Publications by authors named "Peter K Lee"

44 Publications

A dendronised polymer architecture breaks the conventional inverse relationship between porosity and mechanical properties of hydrogels.

Chem Commun (Camb) 2021 Jan;57(6):773-776

School of Molecular Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.

We present a series of synthetic polymer hydrogels which break the traditional correlation between pore size and mechanical properties. The hydrogels are prepared from a dendronised polymer architecture based on a methacrylate copolymer to which poly(amido amine) dendrons are attached. Our approach will be useful in tailoring hydrogels for tissue engineering, controlled drug release, and flexible electronics.
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http://dx.doi.org/10.1039/d0cc07115cDOI Listing
January 2021

What Motivates Chinese Young Adults to Use mHealth?

Healthcare (Basel) 2019 Dec 2;7(4). Epub 2019 Dec 2.

Department of Logistics and Maritime Studies, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China.

mHealth is one of China's national strategies that brings affordable, accessible, and convenient health care to its entire population, may they be in cities or rural areas. Although Chinese young adults are among the first to adopt mHealth, the factors influencing Chinese young adults to use mHealth are yet to be studied both empirically and in depth. This study explores the mechanism that determines Chinese young adults' intention to use mHealth, based on an extended Technology Acceptance Model (TAM). The extended TAM was tested using responses from 486 Chinese young adults. The results showed that perceived usefulness strongly and significantly influenced people's intention to use mHealth. Additionally, communication effectiveness, health consciousness, and perceived ease of use were found as significant factors influencing people's intention to use mHealth through perceived usefulness. Distrust was not found to significantly influence people's intention to use mHealth.
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http://dx.doi.org/10.3390/healthcare7040156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956209PMC
December 2019

Benefit of Mohs Micrographic Surgery Over Wide Local Excision for Melanoma of the Head and Neck: A Rational Approach to Treatment.

Dermatol Surg 2019 03;45(3):381-389

All authors are affiliated with the Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota.

Background: There are limited published data comparing wide local excision (WLE) with Mohs micrographic surgery (MMS) for the treatment of melanoma.

Objective: To describe a novel treatment algorithm for the surgical management of head and neck melanoma and compare rates of local recurrence for tumors treated with either MMS using immunohistochemistry or WLE.

Materials And Methods: A 10-year retrospective chart review including all in situ and invasive melanomas of the head and neck treated at one institution from January 2004 to June 2013.

Results: Among 388 patients with melanoma, MMS was associated with decreased rates of local recurrence (p = .0012). However, patient and tumor characteristics varied significantly, and WLE subgroup was largely composed of higher stage and risk tumors. Subgroup analysis found that patients with in situ or thin invasive tumors (<0.8 mm) treated with MMS had improved local recurrence outcomes (p = .0049), despite more frequent tumor location on high risk anatomic sites (e.g., central face). In addition, MMS was associated with a favorable delay in time to local recurrence among in situ tumors (HR = 31.8; p = .0148).

Conclusion: These findings further support the use of MMS for treatment of melanoma of the head and neck and help to validate our proposed clinical decision tree.
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http://dx.doi.org/10.1097/DSS.0000000000001715DOI Listing
March 2019

Building professionals' intention to use smart and sustainable building technologies - An empirical study.

PLoS One 2018 1;13(8):e0201625. Epub 2018 Aug 1.

Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, China.

Smart and sustainable buildings save energy and material resources and provide a comfortable environment that enhances their occupants' well-being and productivity. It is therefore crucial to understand how building professionals, including designers, engineers, and contractors, view smart and sustainable buildings and what drives them towards smart and sustainable building technologies. This study identifies salient smart and sustainable building features from building professionals' perspective and explores what determines building professionals' intention to use such building technologies. Responses from 543 Hong Kong's building professionals identify that intelligent security, intelligent and responsive fresh air supply, and intelligent and responsive thermal control are among the most important features of smart and sustainable buildings. Results of structural equation modeling grounded on an extended technology acceptance model indicate that facilitating condition and job relevance are related to perceived ease of use while subjective norm pertaining to image and perceived ease of use are predictors of perceived usefulness. Facilitating condition, perceived ease of use and perceived usefulness jointly influence building professionals' intention to use smart and sustainable building technologies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201625PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070263PMC
February 2019

A Novel Alternate Dosing of Vismodegib for Treatment of Patients With Advanced Basal Cell Carcinomas.

