September 2015 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine

 

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Dr. Yang receives 5-year grant as part of next phase of NCI nanotechnology in cancer program

Lily Yang
Lily Yang's current research is completely funded by the NIH.

Dr. Lily Yang's pancreatic cancer team, which focuses on novel imaging and targeted therapeutic agents for battling the disease, has been awarded a U01 Innovative Research in Cancer Nanotechnology grant. The team is one of only four programs that have received awards from all three funding phases of the National Cancer Institute's (NCI) Alliance for Nanotechnology in Cancer. The first phase began in 2005, and five-year funding for the third phase rolled out this month. The new U01 essentially extends the team's 2010-2015 Alliance-funded effort to design a magnetic nanoparticle strategy for targeted therapy and treatment monitoring for pancreatic cancer.

The Alliance is fervently dedicated to changing how cancer is diagnosed, treated, and prevented. Through its programs and initiatives, the organization is committed to building a community of researchers dedicated to using nanotechnology to develop new cancer interventions, and to translating these interventions to the clinical environment.

The team's new award received the NCI's highest impact score of 10, an uncommon ranking that denotes the review panel's opinion that the proposal could have a sustained, powerful influence on the field.

"Our primary aim is to devise a unique, targeted, multifunctional nanoparticle platform for overcoming the physical barriers of tumor stroma that obstruct drug delivery in pancreatic cancer so that we can efficiently deliver potent therapeutic agents into tumor cells," says Dr. Yang, who is sharing PI status with her long-standing collaborator, Emory radiology and imaging scientist Dr. Hui Mao. "Stroma is the connective tissue that supports organs and provides nutrients and regulatory signals for proper cellular polarity and function. It becomes dense and fibrotic in pancreatic cancer, and creates barriers for drug delivery while cultivating aggressive biology and drug resistance. The development of a stroma-breaking nanoparticle platform could be a game changer in the treatment of pancreatic cancer as well as other stroma-rich cancers."

Using insights derived from their prior studies, including a more refined understanding of tumor stroma biology and structure and the identification of multimodal imaging-capable therapeutic nanoparticles for targeting particular cellular receptors in cancer and tumor stromal cells, Dr. Yang, Dr. Mao, surgical oncology division chief Dr. Charles Staley, minimally invasive pancreatic and liver surgery specialist Dr. David Kooby, medical oncologist Bassel El-Reyes, and nuclear medicine researcher Malgorzata Lipowska plan on using the grant to create new and even more powerful nanoparticle drugs for imaging, stromal-penetration, and enhanced targeted delivery of chemotherapy drugs.

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Dr. Patzer: Transplant referral study in JAMA, new R01 to study organ allocation

Dr. Patzer with a patient.
"Researchers should continue to develop, test, and implement pragmatic interventions to improve knowledge of transplantation among both clinicians and patients," Rachel Patzer says.

"Georgia has the lowest kidney transplant rates of any state in the country, and we wanted to find out whether this low rate was related to how dialysis centers refer patients to transplant centers," says Emory transplant and epidemiology investigator Dr. Rachel Patzer, in reference to a study published in the Journal of the American Medical Association. She and her coauthors found that only about one in four of Georgia's patients with end-stage renal disease (ESRD) were referred by a dialysis facility to a transplant center for evaluation within their first year of dialysis. There was also substantial variation in the percentage of referrals among dialysis facilities.

For most of the more than 600,000 ESRD patients in the U.S., kidney transplantation is vastly preferable to dialysis, offering longer survival, better quality of life, and lower costs. U.S. regulations require that all dialysis centers fully inform patients about kidney transplantation and other available treatment options. Dialysis patients typically require a referral for kidney transplant evaluation to begin the transplantation process.

The study included data from the U.S. Renal Data System for 15,279 adult patients with ESRD from 308 Georgia dialysis facilities from January 2005 to September 2011, followed up through September 2012, and linked to kidney transplant referral data collected from adult transplant centers in Georgia in the same period.

