Kord Honda’s research while affiliated with Louis Stokes Cleveland VA Medical Center and other places

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Publications (76)


ASO Visual Abstract: Enhanced Risk Stratification for Sentinel Lymph Node Biopsy in Head and Neck Melanoma Using the Merlin Assay (CP-GEP)
  • Article
  • Full-text available

December 2024

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6 Reads

Annals of Surgical Oncology

Ani Pazhava

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Wesley Y. Yu

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Enhanced Risk Stratification for Sentinel Lymph Node Biopsy in Head and Neck Melanoma Using the Merlin Assay (CP-GEP)

November 2024

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14 Reads

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1 Citation

Annals of Surgical Oncology

Sentinel lymph node biopsy (SLNB) for head and neck melanomas involves complex challenges due to intricate lymphatic networks and delicate anatomic structures. The Merlin Assay (CP-GEP), merging clinicopathologic data with gene expression profiling, offers a non-invasive method to identify patients who have a low risk for nodal metastasis, potentially sparing these low-risk patients from surgical procedures. This study evaluated 250 clinically node-negative patients with stage I, II, or III melanoma from the Mayo Clinic and University Hospitals Cleveland Medical Center who had tumors in the head and neck region diagnosed between 2004 and 2021. All the patients underwent SLNB. The Merlin Assay, using the CP-GEP model, combines patient age at diagnosis, Breslow thickness, and gene expression of eight specific genes from the primary tumor to predict the risk of nodal metastasis. The SLNB positivity rate was 14% overall, and CP-GEP predicted a possible 40.8% reduction in SLNB procedures with a negative predictive value (NPV) of 98%. For 215 SLNB-negative patients (5-year recurrence-free survival [RFS] of 76.9%, distant metastasis-free survival [DMFS] of 84.3%, and melanoma-specific survival [MSS] of 90.6%), CP-GEP improved risk stratification by identifying 100 patients as low risk with 5-year RFS of 86.1%, DMFS of 92.7%, and MSS of 95.3%. Among 167 T1–T2 patients, the SLNB positivity rate was 8.4%, and CP-GEP achieved an SLNB reduction rate of 56.3% with an NPV of 98.9%. The Merlin Assay effectively categorizes head and neck melanoma patients by risk, enabling more accurate clinical decision-making regarding SLNB and follow-up evaluation, especially for early-stage melanoma patients.





Fig 4. National Center for Biotechnology InformationeBasic Local Alignment Search Tool alignment of sequencing data acquired from the human papilloma virusepolymerase chain reaction product. The sequence data obtained from patient's sample (query) showed 97% identities to the prototype human papilloma virus 10 DNA deposited into the National Center for Biotechnology Information GenBank (sbjct).
Recurrent flares of verruca plana arising at the site of embedded metal shrapnel exacerbated by ultraviolet exposure