JAMA Dermatol 2017 04;153(4):321-322

Department of Dermatology, University of Minnesota, Minneapolis.

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http://dx.doi.org/10.1001/jamadermatol.2016.5058DOI Listing
April 2017

Photodynamic Therapy for Non-Melanoma Skin Cancers.

Cancers (Basel) 2016 Oct 4;8(10). Epub 2016 Oct 4.

Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA.

Non-melanoma skin cancer (NMSC) is traditionally treated with surgical excision. Nonsurgical methods such as cryotherapy and topical chemotherapeutics, amongst other treatments, are other options. Actinic keratosis (AKs) are considered precancerous lesions that eventually may progress to squamous cell carcinoma (SCC). Photodynamic therapy (PDT) offers an effective treatment for AKs, and is also effective for superficial basal cell carcinoma (BCC). Nodular BCC and Bowen's disease (SCC in situ) have shown acceptable response rates with PDT, although recurrence rates are higher for these two NMSC subtypes. Methylaminolevulinate (MAL) PDT is a more effective treatment option than 5-aminolevulinic acid (ALA) PDT for nodular BCC. Several studies have shown that PDT results in superior cosmetic outcomes compared to surgical treatment. PDT is overall well-tolerated, with pain being the most common side effect.
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http://dx.doi.org/10.3390/cancers8100090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082380PMC
October 2016

A Review of the Association Between Parkinson Disease and Malignant Melanoma.

Dermatol Surg 2016 Feb;42(2):141-6

*University of Minnesota Medical School, Minneapolis, Minnesota; †Department of Dermatology, University of Minnesota Medical Center, Minneapolis, Minnesota.

Background: An association between melanoma and Parkinson disease (PD) has been hinted at in the neurology and oncology literature since the 1970s after the initiation of levodopa (L-DOPA) therapy for PD. Given that L-DOPA is a substrate in melanin synthesis, there existed a concern that this therapy might cause melanoma.

Objective: The objective was to research possible etiological links to explain the connection between PD and melanoma.

Methods: A PubMed and Google Scholar literature search was performed using access provided by the University of Minnesota biomedical library.

Results: Patients with PD have an overall decreased risk of cancer diagnoses. However, breast cancer and melanoma have an uncharacteristically high rate of co-occurrence with PD. Family history of melanoma and lighter hair and skin color confer a higher risk of developing PD, and having a first-degree relative with either disease conveys a significantly increased risk of developing the other. Other possible connections that have been explored include pigmentation genes in neural-derived cells, pesticides, MC1R polymorphisms, and abnormal cellular autophagy.

Conclusion: Although a link between PD and melanoma exists, the etiology of this link continues to be elusive. Both PD and melanoma are likely multifactorial diseases involving genetic and environmental risk factors.
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http://dx.doi.org/10.1097/DSS.0000000000000591DOI Listing
February 2016

Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using Mel-5 immunostaining: an update from the University of Minnesota.

Dermatol Surg 2013 Dec 24;39(12):1794-9. Epub 2013 Oct 24.

Dermatology Department, University of Minnesota, Minneapolis, Minnesota.

Background: Mohs micrographic surgery (MMS) is gaining acceptance as a treatment for lentigo maligna (LM) and lentigo maligna melanoma (LMM), especially with the use of melanocyte-staining immunohistochemical (IHC) stains. In 2006, we reported our 4-year experience with Mel-5 immunostaining, with only one recurrence noted in 200 patients after a mean follow-up of 38.4 months.(1) OBJECTIVES: We present an update regarding our 13-year experience with the use of Mel-5.