Dr. Patzer and her colleagues found that the median within-facility percentage of patients referred by the dialysis centers within one year of starting dialysis was 24.4 percent, but the percentage referred varied between zero patients and 75 percent of patients. Facilities with the lowest percentage were more likely to treat patients living in high-poverty neighborhoods, had a higher patient-to-social worker ratio, and were more likely to be nonprofit compared to the facilities with the highest percentage of referrals.

Factors associated with a lower percentage of referrals for transplant also included older age and white race, but these factors were not always the same as those associated with lower rates of waitlisting.

"Variability in dialysis facility referral may be contributing to the inequities in access to kidney transplantation that we and others have already found," says Dr. Patzer. "All steps leading to kidney transplant need to be analyzed in order to determine the reasons for low rates of transplant as well as disparities. For example, we found that black patients were referred for evaluation more often than whites, but that a greater percentage of white patients were waitlisted after referral. There may be a variety of reasons for this, but without data on dialysis facility referrals, we might have concluded that these disparities began during the referral stage."

The study notes that referrals may be limited because nephrologists and dialysis facility staff are unsure about which patients to refer for transplantation, and therefore need more guidance about appropriate referrals. Other national studies have found that fewer than 50 percent of nephrologists have a detailed discussion about transplantation with their patients and only 33 percent of patients are informed about transplant options when they begin dialysis.

Dr. Patzer and her coauthors believe their findings may have implications for health policy makers, researchers, clinicians, and patients. "The low percentage of facility referrals and variability across Georgia suggests that standardized guidelines and national policies are needed for patient education regarding treatment options when dialysis begins," she says.

A new R01 from the NIH's National Institute on Minority Health and Health Disparities will fund Dr. Patzer and her team's analysis of another component of the transplant process that has been historically entangled in the disparities issue: organ allocation. Specifically, she and Emory nephrologists Dr. Stephen Pastan and Dr. Laura Plantinga, transplant surgeon Dr. Nicole Turgeon, behavioral scientist Dr. Ngoc-Cam Escoffery, and health policy and management researcher Dr. David Howard will investigate how revised organ allocation policies have impacted racial disparities in transplantation access.

In December 2014, UNOS' national computerized system—which matches kidneys from deceased donors with patients needing transplantation—was revised significantly in hopes of providing additional transplant opportunities for all candidates, and to improve access for specific groups of patients who have traditionally waited longer than average for a transplant. These changes included calculation of transplant waiting time (a key factor in allocation priority) from the date a patient begins dialysis, even if they started dialysis before being accepted for listing at a transplant center, and priority matching of kidneys likely to function the longest with candidates likely to need a kidney for the longest amount of time.

"We will test the hypothesis that the new allocation policy will lead to a reduction in disparities in transplant evaluation, waitlisting, and transplantation by comparing pre-allocation data to post-allocation figures," says Dr. Patzer.

The team will also use the grant to develop, disseminate, and evaluate a model for a systems-level practice of providing feedback to U.S. dialysis centers about their transplant performance which they anticipate could improve overall waitlisting rates and decrease kidney transplantation disparities. This exercise will involve 750 dialysis facilities that treat 50,000+ ESRD patients.

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liver app-iPhone

Liver app released for iPhone and Android

The 1.0 version of the "Surgical Anatomy of the Liver" app, an electronic education tool of Emory's Carlos and Davis Center for Surgical Anatomy and Technique (CSAT), has been made available for free for iPhone and Android devices.

The original iPad version of the app resulted from the collaboration of Emory surgical oncologist Dr. Shishir Maithel, Emory School of Medicine medical illustrator Michael Konomos, and CSAT medical illustrator Andy Matlock. Dr. Maithel guided Mr. Konomos through the initial process of accurately sculpting the complex anatomy of the liver to achieve a synthesis of radiographic, cadaveric, and surgical references as well as the distillation of hundreds of hours of liver surgery. Mr. Matlock took over completion of the project when he joined CSAT, contributing 3d animations and working with Dr. Maithel and the programmer on the publishing process.

