Publications by authors named "Karen Choi"

16 Publications

  • Page 1 of 1

Gastrointestinal Pathology in Samples from Coronavirus Disease 2019 (COVID-19)-Positive Patients.

Arch Pathol Lab Med 2021 May 7. Epub 2021 May 7.

Department of Pathology, University of Michigan, Ann Arbor, MI.

Context: -Although primarily considered a respiratory illness, coronavirus disease 2019 (COVID-19) can cause gastrointestinal manifestations.

Objective: -To evaluate histopathology and in situ hybridization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gastrointestinal samples from patients with recent and remote COVID-19.

Design: -Patients with positive SARS-CoV-2 nasopharyngeal tests and a gastrointestinal tissue specimen were included. SARS-CoV-2 in situ hybridization (ISH) was performed on each sample. A subset had SARS-CoV-2 next generation sequencing (NGS) performed.

Results: -Twenty-five patients met inclusion criteria. Five had positive SARS-CoV-2 nasopharyngeal tests within 7 days of their gastrointestinal procedure. Two were ulcerative colitis patients on steroid therapy who lacked typical COVID-19 symptoms. Their colectomies showed severe ulcerative colitis; one demonstrated SARS-CoV-2 by NGS but a negative ISH. Another had an ischemic colon resected as a complication of the COVID-19 course; however, both ISH and NGS were negative. A fourth had a normal-appearing terminal ileum but positive ISH and NGS. The fifth patient had ileal ulcers with SARS-CoV-2 negativity by both modalities. The remaining 20 patients had positive nasopharyngeal tests an average of 53 days prior to procedure. None of their samples demonstrated SARS-CoV-2 ISH positivity, but one was positive on NGS despite a negative nasopharyngeal test.

Conclusions: -Gastrointestinal findings from SARS-CoV-2-infected patients ranged from normal with virus detected by ISH and NGS, to bowel ischemia secondary to systemic viral effects, without evidence of virus in the tissue. No distinct histologic finding was identified in those with gastrointestinal tissue specimens demonstrating SARS-CoV-2 positivity in this cohort.
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http://dx.doi.org/10.5858/arpa.2021-0137-SADOI Listing
May 2021

Cutaneous Head and Neck Cancers in the High-Risk Immunosuppressed Population.

Otolaryngol Clin North Am 2021 Apr 16;54(2):397-413. Epub 2021 Feb 16.

Department of Otolaryngology Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, 3440 North Broad Street, Kresge West 309, Philadelphia, PA 19140, USA. Electronic address:

The immunosuppressed (IS) population encompasses a diverse cohort of patients to include iatrogenically immunocompromised organ transplant recipients as well as patients with chronic lymphoid malignancies, human immunodeficiency virus/acquired immunodeficiency syndrome, and autoimmune disorders. Cutaneous cancers in this high-risk patient group are clinically distinct from the general immunocompetent population, showing aggressive behavior with associated poor outcomes. This article reviews the pathogenesis, epidemiology, incidence, prognosis, and special considerations required in managing cutaneous cancers in the IS patient population.
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http://dx.doi.org/10.1016/j.otc.2020.11.012DOI Listing
April 2021

Clinical Implication of Diagnostic and Histopathologic Discrepancies in Sinonasal Malignancies.

Laryngoscope 2021 05 18;131(5):E1468-E1475. Epub 2020 Sep 18.

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.

Objectives: To evaluate the incidence of histopathologic diagnostic discrepancy for patients referred to our institution, identify pathologies susceptible to diagnostic error, and assess the impact on survival of histopathologic diagnostic discrepancies.

Methods: Three hundred ninety-seven patients with sinonasal cancers were identified, and discordance between the outside pathologic report and MD Anderson Cancer Center pathologic report was assessed. Overall survival and disease-specific survival were analyzed using Kaplan-Meier and log rank methods.

