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Shekhawat D, Chaiyamoon A, Cardona JJ, Lesser E, Iwanaga J, Loukas M, Killackey MT, Tubbs RS. Renal vein valves: a prevalence, microanatomical and histological study. Surg Radiol Anat 2024; 46:535-541. [PMID: 38446213 DOI: 10.1007/s00276-024-03330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE In the modern era of robotic renal procedures and diagnostics, an even more detailed anatomical understanding than hitherto is necessary. Valves of the renal veins (RVV) have been underemphasized and have been disputed by some authors, and few textbooks describe them. The current anatomical study was performed to address such shortcomings in the literature. METHODS One hundred renal veins were studied in fifty adult formalin-fixed cadavers. Renal veins were removed from the abdomen after sectioning them flush with their entrance to the renal hilum. The inferior vena cava was then incised longitudinally and opened, and RVV were examined grossly and histologically. A classification scheme was developed and applied to our findings. RESULTS Nineteen RVVs were observed in the fifty cadavers (38%). Four (8%) valves were found on right sides and fifteen (30%) on left sides. The valves were seen as cord/band-like, folds, and single and double leaflets. Histologically, they were all extensions of the tunica intima. CONCLUSION On the basis of our study, RVV are not uncommon. They were more common on left sides, and on both sides, they were found within approximately one centimeter of the junction of the inferior vena cava and renal vein. Although the function of such valves cannot be inferred from this anatomical study, the structures of the Single leaflet valve (TS2) and Double leaflet valve (TS3) valves suggest they could prevent venous reflux from the IVC into the kidney.
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Affiliation(s)
- Devendra Shekhawat
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 South Robertson St. Suite 1300, New Orleans, LA, 70112, USA.
| | - Arada Chaiyamoon
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 South Robertson St. Suite 1300, New Orleans, LA, 70112, USA
| | - Juan J Cardona
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 South Robertson St. Suite 1300, New Orleans, LA, 70112, USA
| | - Emma Lesser
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 South Robertson St. Suite 1300, New Orleans, LA, 70112, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 South Robertson St. Suite 1300, New Orleans, LA, 70112, USA
| | - Marios Loukas
- Departmentof Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada
| | - Mary T Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 South Robertson St. Suite 1300, New Orleans, LA, 70112, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Departmentof Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
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Levy S, Attia A, Omar M, Langford N, Vijay A, Jeon H, Galvani C, Killackey MT, Paramesh AS. Collaborative Approach Toward Transplant Candidacy for Obese Patients with End-Stage Renal Disease. J Am Coll Surg 2024; 238:561-572. [PMID: 38470035 DOI: 10.1097/xcs.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND An elevated BMI is a major cause of transplant preclusion for patients with end-stage renal disease (ESRD). This phenomenon exacerbates existing socioeconomic and racial disparities and increases the economic burden of maintaining patients on dialysis. Metabolic bariatric surgery (MBS) in such patients is not widely available. Our center created a collaborative program to undergo weight loss surgery before obtaining a kidney transplant. STUDY DESIGN We studied the outcomes of these patients after MBS and transplant surgery. One hundred eighty-three patients with ESRD were referred to the bariatric team by the transplant team between January 2019 and June 2023. Of these, 36 patients underwent MBS (20 underwent Roux-en-Y gastric bypass and 16 underwent sleeve gastrectomy), and 10 underwent subsequent transplantation, with another 15 currently waitlisted. Both surgical teams shared resources, including dieticians, social workers, and a common database, for easy transition between teams. RESULTS The mean starting BMI for all referrals was 46.4 kg/m 2 and was 33.9 kg/m 2 at the time of transplant. The average number of hypertension medications decreased from 2 (range 2 to 4) presurgery to 1 (range 1 to 3) postsurgery. Similarly, hemoglobin A1C levels improved, with preoperative averages at 6.2 (range 5.4 to 7.6) and postoperative levels at 5.2 (range 4.6 to 5.8) All transplants are currently functioning, with a median creatinine of 1.5 (1.2 to 1.6) mg/dL (glomerular filtration rate 46 [36.3 to 71]). CONCLUSIONS A collaborative approach between bariatric and transplant surgery teams offers a pathway toward transplant for obese ESRD patients and potentially alleviates existing healthcare disparities. ESRD patients who undergo MBS have unique complications to be aware of. The improvement in comorbidities may lead to superior posttransplant outcomes.
