaluate SLE arthritis with high sensitivity and specificity. Rise and plateau time of the optical traces correlate strongly with swollen and tender joint count. The advantages of dDOS are non-invasiveness, objectivity (eliminates inter-rater variability and operator dependency), low cost, and high speed of performance (~5 min per area of scanning) compared to US and MRI. dDOS has the potential to bring much-needed objectivity to the quantification of SLE arthritis. Funding Source(s): N/A

It is estimated that in the USA 1.5 million people suffer from systemic lupus erythematosus (SLE). This autoimmune disease often involves joints, and more than 90% of those affected will experience joint pain, stiffness and swelling at some time during the course of their illness. It is currently difficult to both diagnose and estimate the severity of lupus, because signs and symptoms vary considerably from person to person and there is no single diagnostic test for it. We explored the clinical utility of frequency-domain optical tomography (FDOT) to distinguish finger joints affected by SLE from healthy ones of volunteers. The proximal interphalangeal joints (PIP) of the 2nd to the 5th digit from both hands of 10 SLE patients and 4 healthy volunteers were examined. This resulted in a total of 80 joints affected by SLE and 32 healthy joints. The FDOT system was operated at a frequency of 600MHz. The laser diode employed produced a 1-mm beam at 670nm light, which was guided to 11 positions on the top of the PIP joints. At every location, using an exposure time of 80 ms for 16 phase steps, transmission images were acquired using an ICCD camera. First results of the analysis of the amplitude and phase shift of the images acquired show a sensitivity of 100% and a specificity of 80% to distinguish between joints of healthy volunteers and SLE patients.

We have developed a system of flexible optical imaging bands that can be used to assess the effects of systemic lupus erythematosus (SLE) on finger joints. Each imaging band consists of four pairs of light sources and a photodetector. The light sources contain three different light emitting diodes with wavelengths of 530 nm, 655 nm and 940 nm. Two of these imaging bands are wrapped around the proximal interphalangeal (PIP) joints of the index-, middle-, and ringfingers. The imaging bands gather transmitted and reflected light intensities from the tissues for ~ 4 minutes including two venous occlusions. This results in hemodynamic time traces for all source-detector pairs. From theses traces a rise, plateau, and fall time are calculated. We found that, on average, signals obtained from SLE patients displayed a shorter rise time and longer plateau time as compared to signals from healthy controls. Performing a two-dimensional linear discriminant analysis on the rise and plateau times, we obtained the best specificity of 89% and the best sensitivity of 76 %. Area under the receiver operating characteristic (ROC) curve is 0.86.

Background Hydroxychloroquine (HCQ) is a key component of therapy for Systemic Lupus Erythematosus (SLE). Medication non-adherence is reported in 40%–80% of lupus patients and results in increased morbidity, mortality, and health care utilization. HCQ levels are a sensitive and reliable method to assess medication adherence. Our study evaluated the feasibility of HCQ level measurement in a routine clinical setting and its association with disease activity in a predominantly Hispanic population. Methods SLE patients from the Columbia University Lupus cohort, treated with HCQ for ≥6 months and reporting medication-adherence were included. HCQ levels were measured by whole blood high performance liquid chromatography. Non-adherence was defined as HCQ level Results One-hundred and eight patients were enrolled (table 1); the mean age was 38 years, 91% were female, and 62% were Hispanic. The average SLEDAI-2K was 4.3 (0–20). Forty-one percent of patients had HCQ levels Conclusions HCQ levels Acknowledgements We acknowledge the patients who participated in this study.