Results: Discordance of major histopathologic diagnoses was present in 24% (97 of 397) of reports, with sinonasal undifferentiated carcinoma, sarcoma, neuroendocrine carcinoma, and poorly differentiated carcinoma pathologies having the highest change in diagnosis (P < .01). A further 61% (244 of 397) had minor changes such as histologic grade, subtype, or stage, with sarcoma and neuroendocrine carcinoma pathologies being most susceptible to change (P < .02). Overall, the 5-year overall survival (OS) and disease-specific survival (DSS) was reduced in patients with a major change in histopathologic diagnosis (59.2% vs. 70.2% (P = .02) and 72.9% vs. 81.2% (P = .02), respectively). Furthermore, patients with a major change in diagnosis and prior treatment experienced a significant reduction in 5-year OS (61.9% vs. 70.4%, P = .03 < .01) and DSS (72.4% vs. 81.5%, P = .04).

Conclusion: Histopathological diagnosis of sinonasal tumors is complex and challenging given the rarity of the disease. Obtaining the correct diagnosis is important for treatment selection and survival. In histologies prone to misdiagnoses, obtaining a second opinion from experienced head and neck pathologists at a high-volume institution may potentially lead to a change in treatment recommendations that could result in improved survival in patients with sinonasal malignancies.

Level Of Evidence: 4 Laryngoscope, 131:E1468-E1475, 2021.
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http://dx.doi.org/10.1002/lary.29102DOI Listing
May 2021

Laryngectomy Care in the COVID-19 Era.

JAMA Otolaryngol Head Neck Surg 2020 08;146(8):776

Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey.

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http://dx.doi.org/10.1001/jamaoto.2020.1523DOI Listing
August 2020

Commentary on the management of total laryngectomy patients during the COVID-19 pandemic.

Head Neck 2020 06 23;42(6):1137-1143. Epub 2020 Apr 23.

Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.

The coronavirus disease-2019 (COVID-19) pandemic has rapidly spread across the world, placing unprecedented strain on the health care system. Health care resources including hospital beds, ICUs, as well as personal protective equipment are becoming increasingly rationed and scare commodities. In this environment, the laryngectomee (patient having previously undergone a total laryngectomy) continues to represent a unique patient with unique needs. Given their surgically altered airway, they pose a challenge to manage for the otolaryngologist within the current COVID-19 pandemic. In this brief report, we present special considerations and best practice recommendations in the management of total laryngectomy patients. We also discuss recommendations for laryngectomy patients and minimizing community exposures.
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http://dx.doi.org/10.1002/hed.26183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262329PMC
June 2020

Prognostic performance of the American Joint Committee on Cancer 8th edition of the TNM staging system in patients with early oral tongue cancer.

Head Neck 2019 05 10;41(5):1270-1276. Epub 2018 Dec 10.

Departments of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.

Background: The 8th edition of the American Joint Committee on Cancer's (AJCC) staging system for oral cavity cancer incorporates pathological features. We aimed to assess whether these changes results in better risk stratification of patients with early oral tongue squamous cell carcinoma (OTSCC).

Methods: Overall survival (OS) and disease-specific survival (DSS) of 244 patients were calculated using the Kaplan-Meier method. Multivariate analysis with stepwise selection was performed using Cox proportional hazards regression.

Results: Sixty-two patients (25%) were upstaged using the 8th edition. Multivariate analysis revealed that overall stage using the 8th edition of the AJCC staging system but not using the 7th edition was a significant predictor for both OS and DSS. The 8th edition had lower Akaike information criterion and improved concordance index values compared with the 7th edition.

Conclusion: The 8th edition of AJCC allows better risk stratification and more precise counseling of patients with OTSCC who were previously considered at low risk.
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http://dx.doi.org/10.1002/hed.25553DOI Listing
May 2019

A case report of cavernous sinus thrombosis after trauma.

Int J Pediatr Otorhinolaryngol 2017 Apr 13;95:101-103. Epub 2017 Feb 13.

Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.

Cavernous sinus thrombosis is a rare but well-documented complication of sinus disease, propagated by intracranial spread of infection via valveless veins of the midface, with facial cellulitis as an uncommon source of infection. We present a case of significant intracranial thromboses secondary to nasal dorsal abscess after trauma that was successfully treated with bedside drainage of the abscess in addition to broad-spectrum antibiotics, anticoagulation, and steroids, and remains asymptomatic with seven months follow-up.
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http://dx.doi.org/10.1016/j.ijporl.2017.02.007DOI Listing
April 2017

Leadership Training in Otolaryngology Residency.

Otolaryngol Head Neck Surg 2017 06 28;156(6):1078-1079. Epub 2017 Mar 28.

1 Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA.

Although residency training offers numerous leadership opportunities, most residents are not exposed to scripted leadership instruction. To explore one program's attitudes about leadership training, a group of otolaryngology faculty (n = 14) and residents (n = 17) was polled about their attitudes. In terms of self-perception, more faculty (10 of 14, 71.4%) than residents (9 of 17, 52.9%; P = .461) considered themselves good leaders. The majority of faculty and residents (27 of 31) thought that adults could be taught leadership ability. Given attitudes about leadership ability and the potential for improvement through instruction, consideration should be given to including such training in otolaryngology residency.
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http://dx.doi.org/10.1177/0194599817698441DOI Listing
June 2017

From Morbidity and Mortality to Quality Improvement: Effects of a Structured and Interactive Otolaryngology Conference.

OTO Open 2017 Jan-Mar;1(1):2473974X17692775. Epub 2017 Mar 16.

Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.

Objective: Measure the effects of a structured morbidity and mortality conference format on the attitudes of resident and faculty participants.

Study Design: Prospective cohort study.

Setting: Otorhinolaryngology-head and neck surgery residency training program.

Subjects And Methods: Two changes were implemented to the structure of our morbidity and mortality conference: (1) we adopted a recently described presentation framework called situation-background-assessment-recommendation and (2) appointed a faculty moderator to lead the conference. Surveys were distributed to residents and faculty before and after these modifications were implemented to measure changes in attitude of conference attendees.

Results: After implementing the above changes to the morbidity and mortality conference, participant engagement increased from "moderately engaged" to "extremely engaged" ( < .01). Among both faculty and residents, the perceived educational value of conference also improved from "moderately educational" to "extremely educational" ( < .01). Finally in the attending cohort, the impact on future patient care increased from "no change" to "greatly enhanced" ( < .01).

Conclusion: By implementing the situation-background-assessment-recommendation framework and appointing a faculty moderator to morbidity and mortality conference, participants reported significantly enhanced engagement during the conference, increased educational value of the session, and a positive impact on future patient care.
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http://dx.doi.org/10.1177/2473974X17692775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6239051PMC
March 2017

"How did you feel?": increasing child sexual abuse witnesses' production of evaluative information.

Law Hum Behav 2012 Oct 6;36(5):448-57. Epub 2012 Feb 6.

Gould School of Law & Department of Psychology, University of Southern California.

In child sexual abuse cases, the victim's testimony is essential, because the victim and the perpetrator tend to be the only eyewitnesses to the crime. A potentially important component of an abuse report is the child's subjective reactions to the abuse. Attorneys may ask suggestive questions or avoid questioning children about their reactions, assuming that children, given their immaturity and reluctance, are incapable of articulation. We hypothesized that How questions referencing reactions to abuse (e.g., "how did you feel") would increase the productivity of children's descriptions of abuse reactions. Two studies compared the extent to which children provided evaluative content, defined as descriptions of emotional, cognitive, and physical reactions, in response to different question-types, including How questions, Wh- questions, Option-posing questions (yes-no or forced-choice), and Suggestive questions. The first study examined children's testimony (ages 5-18) in 80 felony child sexual abuse cases. How questions were more productive yet the least prevalent, and Option-posing and Suggestive questions were less productive but the most common. The second study examined interview transcripts of 61 children (ages 6-12) suspected of being abused, in which children were systematically asked How questions regarding their reactions to abuse, thus controlling for the possibility that in the first study, attorneys selectively asked How questions of more articulate children. Again, How questions were most productive in eliciting evaluative content. The results suggest that interviewers and attorneys interested in eliciting evaluative reactions should ask children "how did you feel?" rather than more direct or suggestive questions.
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http://dx.doi.org/10.1037/h0093986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982717PMC
October 2012