March 2023

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16 Reads

JAAD Case Reports


Figure 2. Vitamin D mitigates acute inflammation with durable effects and suppresses markers of NM injury involved in IL-17 signaling pathways. (A) Volcano plot of mean normalized protein expression (NPX) changes for differentially expressed proteins (DEPs) between samples taken 72hr P-E (n = 24) and baseline (n = 24) determined by paired t tests. (B) Venn diagram shows the number of DEPs found in A that are upregulated 72hrs P-I in VitD(-) (n = 12) and VitD(+) (n = 12) relative to baseline (n = 24). Scatter plots show mean ± SEM of NPX values for labeled groups. (C) Pie charts show the percent composition of significantly enriched KEGG pathways using DEP lists from B as input from comparisons between 72hrs P-I VitD(+) and VitD(-) relative to baseline. (D) Venn diagram shows the number of DEPs found in A that are upregulated 6wks P-I in VitD(-) (n = 12) and VitD(+) (n = 11) relative to baseline. Scatter plots show mean ± SEM of NPX values for labeled groups. (E) Pie charts show the percent composition of significantly enriched KEGG pathways using total DEP lists as input from comparisons between 6wks P-I VitD(+) and VitD(-) relative to baseline. (F) Representative H&E staining from biopsies taken 6wks P-I. Scale bar: 100 μm. Arrows denote areas of inflammation in the dermis. (B and D) Significance was determined by linear mixed-effects modeling followed by Benjamini-Hochberg correction for multiple comparisons. *P adj < 0.05,**P adj < 0.01,***P adj < 0.001,****P adj < 0.0001. (C and E): Significant enrichment was determined by a 2-sided hypergeometric test and p-values were corrected using Bonferroni step down. **pV < 0.01.
Figure 3. Repeat NM exposure reveals an intervention-independent divergent inflammatory response. (A) Principal component analysis (PCA) of RNA-Seq data from all samples (n = 110) colored by time of biopsy collection with corresponding 95% CI ellipses shown. Arrows denote 2 distinct clusters within the 72hrs P-I samples (n = 28) whose 95% CI ellipses are shown in the subsequent PCA. (B) Heatmap of percent transformed cell type enrichment scores for 72hrs P-I RNA-Seq counts. Column dendrogram denotes unsupervised clustering of samples, and corresponding group membership of samples is shown below. (C) Representative H&E staining of 72hrs P-I Mild (n = 14) and Severe (n = 14) responders. Examples of spongiosis, degree of interface change, and inflammation are denoted by the triangle, arrowhead, and arrow, respectively. Scale bar: 100 μm. (D) Dot plots of severity scores for degree of spongiosis, interface change, and inflammation observed on H&E sections taken 72hrs P-I. Data are shown as mean ± SEM. Unpaired t tests were used to determine statistical significance. **P < 0.01, ****P < 0.0001. (E) Representative gross images of Mild and Severe participants' arms 72hrs P-I. Dashed circles denote NM exposure site. (F) Dot plot of arm redness differences between exposed and unexposed sites taken after second NM exposure. Two-way ANOVA followed by Tukey's multiple-comparison test were used to determine statistical significance ***P adj < 0.001, ****P adj < 0.0001. mv, mitral valve; ly, lymphocytic; Tcm, central memory T cell; Tem, effector memory T cell; pDC, plasmacytoid DCs.
Figure 4. IL-17 signaling during initial NM exposure is involved in predisposing participants to an exaggerated response upon subsequent NM exposure. (A) PCA of samples taken 72hrs P-E (n = 28). Green and orange arrows show where Mild (n = 14) and Severe (n = 14) participants fall within the total group. The 95% CI ellipses for 72hrs P-E Mild and Severe are shown. (B) Dot plots of DEGs increased (log 2 FC > 1) in 72hrs P-E Severe relative to Mild participants that enrich the IL-17 signaling pathway. Significance was determined by Wald test followed by Benjamini-Hochberg correction for multiple comparisons; *P adj < 0.05, **P adj < 0.01, ***P adj < 0.001, ****P adj < 0.0001. (C) Venn diagram of NM injury DEPs (NPX > 1) in Mild (n = 12) and Severe (n = 12) groups at 72hrs P-E relative to baseline (n = 24). Dot plots show mean NPX; data are shown as mean ± SEM, with error bars of DEPs uniquely increased in 72hrs P-E Severe relative to baseline. Significance was determined by linear mixed-effects modeling followed by Benjamini-Hochberg correction for multiple comparisons; *P adj < 0.05, **P adj < 0.01, ****P adj < 0.0001. (D) Pie charts show the percent composition of significantly enriched KEGG pathways using NM injury DEP lists as input from comparisons between 72hrs P-E Severe and Mild relative to baseline. Significant enrichment was determined by a 2-sided hypergeometric test, and P values were corrected using Bonferroni step down. **pV < 0.01. (E) Dot plots of severity score (scores 0-3) means; data are shown as mean ± SEM, with error bars in H&E sections taken 72hrs P-I and grouped by response severity. Unpaired t tests were used to determine statistical significance; *P < 0.05. (F) Dot plot of arm redness differences between exposed and unexposed sites taken after first NM exposure. Two-way ANOVA followed by Tukey's multiple-comparison test were used to determine statistical significance; *P adj < 0.05.
Figure 5. Vitamin D reduces inflammation, despite an exaggerated response to NM exposure. (A) Venn diagram of the number of NM injury DEPs that are upregulated 72hrs P-I in Mild VitD(-) (n = 7) and VitD(+) (n = 5) relative to baseline (n = 24). Data are shown as mean ± SEM of NPX values for labeled groups. (B) Venn diagram shows the number of NM injury DEPs that are upregulated 72hrs P-I in Severe VitD(-) (n = 5) and VitD(+) (n = 7) relative to baseline. Data are shown as mean ± SEM of NPX values for labeled groups. (C) Venn diagram shows the number of NM injury DEPs that are upregulated 6wks P-I in Mild VitD(-) (n = 4) and VitD(+) (n = 7) relative to baseline. Data are shown as mean ± SEM of NPX values for labeled groups. (D) Venn diagram shows the number of NM injury DEPs that are upregulated 6wks P-I in Severe VitD(-) (n = 7) and VitD(+) (n = 5) relative to baseline. Data are shown as mean ± SEM of NPX values for labeled groups. (E) Dot plots of mean CBC levels; data are shown as mean ± SEM, with error bars at baseline and 24-hours P-I in Mild VitD(-) (n = 7), Mild VitD(+) (n = 5), Severe VitD(-) (n = 5), and Severe VitD(+) (n = 7). Two-way ANOVA followed by Tukey's multiple-comparison test were used to determine statistical significance. *P < 0.05. (F) Dot plots over time of vitamin D metabolites 25(OH) 2 D 3 and 1,25(OH) 2 D 3 . Two-way ANOVA followed by Tukey's multiple-comparison test were used to determine statistical significance. *P adj < 0.05, **P adj < 0.01. (A-D) Significance was determined by linear mixed-effects modeling followed by Benjamini-Hochberg correction for multiple comparisons; *P adj < 0.05, **P adj < 0.01, ***P adj < 0.001, ****P adj < 0.0001.
Vitamin D3 and deconvoluting a rash