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Affiliation(s)
- Shauna Levy
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Abdallah Attia
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Mahmoud Omar
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA (Omar, Killackey)
| | - Nicole Langford
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Adarsh Vijay
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Hoonbae Jeon
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Carlos Galvani
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Mary T Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA (Omar, Killackey)
| | - Anil S Paramesh
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
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Flaris AN, Carnabatu CJ, Schroll RW, Killackey MT. Resident Literature Review for Complication Presented at Morbidity and Mortality Conferences: A Sisyphean Task. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Toraih EA, Elshazli RM, Hussein MH, Elgaml A, Amin M, El‐Mowafy M, El‐Mesery M, Ellythy A, Duchesne J, Killackey MT, Ferdinand KC, Kandil E, Fawzy MS. Association of cardiac biomarkers and comorbidities with increased mortality, severity, and cardiac injury in COVID-19 patients: A meta-regression and decision tree analysis. J Med Virol 2020; 92:2473-2488. [PMID: 32530509 PMCID: PMC7307124 DOI: 10.1002/jmv.26166] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) has a deleterious effect on several systems, including the cardiovascular system. We aim to systematically explore the association of COVID-19 severity and mortality rate with the history of cardiovascular diseases and/or other comorbidities and cardiac injury laboratory markers. METHODS The standardized mean difference (SMD) or odds ratio (OR) and 95% confidence intervals (CIs) were applied to estimate pooled results from the 56 studies. The prognostic performance of cardiac markers for predicting adverse outcomes and to select the best cutoff threshold was estimated by receiver operating characteristic curve analysis. Decision tree analysis by combining cardiac markers with demographic and clinical features was applied to predict mortality and severity in patients with COVID-19. RESULTS A meta-analysis of 17 794 patients showed patients with high cardiac troponin I (OR = 5.22, 95% CI = 3.73-7.31, P < .001) and aspartate aminotransferase (AST) levels (OR = 3.64, 95% CI = 2.84-4.66, P < .001) were more likely to develop adverse outcomes. High troponin I more than 13.75 ng/L combined with either advanced age more than 60 years or elevated AST level more than 27.72 U/L was the best model to predict poor outcomes. CONCLUSIONS COVID-19 severity and mortality are complicated by myocardial injury. Assessment of cardiac injury biomarkers may improve the identification of those patients at the highest risk and potentially lead to improved therapeutic approaches.
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Affiliation(s)
- Eman A. Toraih
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLA
- Department of Histology and Cell Biology, Genetics Unit, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Rami M. Elshazli
- Department of Biochemistry and Molecular Genetics, Faculty of Physical TherapyHorus University ‐ EgyptNew DamiettaEgypt
| | | | - Abdelaziz Elgaml
- Department of Microbiology and Immunology, Faculty of PharmacyMansoura UniversityMansouraEgypt
- Department of Microbiology and Immunology, Faculty of PharmacyHorus University ‐ EgyptNew DamiettaEgypt
| | - Mohamed Amin
- Department of Biochemistry, Faculty of PharmacyMansoura UniversityMansouraEgypt
| | - Mohammed El‐Mowafy
- Department of Microbiology and Immunology, Faculty of PharmacyMansoura UniversityMansouraEgypt
| | - Mohamed El‐Mesery
- Department of Biochemistry, Faculty of PharmacyMansoura UniversityMansouraEgypt
| | - Assem Ellythy
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLA
| | - Juan Duchesne
- Department of Surgery, Trauma/Acute Care and Critical CareTulane School of MedicineNew OrleansLA
| | - Mary T. Killackey
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLA
| | - Keith C. Ferdinand
- John W. Deming Department of Medicine, School of MedicineTulane UniversityNew OrleansLA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of MedicineTulane UniversityNew OrleansLA70112USA
| | - Manal S. Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
- Department of Biochemistry, Faculty of MedicineNorthern Border UniversityArarSaudi Arabia