Mr. Matlock also redesigned the app for the small screen. "The Android version was especially challenging because we had to take into account all the various sizes that Android devices have, from full size tablets down to phones," he says. "The Android version was built so that the interface would scale depending on the size of the screen. When it gets small enough, it switches to a mobile interface."

CSAT has also released the 1.7 version of the liver app for the iPad, which includes the additional feature of transparency, thereby allowing the user to see the liver and the structures beneath its surface simultaneously.

iMedicalApps, considered the leading online publication for medical professionals, patients, and analysts interested in mobile medical technology and health care apps, gave the liver app a five star review, remarking that it "should be the benchmark that other institutions strive for when making free informational apps."

Emory users can download the app in its various versions from Emory's Internal App Store (use Emory login). Otherwise, the app is available for the iPad here, the iPhone here, and Android here.

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Dr. Klingensmith and Dr. Lyons win 1st place awards at GSACS 2015 Annual Meeting

Nathan Klingensmith and John Lyons
Nathan Klingensmith, John Lyons

At the 2015 Georgia Society of the American College of Surgeons Annual Meeting, PGY2 resident Dr. Nathan Klingensmith won the general surgery resident abstract competition for “Time Dependent Changes of Tight Junctions Alter Intestinal Permeability in Alcohol Fed Mice with Septic Peritonitis.”

The abstract reported that the combination of sepsis with chronic alcohol ingestion increased intestinal permeability to large molecules in mice by affecting expression of tight junction proteins. The investigators concluded that discerning the temporal mechanistic changes that influenced this permeability could guide future treatments relevant to the time of presentation following septic insult in patients with histories of habitual alcohol consumption.

During the Day of Trauma portion of the meeting, Dr. John Lyons, also a PGY2, won the basic science resident paper competition for “Intestinal Co-Expression of SV-40 TAg and Bcl-2 Increases Gut Apoptosis During Sepsis,” which examined changes in intestinal cell proliferation and death during sepsis.

Dr. Lyons and his coauthors found that mice with genetically increased intestinal cell proliferation and the typical co-expression of an anti-death protein, paradoxically experienced increased intestinal cell death during severe sepsis. They determined that understanding the mechanisms of this process could provide clues about the factors that control intestinal cell proliferation and death during times of stress, and offer insight into ways to sustain intestinal health during critical illness.

Dr. Klingensmith and Dr. Lyons are on research sabbatical in the lab of Dr. Craig Coopersmith, vice chair of research of the Emory Department of Surgery and one of the top investigators of sepsis and shock in the country.

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Wendy Greene
Wendy Greene

Welcome our new faculty

Wendy R. Greene MD

Associate Professor of Surgery and Director, Acute and Critical Care Surgery, Emory Critical Care Center

In addition to being the director of the Acute and Critical Care Surgery Service of Emory University Hospital, Dr. Greene is an attending in the hospital's Surgical Intensive Care Unit. She received her MD from the Howard University College of Medicine, Washington, DC, class of 1992. Her postgraduate medical training included a residency in general surgery at Howard University Hospital, a reconstructive surgery residency at George Washington University, a surgical critical care fellowship at the Washington Hospital Center, and a trauma critical care fellowship at INOVA Fairfax Hospital. Prior to Emory, she served as an associate professor of surgery at Howard University College of Medicine and associate director of the division of trauma and surgical critical care at Howard University Hospital.

Raymond Lynch
Raymond Lynch

Raymond J. Lynch, MD

Assistant Professor of Surgery, Division of Transplantation

Dr. Lynch received his MD along with a master’s degree in immunobiology from Yale University School of Medicine in 2005. He completed his residency in general surgery at the University of Michigan as well as a two year research fellowship funded by the American Society of Transplant Surgeons. After completing his fellowship in abdominal transplantation at Emory, he joined the faculty of the University of Kansas Medical Center. Dr. Lynch specializes in adult and pediatric liver and kidney transplantation and hepatopancreatobiliary diseases and malignancies. His academic interests include resource utilization and outcomes analysis in transplantation. He was awarded the 2014 Vanguard Award from the American Society of Transplant Surgeons for prior studies on accommodation following renal transplantation.