January 2023

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146 Reads

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8 Citations

JCI Insight

BACKGROUND Adverse drug reactions are unpredictable immunologic events presenting frequent challenges to clinical management. Systemically administered cholecalciferol (vitamin D3) has immunomodulatory properties. In this randomized, double-blinded, placebo-controlled interventional trial of healthy human adults, we investigated the clinical and molecular immunomodulatory effects of a single high dose of oral vitamin D3 on an experimentally induced chemical rash.METHODS Skin inflammation was induced with topical nitrogen mustard (NM) in 28 participants. Participant-specific inflammatory responses to NM alone were characterized using clinical measures, serum studies, and skin tissue analysis over the next week. All participants underwent repeat NM exposure to the opposite arm and then received placebo or 200,000 IU cholecalciferol intervention. The complete rash reaction was followed by multi-omic analysis, clinical measures, and serum studies over 6 weeks.RESULTSCholecalciferol mitigated acute inflammation in all participants and achieved 6 weeks of durable responses. Integrative analysis of skin and blood identified an unexpected divergence in response severity to NM, corroborated by systemic neutrophilia and significant histopathologic and clinical differences. Multi-omic and pathway analyses revealed a 3-biomarker signature (CCL20, CCL2, CXCL8) unique to exaggerated responders that is suppressed by cholecalciferol and implicates IL-17 signaling involvement.CONCLUSION High-dose systemic cholecalciferol may be an effective treatment for severe reactions to topical chemotherapy. Our findings have broad implications for cholecalciferol as an antiinflammatory intervention against the development of exaggerated immune responses.TRIAL REGISTRATIONclinicaltrials.gov (NCT02968446).FUNDINGNIH and National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS; grants U01AR064144, U01AR071168, P30 AR075049, U54 AR079795, and P30 AR039750 (CWRU)).





Citations (51)


... Recent studies from various specialties as well as otolaryngology subspecialties have demonstrated declining Medicare physician reimbursement rates. General surgery, 1 neurosurgery, 2 plastic surgery, 3 orthopedic surgery, 4 and dermatology 5,6 have all seen reductions in their respective MPFS procedures as well as downward trends in specific CPTs. No studies to date, however, have evaluated reimbursements for commonly performed procedures within laryngology. ...

Reference:

A Medicare Physician Fee Schedule Analysis of Reimbursement Trends in Laryngology from 2000 to 2021
Trends in Medicare Reimbursement for Dermatopathology Services, 2000-2021
  • Citing Article
  • December 2022

American Journal of Dermatopathology

... The RNAseq data revealed an array of highly enriched myeloid phagocytes in NM-exposed dermis consistent with the murine models (Figs. 2, 3). In human skin a myriad of myeloid cells including neutrophils, conventional dendritic cells (cDC), plasmacytoid DC (pDC), and monocytes were detected (Fig. 6c) 20 . Contrary to the previously held notion of myeloid-driven skin damage after NM exposure, we also detected a dynamic repository of antigen-experienced memory T lymphocytes, particularly effector memory (Tem) CD4 + helper and CD8 + cytotoxic T cells. ...

Vitamin D3 and deconvoluting a rash

JCI Insight

... It has been reported to present in a cellulitis-like manner with a similar constellation of symptoms to our patient, including swelling, erythema and tenderness. 10 In these cases, histopathology would demonstrate infiltration of the dermis or subcutaneous tissues with leukaemic cells. Leukaemia cutis is known to be associated with poor prognosis and should be considered in patients with new skin manifestations with a known underlying haematological malignancy. ...