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Elshazli RM, Toraih EA, Elgaml A, El-Mowafy M, El-Mesery M, Amin MN, Hussein MH, Killackey MT, Fawzy MS, Kandil E. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PLoS One 2020; 15:e0238160. [PMID: 32822430 PMCID: PMC7446892 DOI: 10.1371/journal.pone.0238160] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Evidence-based characterization of the diagnostic and prognostic value of the hematological and immunological markers related to the epidemic of Coronavirus Disease 2019 (COVID-19) is critical to understand the clinical course of the infection and to assess in development and validation of biomarkers. METHODS Based on systematic search in Web of Science, PubMed, Scopus, and Science Direct up to April 22, 2020, a total of 52 eligible articles with 6,320 laboratory-confirmed COVID-19 cohorts were included. Pairwise comparison between severe versus mild disease, Intensive Care Unit (ICU) versus general ward admission and expired versus survivors were performed for 36 laboratory parameters. The pooled standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated using the DerSimonian Laird method/random effects model and converted to the Odds ratio (OR). The decision tree algorithm was employed to identify the key risk factor(s) attributed to severe COVID-19 disease. RESULTS Cohorts with elevated levels of white blood cells (WBCs) (OR = 1.75), neutrophil count (OR = 2.62), D-dimer (OR = 3.97), prolonged prothrombin time (PT) (OR = 1.82), fibrinogen (OR = 3.14), erythrocyte sedimentation rate (OR = 1.60), procalcitonin (OR = 4.76), IL-6 (OR = 2.10), and IL-10 (OR = 4.93) had higher odds of progression to severe phenotype. Decision tree model (sensitivity = 100%, specificity = 81%) showed the high performance of neutrophil count at a cut-off value of more than 3.74x109/L for identifying patients at high risk of severe COVID-19. Likewise, ICU admission was associated with higher levels of WBCs (OR = 5.21), neutrophils (OR = 6.25), D-dimer (OR = 4.19), and prolonged PT (OR = 2.18). Patients with high IL-6 (OR = 13.87), CRP (OR = 7.09), D-dimer (OR = 6.36), and neutrophils (OR = 6.25) had the highest likelihood of mortality. CONCLUSIONS Several hematological and immunological markers, in particular neutrophilic count, could be helpful to be included within the routine panel for COVID-19 infection evaluation to ensure risk stratification and effective management.
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Affiliation(s)
- Rami M. Elshazli
- Department of Biochemistry and Molecular Genetics, Faculty of Physical Therapy, Horus University - Egypt, New Damietta, Egypt
| | - Eman A. Toraih
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana, United States of America
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Abdelaziz Elgaml
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Horus University - Egypt, New Damietta, Egypt
| | - Mohammed El-Mowafy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Mohamed El-Mesery
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Mohamed N. Amin
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Mohammad H. Hussein
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana, United States of America
| | - Mary T. Killackey
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana, United States of America
| | - Manal S. Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, KSA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University, School of Medicine, New Orleans, Los Angeles, United States of America
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Toraih EA, El-Wazir A, Ageeli EA, Hussein MH, Eltoukhy MM, Killackey MT, Kandil E, Fawzy MS. Unleash multifunctional role of long noncoding RNAs biomarker panel in breast cancer: a predictor classification model. Epigenomics 2020; 12:1215-1237. [PMID: 32812439 DOI: 10.2217/epi-2019-0291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Aim: We aimed to explore the circulating expression profile of nine lncRNAs (MALAT1, HOTAIR, PVT1, H19, ROR, GAS5, ANRIL, BANCR, MIAT) in breast cancer (BC) patients relative to normal and risky individuals. Methods: Serum relative expressions of the specified long non-coding RNAs were quantified in 155 consecutive women, using quantitative reverse-transcription PCR. Random Forest (RF) and decision tree were also applied. Results: Significant MALAT1 upregulation and GAS5 downregulation could discriminate risky women from healthy controls. Overexpression of the other genes showed good diagnostic performances. Lower GAS5 levels were associated with metastasis and recurrence. RF model revealed a better performance when combining gene expression patterns with risk factors. Conclusion: The studied panel could be utilized as diagnostic/prognostic biomarkers in BC, providing promising epigenetic-based therapeutic targets.