Objectives: No model exists to predict which patients with elbow ulnar collateral ligament (UCL) injuries will successfully return to play (RTP) with non-operative treatment. The reported rates for successful RTP after non-operative management of UCL injuries are limited and vary widely. Furthermore, patient and UCL injury characteristics that influence failure of non-operative treatment have not been established. We sought to identify which factors were most significant in predicting which patients would have successful RTP after non-operative management of UCL injury. In doing so, we created the Elbow UCL Injury Prognosis Score to identify and weigh factors that predict failure of non-operative treatment. The parameters include: age, position, competition level, moving valgus stress test (MVST), 5th finger sensation, UCL tenderness, and MRI findings including tear type, location, and chronicity features. This score will predict which patients will succeed non-operative management, avoiding unnecessary surgery while simultaneously identify patients for whom non-operative management would be delaying the inevitable need for surgical intervention. Methods: 205 patients were evaluated by the senior author for a UCL injury. Physical exam findings, imaging characteristics and patient demographics were retrospectively collected and entered into a HIPAA-compliant REDCap database after IRB approval of the study design. Of these patients, 138 underwent a trial of non-operative treatment and were either cleared for RTP (n= 55) or eventually underwent surgical intervention (n= 83) after a minimum one-month trial of non-operative management. Sixty-seven patients decided to have surgery immediately without trialing non-operative management and were excluded from the scoring system. The Elbow UCL Injury Prognosis Score was developed and validated using stepwise feature selection by Akaike information criterion (AIC). Three-fold cross validation was performed using these ten variables as predictors. The mean and standard deviation of area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value were evaluated. Results: The area under curve for non-operative failure predicting non-operative management failure was 0.79 (0.054), with sensitivity=0.85 (0.088), specificity=0.72 (0.032), positive predictive value=0.83 (0.023), negative predictive value=0.77 (0.091) [mean (standard deviation (SD))]. Patients were predicted to succeed non-operative management if they scored less than 10, while for a score greater than or equal to 10 patients would likely fail non-operative management and require surgical intervention for their UCL injury (Table 1). Conclusion: The Elbow UCL Injury Prognosis Score is a statistically rigorous, powerful tool for predicting which patients will most likely RTP with non-operative treatment. We hope this score can provide surgeons with a useful tool to enhance and enable shared decision making with patients when faced with UCL injuries at all competitive levels. [Table: see text]

The synthesis of oxidized graphene nanoribbons (O-GNR) via longitudinal unzipping of carbon nanotubes opens avenues for their further development for a variety of biomedical applications. Evaluation of the cyto- and bio-compatibility is necessary to develop any new material for in vivo biomedical applications. In this study, we report the cytotoxicity screening of O-GNRs water-solubilized with PEG-DSPE (1,2-distearoyl- sn -glycero-3-phosphoethanolamine-N-[amino(polyethylene glycol)]), using six different assays, in four representative cell lines; Henrietta Lacks cells (HeLa) derived from cervical cancer tissue, National Institute of Health 3T3 mouse fibroblast cells (NIH-3T3), Sloan Kettering breast cancer cells (SKBR3) and Michigan cancer foundation-7 breast cancer cells (MCF7). These cell lines significantly differed in their response to O-GNR-PEG-DSPE formulations; assessed and evaluated using various endpoints (lactate dehydrogenase (LDH) release, cellular metabolism, lysosomal integrity and cell proliferation) for cytotoxicity. In general, all the cells showed a dose-dependent (10–400 μg/ml) and time-dependent (12–48 h) decrease in cell viability. However, the degree of cytotoxicity was significantly lower in MCF7 or SKBR3 cells compared to HeLa cells. These cells were 100% viable upto 48 h, when incubated at 10 μg/ml O-GNR-PEG-DSPE concentration, and showed decrease in cell viability above this concentration with ∼78% of cells viable at the highest concentration (400 μg/ml). In contrast, significant cell death (5–25% cell death depending on the time point, and the assay) was observed for HeLa cells even at a low concentration of 10 μg/ml. The decrease in cell viability was steep with increase in concentration with the CD 50 values ≥ 100 μg/ml depending on the assay, and time point. Transmission electron microscopy of the various cells treated with the O-GNR solutions show higher uptake of the O-GNR-PEG-DSPEs into HeLa cells compared to other cell types. Additional analysis indicates that this increased uptake is the dominant cause of the significantly higher toxicity exhibited by HeLa cells. The results suggest that water-solubilized O-GNR-PEG-DSPEs have a heterogenous cell-specific cytotoxicity, and have significantly different cytotoxicity profile compared to graphene nanoparticles prepared by the modified Hummer's method (graphene nanoparticles prepared by oxidation of graphite, and its mechanical exfoliation) or its variations.

not Available.