Methods And Materials: Patients with primary or recurrent LM or LMM (n = 260) underwent MMS with Mel-5; 174 were followed up to evaluate for recurrence, with a mean follow-up of 34 months. The 200 patients described in the initial case series from 1999 to 2003 were also followed.

Results: Of the 460 patients treated from January 1999 to December 2011, five recurrences were noted in four patients; one in the initial case series and four in this new, updated series, including one re-recurrence from the initial series. One melanoma-related death occurred in a patient intermittently lost to follow-up.

Conclusion: MMS with Mel-5 immunostaining continues to yield excellent results in the treatment of LM and LMM.
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http://dx.doi.org/10.1111/dsu.12356DOI Listing
December 2013

Current methods for photodynamic therapy in the US: comparison of MAL/PDT and ALA/PDT.

J Drugs Dermatol 2013 Aug;12(8):925-30

There is some debate regarding the rate of progression of actinic keratosis (AK) into squamous cell carcinoma (SCC).1-4 However, it is clear that treatment for AK lesions is warranted. Results from numerous studies with aminolevulinic acid (ALA) and methyl aminolevulinate (MAL) photodynamic therapy (PDT) for the treatment of AKs, SCC, and Bowen's disease show high rates of clearance for these lesions. MAL/PDT provides similar efficacy to ALA/PDT with the benefits of shorter incubation times according to the approved FDA labeling, greater selectivity, reduced pain during and immediately following therapy, and fewer systemic side effects. Cosmetic outcomes are better with PDT than with cryosurgery or excisional surgery. A number of case reports show efficacy with ALA/PDT and MAL/PDT for acne, photorejuvenation, and other off-label indications. Side effects with PDT tend to be mild to moderate and transient in nature. Overall, ALA/PDT and MAL/PDT are effective for a variety of skin diseases and conditions. MAL/PDT provides some advantages over ALA/PDT.
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August 2013

Defining physiatry and future scope of rehabilitation medicine.

Authors:
Peter K W Lee

Ann Rehabil Med 2011 Aug 31;35(4):445-9. Epub 2011 Aug 31.

Department of Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

To identify the 'physiatry' in a single word is difficult. This may be due that physiatry originated from two different fields, physical medicine and rehabilitation and focuses on assisting the general improvement of functional recovery in disabled patients. In addition, physiatry has new markets to develop; health and welfare. Therefore, the identity of physiatry will change depending on how physiatrists act in these fields. We attempt to define the physiatry from several aspects.
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http://dx.doi.org/10.5535/arm.2011.35.4.445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309231PMC
August 2011

Effects of robot-assisted gait training on cardiopulmonary fitness in subacute stroke patients: a randomized controlled study.

Neurorehabil Neural Repair 2012 May 15;26(4):318-24. Epub 2011 Nov 15.

1Sungkyunkwan University, Seoul, Republic of Korea.

Background: . Robot-assisted gait training has the potential to improve cardiopulmonary fitness after stroke, even for patients who are in the early stages of recovery and not independent ambulators. The authors compared the effects of robot-assisted gait training and conventional physical therapy on cardiopulmonary fitness.

Methods: . A prospective single-blinded, randomized controlled study of 37 patients receiving inpatient rehabilitation was performed within 1 month after stroke onset. The robot-assisted gait training group (n = 20) received 40 minutes of gait training with Lokomat and 60 minutes of conventional physical therapy each day, whereas the control group (n = 17) received 100 minutes of conventional physical therapy daily. Using a semirecumbent cycle ergometer, changes in cardiopulmonary fitness were investigated using incremental exercise testing. Motor and gait functional recovery was measured according to changes in the lower-extremity score of the Fugl-Meyer Assessment Scale (FMA-L), leg score of the Motricity Index (MI-L), and the Functional Ambulation Category (FAC).

Results: . Compared with the control group, the robot group showed 12.8% improvement in peak VO(2) after training (P < .05). Compared with the control group, the robot group also improved in FMA-L score (P < .05).