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Affiliation(s)
- Eman A Toraih
- Department of Histology & Cell Biology, Genetics Unit, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt.,Department of Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Aya El-Wazir
- Department of Histology & Cell Biology, Genetics Unit, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Essam Al Ageeli
- Department of Clinical Biochemistry (Medical Genetics), Faculty of Medicine, Jazan University, Jazan 82911, Saudi Arabia
| | - Mohammad H Hussein
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Mohamed M Eltoukhy
- College of Computing and Information Technology, Khulais, University of Jeddah, Jeddah 21959, Saudi Arabia.,Department of Computer Science, Faculty of Computers and Informatics, Suez Canal University, Ismailia 41522, Egypt
| | - Mary T Killackey
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Emad Kandil
- Department of Surgery, Division of Endocrine & Oncologic Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt.,Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar 1321, Saudi Arabia
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Al-Qurayshi Z, Nichols RL, Killackey MT, Kandil E. Mortality Risk in Necrotizing Fasciitis: National Prevalence, Trend, and Burden. Surg Infect (Larchmt) 2020; 21:840-852. [PMID: 32196411 DOI: 10.1089/sur.2019.277] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Necrotizing fasciitis (NF) is a fulminant, life-threating infection of fascia and subcutaneous tissue. Because of the low incidence, previous studies were statistically underpowered to assess factors associated with the risk of mortality. The aim of this study is to identify the risk factors associated with mortality in this select group of patients. Methods: A retrospective cross-sectional study was performed utilizing the Nationwide Readmissions Database, 2010-2014. The database captures 56.6% of all U.S. annual hospitalizations. Study population included inpatients admitted emergently with NF. Results: A total of 4,178 cases were included, of which 2,061(48.9%) patients had a history of diabetes mellitus (DM). The most common presentation was septicemia (39.5%) and 9.2% were admitted initially as cellulitis/abscess. Overall mortality risk was 12.6% with no substantial change in the annual trend. Mortality in patients with diabetes was substantially lower (8.5% vs. 16.5%, odds ratio [OR]: 0.44, 95% confidence interval [CI] = [0.34, 0.56], p < 0.001). Factors associated with a higher mortality risk included: older age, chronic liver diseases, disseminated intravascular coagulopathy, septic shock, pulmonary complications, acute renal failure, and not undergoing surgical intervention (p < 0.05 each). Patients who did not undergo surgical debridement were more likely to be ≥65 years of age and have multiple comorbidities. Hyperbaric oxygen therapy and intravenous immunoglobulin were used in 1.3% and 0.3% of the sample, respectively, with no reported use among patients who died. Conclusions: This study provides a new and updated perspective on the prevalence, trend, and outcomes of NF in the United States. Necrotizing fasciitis is associated with septicemia and lack of surgical intervention is associated with a higher mortality.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ronald L Nichols
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mary T Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Garstka ME, Randolph GW, Haddad AB, Nathan CAO, Ibraheem K, Farag M, Deot N, Adib H, Hoof M, French K, Killackey MT, Kandil E. Gender disparities are present in academic rank and leadership positions despite overall equivalence in research productivity indices among senior members of American Head and Neck Society (AHNS) Fellowship Faculty. Head Neck 2019; 41:3818-3825. [PMID: 31418942 DOI: 10.1002/hed.25913] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/09/2019] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to examine potential disparities in scholarly performance based on sex, academic rank, leadership positions, and regional distribution of faculty in accredited Head and Neck Surgery fellowships in the United States. METHODS Online faculty listings for 37 accredited fellowships were organized according to academic rank, leadership position, sex, and institutional location. Academic productivity was measured with three bibliometric indices: h-index, m-index, and the weighted relative citation ratio. RESULTS A total of 732 faculty members were included, of which 153 (21%) were female. Fifty-eight males (89.2%) held leadership positions, compared to seven females (10.8%). There was no significant difference in overall productivity between male and female senior faculty. There were regional differences in productivity by sex. CONCLUSIONS Females are underrepresented in senior faculty and within three common leadership positions, although scholarly productivity for male and female senior faculty and for those in leadership positions is similar.