Bilateral periorbital leukemia cutis presenting as suspected cellulitis
  • Citing Article
  • March 2021

Orbit (Amsterdam, Netherlands)

... DM can be challenging to diagnose. Primary tumors can be either amelanotic or melanotic, often resembling other cutaneous malignancies or even benign scar tissue or dermatofibroma [7,8]. Histologically, DM presents as spindle-shaped melanocytes embedded in a dense, fibrous (desmoplastic) collagen matrix, with diminished cellularity relative to other cutaneous melanomas [1]. ...

Pure and Mixed Desmoplastic Melanomas: A Retrospective Clinicopathologic Comparison of 33 Cases
  • Citing Article
  • January 2021

American Journal of Dermatopathology

... As a result, the lipoprotein maturation and trafficking pathways have been a focus of novel antibiotic discovery (6). Several compounds have recently been described that target maturation steps in both E. coli and Acinetobacter baumannii (38)(39)(40)(41). Novel inhibitors of lipoprotein trafficking have also been reported that target LolCDE in E. coli (22)(23)(24). ...

Biopsy patterns and errors in biopsy requisition forms at different times of day
  • Citing Article
  • August 2020

International Journal of Dermatology

... Following the first report of the successful treatment of AAV with RTX, different rare clinical manifestations were reported as having been successfully treated with RTX. Some of the most important rare clinical presentations in GPA patients, which resolved following RTX, include retrobulbar granuloma [78], refractory ophthalmic [126], pachymeningitis [146], the presence of orbital inflammation [122], long-established end-stage renal disease [147], post-kidney-transplantation glomerulonephritis-related AAV [148], pituitary GPA [149], renal mass [150], gastric ulcer [151], pancreatitis [152], ophthalmoplegia [153], pyoderma gangrenosum [154][155][156], prostatitis [157] aortic inflammation [158], intestinal involvement [159], mastitis [160], aortitis [161], gingivitis [162], Isolated Pauci-Immune Pulmonary Capillaritis [163], isolated orbital GPA [164], cranial neuropathy [165], severe necrotizing scleritis [166], genital necrosis and inflammation [167], GPA-associated subcutaneous cheek odule [168], pseudo-tumoral digital nodules [169], hypertrophic pachymeningitis [170,171], acute myocarditis [172], palpable purpura [173], central nervous system vasculitis [174], intra-cranial hypertension [175,176], tracheobronchial stenosis [142], acute aortic valve regurgitation [177], GPA-mimicking meningeal tuberculosis [178], gynecological involvement [179], GPA-mimicking lung malignancies [180], CNS ischemic lesions [181], leukocytoclastic vasculitis-induced penile necrosis [182], stem cell transplantation [183], progressive skull base osteomyelitis [184], severe bilateral sensorineural hearing loss [185], nasal septal abscesses [186], oral and skin ulcer [187], nasal septal abscesses [186], membranous nephropathy [188], ventricular tachycardia [189], and hydralazine-induced AAV [190]. ...

Granulomatosis with polyangiitis presenting as palpable purpura with sinusitis, hemoptysis, and lung cavitation

Journal of Cutaneous Pathology

... SS usually presents in individuals in their sixth decade of life [7,10,11]. Occurrence of SS in the pediatric population is rare (with an estimated 5-8% of cases of SS being reported in children [12]), although several cases of pediatric SS have been recently reported in literature [13][14][15][16][17][18][19][20]. In a 2019 French study of 10 pediatric SS patients, the investigators reported a median age of 2.7 years at presentation and a female to male ratio of 2:3. ...

Vesiculobullous eruption in neutropenic patient with Crohn's disease

JAAD Case Reports

... Miliaria crystallina (MC) is a superficial form of miliaria when sweat glands are obstructed within the stratum corneum [1]. Although there are few adult cases of MC associated with hypernatremia, there is only one neonatal case of MC associated with hypernatremic dehydration (HD) in the literature [3][4][5]. Herein, we report a second neonatal case with MC developed during treatment of severe HD. ...

Clear vesicular eruption in the intensive care unit

JAAD Case Reports

... ICI-induced SLR poses a significant diagnostic challenge [6], with the lungs involved in 60% of cases [7,8]. This can mimic metastasis, as the lungs are the most common site of metastasis for RCC [9]. ...

Immune checkpoint inhibitor-induced sarcoidosis-like granulomas
  • Citing Article
  • July 2019

International Journal of Clinical Oncology