Conclusion: . Patients can be trained to increase their VO(2) and lower-extremity strength using a robotic device for stepping during inpatient rehabilitation. This training has the potential to improve cardiopulmonary fitness in patients who are not yet independent ambulators, but that may require more than 2 weeks of continued, progressive training.
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http://dx.doi.org/10.1177/1545968311408916DOI Listing
May 2012

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

Dermatol Surg 2011 Nov 3;37(11):1663-5. Epub 2011 Oct 3.

Department of Dermatology, University of Minnesota, Minneapolis, Minnesota 55455, USA.

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http://dx.doi.org/10.1111/j.1524-4725.2011.02119.xDOI Listing
November 2011

Neural correlates of donepezil-induced cognitive improvement in patients with right hemisphere stroke: a pilot study.

Neuropsychol Rehabil 2011 Aug 30;21(4):502-14. Epub 2011 Jun 30.

Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Donepezil has been proven effective in the treatment of Alzheimer's disease and vascular dementia. However, its effects on the cognitive neural network have not been fully investigated. The purpose of this study was to evaluate the effect of donepezil on reorganisation of the cognitive neural network in patients with post-stroke cognitive impairment using functional MRI (fMRI). Fourteen patients with stroke in the right hemisphere were enrolled. Participants were randomly assigned to the experimental or the control group. Donepezil (5 mg) or placebo was administered daily for four weeks. Cognitive function assessment was performed before and immediately after treatment, and repeated one month after cessation of treatment. fMRI was performed before and after treatment. Ten out of 14 patients (six in the experimental group, four in the control group) successfully completed all experimental processes. The experimental group showed significant improvements in the Mini-Mental Status Examination during the post-treatment evaluation and one-month follow-up compared to the pre-treatment evaluation (p < .05). No improvement was observed in the control group. In the experimental group fMRI showed increased activation in both prefrontal areas, both inferior frontal lobes, and in the left inferior parietal lobe. Increased recruitment of the parieto-frontal networks in the selected patients was considered to be a neural correlate of cognitive improvement induced by donepezil.
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http://dx.doi.org/10.1080/09602011.2011.582708DOI Listing
August 2011

Effects of hippotherapy on gait parameters in children with bilateral spastic cerebral palsy.

Arch Phys Med Rehabil 2011 May;92(5):774-9

Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong, Seoul, Republic of Korea.

Objectives: To evaluate the effects of hippotherapy on temporospatial parameters and pelvic and hip kinematics of gait in children with bilateral spastic cerebral palsy.

Design: Nonrandomized prospective controlled trial.

Setting: Outpatient therapy center.

Participants: Children (N=32) with bilateral spastic cerebral palsy, Gross Motor Function Classification System level 1 or 2.

Intervention: Hippotherapy (30 min twice weekly for 8 consecutive weeks).

Main Outcome Measures: Temporospatial parameters and pelvic and hip kinematic parameters in 3-dimensional motion analysis, Gross Motor Function Measure (GMFM)-88, and score for dimensions D (standing) and E (walking, running, jumping) of the GMFM, GMFM-66, and Pediatric Balance Scale (PBS).

Results: Hippotherapy significantly improved walking speed, stride length, and pelvic kinematics (average pelvic anterior tilt, pelvic anterior tilt at initial contact, pelvic anterior tilt at terminal stance). Scores for dimension E of the GMFM, GMFM-66 and PBS also increased.

Conclusions: Hippotherapy provided by licensed health professionals using the multidimensional movement of the horse may be used in conjunction with standard physical therapy for improvement of gait and balance in children with bilateral spastic cerebral palsy.
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http://dx.doi.org/10.1016/j.apmr.2010.11.031DOI Listing
May 2011

Capecitabine for skin cancer prevention in solid organ transplant recipients.

Clin Transplant 2011 Jul-Aug;25(4):541-8. Epub 2010 Nov 2.

Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA.