Neil Saunders
Neil Saunders

Neil D. Saunders, MD

Assistant Professor of Surgery, Division of General and GI Surgery

Dr. Saunders received his MD from the University of Illinois College of Medicine in 2008. His postgraduate medical training included a general surgery residency at Emory, followed by a complex general surgical oncology fellowship at Ohio State University. His clinical specialties are robotic surgery, endocrine surgery, and malignancies of the thyroid, adrenal, and parathyroid. His primary research interests are thyroid cancer, surgical outcomes, and quality improvement.

Jamil Stetler
Jamil Stetler

Jamil L. Stetler, MD

Assistant Professor of Surgery, Division of General and GI Surgery

Dr. Stetler was raised in Atlanta. After obtaining his MD at Wake Forest University School of Medicine in 2009, he returned to his hometown and did his general surgery residency and minimally invasive surgery fellowship at Emory. During his fellowship, which focused on advanced laparoscopic and bariatric surgery techniques, he was mentored by Dr. Edward Lin, Dr. Scott Davis, and Dr. Ankit Patel. Dr. Stetler has now joined his former mentors on the surgical weight-loss team of the Emory Bariatric Center. He is also a general surgery attending at Emory Saint Joseph’s Hospital. Dr. Stetler hopes to assemble a training video library of various surgical techniques as a resource for resident education.

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Remote locations for Grand Rounds

For those faculty, staff, and trainees who may be unable to leave their facilities on Thursday mornings to attend Surgical Grand Rounds at Emory University Hospital Auditorium, remote viewing sites are available. They are located at:

Grady Memorial Hospital, Sherman Conference Room, 3rd floor, Glenn Building

Emory Saint Joseph's Hospital, Education Center, Classroom 4

Emory University Hospital Midtown, 5th floor, MOT Classroom 4

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Upcoming events

EVENT DATE/TIME LOCATION
5th Annual Winship Win the Fight 5K
Atlanta Braves president John Schuerholz is grand marshal.
Oct. 3, 2015 More info.
SURGICAL GRAND ROUNDS
Improved Clinical Documentation to Achieve Top Performance Rankings and More Accurate Reimbursement

Presenters:
A.L. Jackson Slappy, MD
– Assistant Professor of Surgery, Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine
– Director, Care Coordination Surgery, Emory University Hospital
– Acting Chief, General Surgery, Atlanta VA Medical Center

Bonnie Epps, RN
– Director, Clinical Documentation Improvement, Emory Healthcare
Karen O'Donald, CPA
– Director, Tax and Financial Performance Informatics, Emory Healthcare
7:00 a.m.-8:00 a.m., Oct. 1, 2015 EUH auditorium
SURGICAL GRAND ROUNDS
The Difficult Abdominal Wall: Controversies, Problems, and Techniques

Presented by Christopher Funderburk, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
7:00 a.m.-8:00 a.m., Oct. 15, 2015 EUH auditorium
Department of Surgery Division Chiefs Meeting 5:30 p.m.-7:00 p.m., Oct. 20, 2015 Surgery Education Office, EUH, H108 & H110
SURGICAL GRAND ROUNDS
21st Annual W. Dean Warren Lecture
The Operative Management of Metastatic Neuroendocrine Cancer to the Liver – Impact or Not?

Presented by David M. Nagorney, MD
– Professor of Surgery, Division of General and GI Surgery, Department of Surgery, Mayo Clinic, Rochester
– Program Director, Hepato-Pancreatico-Biliary Fellowship, Mayo Clinic
7:00 a.m.-8:00 a.m., Oct. 29, 2015 EUH auditorium
The Microbiome and Human Health Nov. 5-9, 2015

Emory Conference Center

More info.

Emory Veteran's Day Ceremony 10:55 a.m., Nov. 11, 2015

Emory Quadrangle

     
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