Myelin repair is accelerated by inactivating CXCR2 on nonhematopoietic cells.

J Neurosci 2010 Jul;30(27):9074-83

Neuroinflammation Research Centre, Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS and remyelination in MS ultimately fails. Although strategies to promote myelin repair are eagerly sought, mechanisms underlying remyelination in vivo have been elusive. CXCR2 is expressed on neutrophils and oligodendrocyte lineage cells in the CNS. CXCR2-positive neutrophils facilitate inflammatory demyelination in demyelination models such as experimental autoimmune encephalomyelitis (EAE) and cuprizone intoxication. Systemic injection of a small molecule CXCR2 antagonist at the onset of EAE decreased demyelinated lesions. These results left the cellular target of the CXCR2 antagonist uncertain and did not clarify whether CXCR2 blockade prevented demyelination or promoted remyelination. Here, we show that the actions of CXCR2 on nonhematopoietic cells unexpectedly delay myelin repair. Bone marrow chimeric mice (Cxcr2(+/-)-->Cxcr2(-/-) and Cxcr2(+/-)-->Cxcr2(+/+)) were subjected to two distinct models of myelin injury. In all cases, myelin repair was more efficient in Cxcr2(+/-)-->Cxcr2(-/-) animals. Oligodendrocyte progenitor cells (OPCs) in demyelinated lesions of Cxcr2(+/-)-->Cxcr2(-/-) mice proliferated earlier and more vigorously than in tissues from Cxcr2(+/-)--> Cxcr2(+/+) animals. In vitro demyelinated CNS slice cultures also showed better myelin repair when CXCR2 was blocked with neutralizing antibodies or was genetically deleted. Our results suggest that CXCR2 inactivation permits optimal spatiotemporal positioning of OPCs in demyelinating lesions to receive local proliferative and differentiating signals. Given that CXCR2 exerts dual functions that promote demyelination and decrease remyelination by actions toward hematopoietic cells and nonhematopoietic cells, respectively, our findings identify CXCR2 as a promising drug target for clinical demyelinating disorders.
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http://dx.doi.org/10.1523/JNEUROSCI.1238-10.2010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917803PMC
July 2010

CXCR2-positive neutrophils are essential for cuprizone-induced demyelination: relevance to multiple sclerosis.

Nat Neurosci 2010 Mar 14;13(3):319-26. Epub 2010 Feb 14.

Neuroinflammation Research Center, Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Multiple sclerosis is an inflammatory demyelinating disorder of the CNS. Recent studies have suggested diverse mechanisms as underlying demyelination, including a subset of lesions induced by an interaction between metabolic insult to oligodendrocytes and inflammatory mediators. For mice of susceptible strains, cuprizone feeding results in oligodendrocyte cell loss and demyelination of the corpus callosum. Remyelination ensues and has been extensively studied. Cuprizone-induced demyelination remains incompletely characterized. We found that mice lacking the type 2 CXC chemokine receptor (CXCR2) were relatively resistant to cuprizone-induced demyelination and that circulating CXCR2-positive neutrophils were important for cuprizone-induced demyelination. Our findings support a two-hit process of cuprizone-induced demyelination, supporting the idea that multiple sclerosis pathogenesis features extensive oligodendrocyte cell loss. These data suggest that cuprizone-induced demyelination is useful for modeling certain aspects of multiple sclerosis pathogenesis.
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http://dx.doi.org/10.1038/nn.2491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827651PMC
March 2010

Targeted injury of type II alveolar epithelial cells induces pulmonary fibrosis.