Skin cancers are the most common malignancies in solid organ transplant recipients (SOTR). A case-observational, retrospective study was performed to determine the efficacy of low-dose capecitabine in the secondary prevention of skin cancers in SOTRs treated at a single institution. SOTRs with recurrent squamous cell carcinoma (SCC) and/or basal cell carcinoma (BCC) were given low-dose capecitabine 1 g/m(2) daily, days 1-14 of a 21-d treatment cycle. Skin surveillance was performed by dermatologists every 1-3 months. Cumulative incidence rates of SCC, BCC, and actinic keratosis (AK) before and after treatment were scored and statistically compared for each patient using a non-parametric Wilcoxon signed rank test. Fifteen patients (13 men and two women) with a median age of 57 yr (range 40-73) were treated. Incidence rates as measured by mean number of events per month declined by 0.33 for SCC, 0.04 for BCC, and 2.45 for AK (p < 0.05). The most common grade 3 and 4 toxicities included fatigue (40.0%), hand-foot syndrome (20.0%), and diarrhea (20.0%). The discontinuation rate at one yr was approximately 33.3%. We conclude that oral capecitabine significantly decreases the incidence rates of recurrent SCC, BCC, and AK in SOTRs and is associated with manageable toxicity.
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http://dx.doi.org/10.1111/j.1399-0012.2010.01348.xDOI Listing
January 2012

Long-term effects of rTMS on motor recovery in patients after subacute stroke.

J Rehabil Med 2010 Sep;42(8):758-64

Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Objective: Repetitive transcranial magnetic stimulation (rTMS) has been recognized as a promising intervention for treatment of stroke patients. However, most previous reports have described the short-term effects of rTMS on motor performance. We conducted a sham-controlled trial to evaluate long-term effects of high-frequency rTMS on motor recovery in subacute stroke patients.

Methods: Twenty-eight patients were randomly divided into two groups, and received either real or control rTMS. Both treatments were accompanied by motor practice. A daily dose of 1000 pulses of subthreshold 10 Hz rTMS was applied over the primary motor cortex of the affected hemisphere for 10 days within one month after onset of stroke. Motor function was assessed before and after treatment, and 3 months after the stroke.

Results: Motor function improved in both groups after treatment; however, patients who received real rTMS experienced additional improvement in motor function of the affected upper limb. Over 3 months after the stroke, the time and type of intervention for the Motoricity Index of the affected upper extremity showed significant interaction.

Conclusion: Positive long-term effects on motor recovery could be achieved after 10 daily sessions of high-frequency rTMS in conjunction with motor practice during the sub-acute period of stroke.
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http://dx.doi.org/10.2340/16501977-0590DOI Listing
September 2010

Closure of large surgical defects on the cutaneous upper lip using an island pedicle flap.

Dermatol Surg 2010 Jun 10;36(6):931-4. Epub 2010 May 10.

Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.

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http://dx.doi.org/10.1111/j.1524-4725.2010.01570.xDOI Listing
June 2010

Myocutaneous island pedicle "sling" flap for correction of central upper cutaneous (philtral) lip defects.

Dermatol Surg 2010 May 1;36(5):671-4. Epub 2010 Apr 1.

Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.

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http://dx.doi.org/10.1111/j.1524-4725.2010.01527.xDOI Listing
May 2010

Condyloma and other infections including human immunodeficiency virus.

Surg Clin North Am 2010 Feb;90(1):99-112, Table of Contents

UMDNJ-Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.

Sexually transmitted diseases (STDs) are a common public health problem and as such may be more common in a surgical practice than is believed. The recognition that a virus can be responsible for a cancer has profound significant public health implications. This article reviews the presentation and management of the more common perianal STDs including human immunodeficiency virus, as well as the pathogenesis and management of anal intraepithelial neoplasia.
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http://dx.doi.org/10.1016/j.suc.2009.09.005DOI Listing
February 2010

Reduction in the incidence of squamous cell carcinoma in solid organ transplant recipients treated with cyclic photodynamic therapy.

Dermatol Surg 2010 May 4;36(5):652-8. Epub 2009 Nov 4.

Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.

