Bart T. Endrizzi

Kruppel-like factor 2 regulates thymocyte and T-cell migration

Mammalian Kruppel-like transcription factors are implicated in regulating terminal differentiation of several tissue types. Deficiency in Kruppel-like factor (KLF) 2 (also known as LKLF) leads to a massive loss of the peripheral T-cell pool, suggesting KLF2 regulates T-cell quiescence and survival. Here we show, however, that KLF2 is essential for T-cell trafficking. KLF2-deficient (Klf2-/-) thymocytes show impaired expression of several receptors required for thymocyte emigration and peripheral trafficking, including the sphingosine-1-phosphate (S1P) receptor S1P1, CD62L and β7 integrin. Furthermore, KLF2 both binds and transactivates the promoter for S1P1—a receptor that is critical for thymocyte egress and recirculation through peripheral lymphoid organs. Our findings suggest that KLF2 serves to license mature T cells for trafficking from the thymus and recirculation through secondary lymphoid tissues.

Capecitabine for skin cancer prevention in solid organ transplant recipients

Jirakulaporn T, Endrizzi B, Lindgren B, Mathew J, Lee PK, Dudek AZ. Capecitabine for skin cancer prevention in solid organ transplant recipients.
Clin Transplant 2011: 25: 541–548.

Management of Carcinoma of the Skin in Solid Organ Transplant Recipients with Oral Capecitabine

An increasing number of long-term solid organ transplant patients are presenting for dermatologic evaluation. This patient population demonstrates a higher rate of skin cancer development due largely to the immunosuppression required to maintain the organ transplant. A subset of transplant patients have significant morbidity due to the many excisions required to decrease their tumor burden. An effective adjuvant therapy to surgical excision has long been sought to reduce the rate and severity of tumor development in this population.

Capecitabine to reduce nonmelanoma skin carcinoma burden in solid organ transplant recipients

BACKGROUND Solidorgan transplant recipients (SOTRs) are at greater risk of nonmelanoma skin cancer (NMSC) than the general population, in large part because of their immunosuppression. Select individual SOTRs demonstrate a rate of tumor development at the upper end of their cohort. Capecitabine, a prodrug converted in the body to 5‐fluorouracil (5‐FU), may alter the risk for development of NMSC in an individual SOTR with a high rate of tumor development. OBJECTIVE To report observations of a series of 10 SOTRs treated with capecitabine as adjuvant prevention for high‐incidence NMSC. METHODS Ten SOTRs were administered cycles of low‐dose oral capecitabine (0.5–1.5 g/m2 per day) for days 1 to 14 of a 21‐day treatment cycle. Measurements (skin screenings, laboratory and toxicity monitoring) were performed every 1 to 3 months. Incidence rates of squamous cell carcinoma (SCC) before and during treatment were determined and compared using the Wilcoxon signed‐rank test. RESULTS The average incidence rate (mean ± SD) of SCC before treatment (0.56 ± 0.28 SCCs/month, range 0.17–1.17 SCCs/month) declined to 0.16 ± 0.11 SCCs/month (range 0–0.33 SCCs/month) during the first 12 months of treatment (mean reduction 68 ± 30.0%, range 0–100%, p < .005). Reduction in actinic keratosis was observed. Common side effects included fatigue, nausea, hand‐and‐foot syndrome, gout, and poor renal function. Seven of 10 participants required dose adjustment, and two of these were discontinued from the study drug because of side effects. LIMITATIONS Case series design, small observational population. CONCLUSIONS SOTRs experienced a clinically and statistically significant decline in incident SCCs during treatment with low‐dose oral capecitabine, with varying degrees of side effects. Larger randomized trials will determine the dose and efficacy of capecitabine for adjuvant treatment of NMSC in SOTRs.

A randomized controlled trial of fractional laser therapy and dermabrasion for scar resurfacing.

Background Dermabrasion has been the standard resurfacing procedure for postsurgical scars, but recovery can be long. Fractionated carbon dioxide (CO2) laser is a safe, effective tissue resurfacing modality, but no prospective trial has compared its safety or efficacy with that of dermabrasion for postsurgical scar resurfacing. Objective To compare the safety and efficacy of single‐treatment fractional photothermolysis with that of single‐treatment dermabrasion for postsurgical scar resurfacing on the face. Methods and Materials A split‐scar method was used to compare fractionated CO2 laser and diamond fraise dermabrasion on postsurgical scars of the face. Primary endpoint was safety at day 0, 1 week, and 1 month. Secondary endpoint was efficacy at 3 months as measured by blinded evaluation of standardized photographs. Results Safety data revealed that there was less erythema (p = .001) and bleeding (p = .001) at day 0, less erythema (p = .01) and edema (p = .046) at 1 week, and a trend toward less erythema at 1 month (p = .06) with fractionated CO2. Efficacy data at 3 months revealed equivalent scar improvements (p = .77). Conclusion Fractionated CO2 laser therapy should be considered a safe alternative for surgical scar resurfacing on the face. The safety profile exceeds that of dermabrasion, and it has a quicker clinical recovery and equivalent cosmetic efficacy.

Treatment of angiofibromas of tuberous sclerosis with 5-aminolevulinic acid blue light photodynamic therapy followed by immediate pulsed dye laser

&NA; The authors have indicated no significant interest with commercial supporters.

Efficacy of a multiple diode laser system for body contouring

Low‐level laser therapy (LLLT) has been shown to induce cellular reactions in nonphotosynthetic cells however skepticism remains regarding efficacy at the clinical level. The purpose of this study was to evaluate the efficacy of LLLT independent of liposuction. Additionally, a weight loss supplement (Curva™, Santa Barbra Medical Innovations, Santa Barbra, CA) was evaluated. This clinical trial evaluates the effectiveness of the Erchonia EML Laser (Zerona™ System, Santa Barbra Medical Innovations) for non‐invasive fat reduction and body contouring in a split‐body clinical evaluation.

The Victory stitch: a novel running v-shaped horizontal mattress suturing technique.

Many suturing methods exist for epidermal closure, the simple running suture being the most commonly used technique among dermatologic surgeons. Herein we describe a novel running horizontal mattress suture technique, the Victory stitch, that improves upon the shortcomings of the simple running and horizontal mattress techniques. The advantages of the simple running suture are its fast execution and wound edge approximation. Its two major disadvantages are the risk of poor wound edge eversion in inexperienced hands and the potential for suture track-marks with nonabsorbable suture when used in areas of tension for a prolonged period. To improve eversion, two running mattress suture techniques have been described: the horizontal and vertical mattress sutures. Both techniques are effective but are slower to place than simple running sutures and risk potential suture track marks. These epidermal techniques also theoretically threaten tissue viability when excess tension is placed on the wound edge. The Victory stitch achieves excellent wound edge eversion; minimizes suture track-marks, especially in areas requiring prolonged suture retention; and reduces the potential for tissue necrosis in high-tension zones. To study the utility of the Victory stitch, we compared cosmetic outcomes of 10 wounds closed using this novel method with those using the simple running suturing technique. Technique

Horizontal Relaxing Incisions Limit False Positives in Thick Mohs Sections

During microscopic evaluation of frozen sections, the Mohs surgeon may notice extraneous tissue fragments on a slide in addition to the intended tissue, known as “floaters.” In MMS, floaters have been characterized as originating from a tissue piece discontiguous with the main excisional specimen. These floaters can derive from the same tissue specimen (e.g., friable aggregate of neoplastic basaloid cells falling into sectioning plane) or from a different specimen (e.g., implantation onto slide from contamination with dirty microtome blade).