Am J Respir Crit Care Med 2010 Feb 22;181(3):254-63. Epub 2009 Oct 22.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, 1150 West Medical Center Drive, 6301 MSRB III, Ann Arbor, MI 48109-5642, USA.

Rationale: Ineffective repair of a damaged alveolar epithelium has been postulated to cause pulmonary fibrosis. In support of this theory, epithelial cell abnormalities, including hyperplasia, apoptosis, and persistent denudation of the alveolar basement membrane, are found in the lungs of humans with idiopathic pulmonary fibrosis and in animal models of fibrotic lung disease. Furthermore, mutations in genes that affect regenerative capacity or that cause injury/apoptosis of type II alveolar epithelial cells have been identified in familial forms of pulmonary fibrosis. Although these findings are compelling, there are no studies that demonstrate a direct role for the alveolar epithelium or, more specifically, type II cells in the scarring process.

Objectives: To determine if a targeted injury to type II cells would result in pulmonary fibrosis.

Methods: A transgenic mouse was generated to express the human diphtheria toxin receptor on type II alveolar epithelial cells. Diphtheria toxin was administered to these animals to specifically target the type II epithelium for injury. Lung fibrosis was assessed by histology and hydroxyproline measurement.

Measurements And Main Results: Transgenic mice treated with diphtheria toxin developed an approximately twofold increase in their lung hydroxyproline content on Days 21 and 28 after diphtheria toxin treatment. The fibrosis developed in conjunction with type II cell injury. Histological evaluation revealed diffuse collagen deposition with patchy areas of more confluent scarring and associated alveolar contraction.

Conclusions: The development of lung fibrosis in the setting of type II cell injury in our model provides evidence for a causal link between the epithelial defects seen in idiopathic pulmonary fibrosis and the corresponding areas of scarring.
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http://dx.doi.org/10.1164/rccm.200810-1615OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2817814PMC
February 2010

The intracellular domain of teneurin-1 interacts with MBD1 and CAP/ponsin resulting in subcellular codistribution and translocation to the nuclear matrix.

Exp Cell Res 2005 Apr;305(1):122-32

Friedrich Miescher Institute, Novartis Research Foundation, Maulbeerstrasse 66, CH-4058 Basel, Switzerland.

Teneurin-1 is a type II transmembrane protein expressed in neurons of the developing and adult central nervous system. To investigate the intracellular signaling of teneurin-1, we searched for proteins interacting with its intracellular domain. One of the proteins identified is the c-Cbl-associated protein CAP/ponsin, an adaptor protein containing SH3 domains. This interaction results on one hand in the recruitment of the soluble intracellular domain of teneurin-1 to the cell membrane enriched in CAP/ponsin. On the other hand, it leads to the translocation of CAP/ponsin to the nucleus, the major site of accumulation of the intracellular domain of teneurin-1. The second interacting protein identified is the methyl-CpG binding protein MBD1. In the nucleus, the intracellular domain of teneurin-1 colocalizes with this transcriptional repressor in foci associated with the nuclear matrix. We propose that these interactions are part of a specific signaling pathway. Evidence for cleavage and nuclear translocation of the intracellular domain has been obtained by the detection of endogenous teneurin-1 immunoreactivity in nuclear speckles in chick embryo fibroblasts. Furthermore, in the nuclear matrix fraction of these cells as well as in cells expressing a hormone-inducible full-length teneurin-1 protein, a teneurin-1 fragment of identical size could be detected as in cells transfected with the intracellular domain alone.
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http://dx.doi.org/10.1016/j.yexcr.2004.12.020DOI Listing
April 2005