Background And Objectives: Squamous cell carcinomas (SCCs) produce significant morbidity in solid organ transplant recipients (SOTRs), particularly in patients who develop multiple tumors. Topical photodynamic therapy (PDT) has been shown to decrease the number of keratotic lesions in SOTRs, but the duration of the beneficial effect is limited. The aim of this study was to evaluate the potential benefit of cyclic PDT in the prevention of new SCCs in SOTRs.

Methods: Twelve high-risk SOTRs received cyclic PDT treatments at 4- to 8-week intervals for 2 years. The development of new SCCs (invasive and in situ) performed 12 and 24 months after the start of cyclic PDT were compared with the number of SCCs developed during the year before initiation of cyclic PDT.

Results: The median reduction in the 12- and 24-month post-treatment counts from the 1-month pretreatment counts was 79.0% (73.3-81.8%) and 95.0% (87.5-100.0%), respectively. Treatments were well tolerated.

Conclusion: Cyclic PDT with 5-aminolevulinic acid may reduce the incidence of SCC in SOTRs. Additional studies with larger numbers of patients and optimized protocols are necessary to further explore the potential benefits of cyclic PDT in the prevention of skin cancer in this high-risk patient population.
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http://dx.doi.org/10.1111/j.1524-4725.2009.01384.xDOI Listing
May 2010

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

Dermatol Surg 2009 Nov 13;35(11):1849-51. Epub 2009 Aug 13.

Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.

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http://dx.doi.org/10.1111/j.1524-4725.2009.01304.xDOI Listing
November 2009

Management of carcinoma of the skin in solid organ transplant recipients with oral capecitabine.

Dermatol Surg 2009 Oct 28;35(10):1567-72. Epub 2009 Jul 28.

Department of Dermatology, University of Minnesota. MN 55455-0392, USA.

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http://dx.doi.org/10.1111/j.1524-4725.2009.01277.xDOI Listing
October 2009

Accuracy of teledermatology for pigmented neoplasms.

J Am Acad Dermatol 2009 Nov 12;61(5):753-65. Epub 2009 Aug 12.

Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA.

Background: Accurate diagnosis and management of pigmented lesions is critical because of the morbidity and mortality associated with melanoma.

Objective: We sought to compare accuracy of store-and-forward teledermatology for pigmented neoplasms with standard, in-person clinic dermatology.

Methods: We conducted a repeated measures equivalence trial involving veterans with pigmented skin neoplasms. Each lesion was evaluated by a clinic dermatologist and a teledermatologist; both generated a primary diagnosis, up to two differential diagnoses, and a management plan. The primary outcome was aggregated diagnostic accuracy (match of any chosen diagnosis with histopathology). We also compared the severity of inappropriately managed lesions and, for teledermatology, evaluated the incremental change in accuracy when polarized light dermatoscopy or contact immersion dermatoscopy images were viewed.

Results: We enrolled 542 patients with pigmented lesions, most were male (96%) and Caucasian (97%). The aggregated diagnostic accuracy rates for teledermatology (macro images, polarized light dermatoscopy, and contact immersion dermatoscopy) were not equivalent (95% confidence interval for difference within +/-10%) and were inferior (95% confidence interval lower bound <10%) to clinic dermatology. In general, the addition of dermatoscopic images did not significantly change teledermatology diagnostic accuracy rates. In contrast to diagnostic accuracy, rates of appropriate management plans for teledermatology were superior and/or equivalent to clinic dermatology (all image types: all lesions, and benign lesions). However, for the subgroup of malignant lesions (n = 124), the rate of appropriate management was significantly worse for teledermatology than for clinic dermatology (all image types). Up to 7 of 36 index melanomas would have been mismanaged via teledermatology.

Limitations: Nondiverse study population and relatively small number of melanomas were limitations.

Conclusions: In general, the diagnostic accuracy of teledermatology was inferior whereas management was equivalent to clinic dermatology. However, for the important subgroup of malignant pigmented lesions, both diagnostic and management accuracy of teledermatology was generally inferior to clinic dermatology and up to 7 of 36 index melanomas would have been mismanaged via teledermatology. Teledermatology and teledermatoscopy should be used with caution for patients with suspected malignant pigmented lesions.
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http://dx.doi.org/10.1016/j.jaad.2009.04.032DOI Listing
November 2009

Inhibition of hyaluronan synthases decreases matrix metalloproteinase-7 (MMP-7) expression and activity.

Surgery 2009 Mar;145(3):322-9

Department of Surgery and Surgical Oncology, Roswell Park Cancer Institute, University at Buffalo/State University of New York, Buffalo, NY 14263, USA.

Introduction: Hyaluronan (HA) and its biosynthetic enzymes hyaluronan synthases (HAS2 and HAS3) mediate Matrigel invasion by SW620 colon carcinoma cells. Because matrix metalloproteinases (MMPs) have been implicated in cancer invasion, we hypothesized that changes in HAS expression would alter MMP expression and activity in these cells.

Methods: To determine whether an MMP was involved in invasion, Matrigel invasion assays with SW620 cells were performed in the presence or absence of the MMP inhibitors GM6001 or TIMP2. HAS isozymes were inhibited by stably transfecting SW620 cells with vectors that contained antisense HAS2 and/or -3 cDNA; transfection with an empty vector served as a control. MMP-7 transcription was assessed by quantitative reverse transcription polymerase chain reaction (RT-PCR). MMP-7 protein was detected by enzyme-linked immunosorbent assay (ELISA) and enzymatic activity compared using zymography.

Results: GM6001 and TIMP2 decreased Matrigel invasion, which confirms that an MMP played a key role in this process. MMP-7 expression was then detected in SW620 cells. Finally, MMP-7 expression, protein, and enzymatic activity were significantly lower in antisense HAS tranfectants than in SW620 or vector control cells.

Conclusion: We have demonstrated previously that inhibition of HAS expression and HA production in SW620 colon carcinoma cells inhibits Matrigel invasion. In the studies presented here, we have demonstrated that SW620 cells express high levels of MMP-7 and that inhibition of HAS isozymes dramatically decreases MMP-7 expression, protein, and enzymatic activity. Taken together, these findings suggest that HAS and HA may mediate cellular invasion via changes in MMP-7 expression.
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http://dx.doi.org/10.1016/j.surg.2008.11.008DOI Listing
March 2009

Accuracy of teledermatology for nonpigmented neoplasms.

J Am Acad Dermatol 2009 Apr 13;60(4):579-88. Epub 2009 Feb 13.

Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota 55417, USA.

Background: Studies of teledermatology utilizing the standard reference of histopathology are lacking.

Objective: To compare accuracy of store-and-forward teledermatology for non-pigmented neoplasms with in-person dermatology.

Methods: This study was a repeated-measures equivalence trial involving veterans with non-pigmented skin neoplasms. Each lesion was evaluated by an in-person dermatologist and a teledermatologist; both generated a primary diagnosis, up to two differential diagnoses, and management plan. The primary outcome was aggregated diagnostic accuracy (percent correct matches of any chosen diagnosis with histopathology). Secondary outcomes included management plan accuracy (percent correct matches with expert panel management plan). Additional analyses included evaluation of the incremental effect of using polarized light dermatoscopy in addition to standard macro images, and evaluating benign and malignant lesion subgroups separately.

Results: Most of the 728 participants were male (97.8%) and Caucasian (98.9%). The aggregated diagnostic accuracy (primary outcome) of teledermatology (macro images) was not equivalent (95% confidence interval [CI] for difference within +/-10%) and was inferior (95% CI lower bound <10%) to in-person dermatology for all lesions and the subgroups of benign and malignant lesions. However, management plan accuracy was equivalent. Teledermatology aggregated diagnostic accuracy using polarized light dermatoscopy was significantly better than for macro images alone (P = .0017). The addition of polarized light dermatoscopy showed the same pattern for malignant lesions, but not for benign lesions. Most interestingly, for malignant lesions, the addition of polarized light dermatoscopy yielded equivalent aggregated diagnostic accuracy rates.

Limitations: Non-diverse study population.

Conclusions: Using macro images, the diagnostic accuracy of teledermatology was inferior to in-person dermatology, but accuracy of management plans was equivalent. The addition of polarized light dermatoscopy yielded significantly better aggregated diagnostic accuracy, but management plan accuracy was not significantly improved. For the important subgroup of malignant lesions, the addition of polarized light dermatoscopy yielded equivalent diagnostic accuracy between teledermatologists and clinic dermatologists.
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http://dx.doi.org/10.1016/j.jaad.2008.11.892DOI Listing
April 2009

The effect of a hyaluronan-carboxymethylcellulose membrane vs. polyglactin 910 mesh on intra-abdominal tumor formation in mice.

Dis Colon Rectum 2008 Sep 17;51(9):1403-7. Epub 2008 Apr 17.

Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.

Purpose: Hyaluronan mediates growth of SW620 colon cancer cells. Because hyaluronan is the active ingredient in Seprafilm, we hypothesized that Seprafilm would affect intraperitoneal tumor growth in a mouse model of peritoneal seeding.

Methods: Immunodeficient mice underwent laparotomy and intraperitoneal inoculation of 10(5) SW620 cells. Seprafilm (n = 22), Vicryl mesh (foreign body control; n = 24), or no material (sham; n = 19) was placed under the incision. Mice were killed after four weeks and tumors were dissected, counted, and weighed.

Results: Ninety-five percent of mice in the sham group and 96 percent in the Vicryl group developed intraperitoneal tumors. In contrast, only 64 percent of mice in the Seprafilm group developed tumors (P = 0.024), and these tumors were smaller than those in the sham group; (Seprafilm = 42 +/- 9 mg vs. sham = 82 +/- 17 mg; P = 0.05). In contrast, tumors in the Vicryl group were dramatically larger (349 +/- 49 mg; P < 0.001 vs. sham or Seprafilm).

Conclusions: Despite previous data that suggested that hyaluronan increases colon cancer cell growth, we found that Seprafilm decreased tumor formation and tended to decrease size in this model. In contrast, Vicryl mesh increased tumor formation and size. Our results suggest that Seprafilm does not promote intraperitoneal tumor growth, especially compared with Vicryl mesh.
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http://dx.doi.org/10.1007/s10350-008-9299-zDOI Listing
September 2008

Black-spot poison ivy.

Dermatitis 2008 Jan-Feb;19(1):48-51

Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA.

In black-spot poison ivy dermatitis, a black lacquerlike substance forms on the skin when poison ivy resin is exposed to air. Although the Toxicodendron group of plants is estimated to be the most common cause of allergic contact dermatitis in the United States, black-spot poison ivy dermatitis is relatively rare.
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June 2008

Modification of the purse-string closure for large defects of the extremities.

Dermatol Surg 2008 Feb 17;34(2):243-5. Epub 2007 Dec 17.

Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.

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http://dx.doi.org/10.1111/j.1524-4725.2007.34048.xDOI Listing
February 2008

Plaque-type syringoma: two cases misdiagnosed as microcystic adnexal carcinoma.

J Cutan Pathol 2008 Jun 12;35(6):570-4. Epub 2007 Nov 12.

Department of Dermatology, University of Minnesota, Minneapolis, MN 55417, USA.

Background: Plaque-type syringoma is a rare variant of syringoma. This benign neoplasm may be easily misdiagnosed as microcystic adnexal carcinoma (MAC), potentially resulting in unnecessary surgery with disfiguring consequences.

Methods: We report two cases of plaque-type syringoma that were initially diagnosed as MAC. Microscopically, these lesions were composed of nests of cuboidal cells arrayed within sclerotic collagen in the upper dermis. The deep reticular dermis was spared. No perineural involvement was observed.

Results And Conclusions: Our cases are discussed in the context of histopathologic diagnosis. Detailed histopathologic findings of syringoma, as well as other considerations in the differential diagnosis, are reviewed. We also include a review of all cases of plaque-type syringoma published to date.
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http://dx.doi.org/10.1111/j.1600-0560.2007.00843.xDOI Listing
June 2008
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