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Affiliation(s)
- Meghan E Garstka
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Antoine B Haddad
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Kareem Ibraheem
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mahmoud Farag
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Neal Deot
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Hania Adib
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Marcus Hoof
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Kaley French
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary T Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Al-Qurayshi Z, Crowther JE, Hamner JB, Ducoin C, Killackey MT, Kandil E. Disparities of Immunotherapy Utilization in Patients with Stage III Cutaneous Melanoma: A National Perspective. Anticancer Res 2018; 38:2897-2901. [PMID: 29715114 DOI: 10.21873/anticanres.12536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Immunotherapy combined with surgery is associated with better survival than surgery alone in patients with advanced melanoma. This study examined the utilization of immunotherapy in relation to population characteristics and the associated survival benefit. MATERIALS AND METHODS This was a retrospective cohort study utilizing the US National Cancer Database. The study population included 6,165 adult patients (≥18 years) with stage III cutaneous melanoma (median follow-up=32 months). RESULTS A total of 1,854 patients underwent immunotherapy in addition to surgery, which was associated with a survival benefit over surgery alone (hazard ratio(HR)=0.66, 95% confidence interval(CI)=0.56-0.77, p<0.001). Older age, presence of comorbidities, Medicaid/Medicare insurance, and living in a community with lower average education level were associated with less immunotherapy utilization (all p<0.05). No statistically significant racial disparity in immunotherapy usage was found (p=0.07). CONCLUSION Compared to other demographic factors, insurance status was associated with the greatest disparities in immunotherapy utilization and mortality for patients who underwent surgery for advanced melanoma.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Jason E Crowther
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - John B Hamner
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Christopher Ducoin
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Mary T Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A.
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Abstract
Obesity is a worldwide epidemic leading to severe comorbidity that damages end-organ function. Overall transplant outcomes in this population are inferior to those in nonobese patients. Large population studies show decreased patient and graft survival in obese kidney transplant patients. Despite the poorer outcomes, kidney transplantation is considered because of the survival benefit as compared with the wait-listed dialysis patients. In liver transplantation, the benefit to transplantation as compared with remaining on the list is obvious, as there is no viable liver dialysis at this time. Obesity in potential organ donors impacts both medical and surgical issues. Obesity-related kidney disease affects both the remaining and transplanted kidney. Pancreas donor organs are associated with decreased early graft survival. Liver donor organs with significant steatosis lead to an increased risk for delayed or nonfunction of the organ. Immunosuppressive drugs with variable lipophilicity and altered volume of distribution can greatly affect the therapeutic usefulness of these drugs. Transplant candidates benefit from a multidisciplinary team approach to their care. As the epidemic progresses and less-invasive treatments for metabolic surgery evolve, we are likely to require more patients to lose weight prior to transplantation as we continue to strive for improved outcomes.
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Cannon RM, Killackey MT, Buell JF. Laparoscopic Hepatectomy for Colorectal Metastases: Ready for Prime Time? Curr Colorectal Cancer Rep 2011. [DOI: 10.1007/s11888-011-0087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Paramesh AS, Hanley K, Slakey DP, Killackey MT, Zhang R, Buell J. Who's your donor? Bringing about Louisiana's first domino paired exchange transplants. J La State Med Soc 2011; 163:102-104. [PMID: 21667804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although living donation is the preferred method of kidney transplant, many donors are not a match with their intended recipient. One unique way of overcoming this is by performing a donor paired exchange. By swapping donors, transplant centers may be able to bring about multiple transplants that would not have otherwise been possible. This manuscript describes the first three way domino paired donor exchange transplant in Louisiana. Because of a single altruistic donor, we were able to facilitate three recipients getting transplanted. We discuss the formulation of this unique program, the choosing of potential donor/recipient pairs and outcomes. A review of the controversies of paired kidney donation is also presented.
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Affiliation(s)
- Anil S Paramesh
- Tulane Abdominal Transplant Institute, Tulane University School of Medicine, New Orleans, USA
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Paramesh AS, Zhang R, Baber J, Yau CL, Slakey DP, Killackey MT, Ren Q, Sullivan K, Heneghan J, Florman SS. The effect of HLA mismatch on highly sensitized renal allograft recipients. Clin Transplant 2010; 24:E247-52. [DOI: 10.1111/j.1399-0012.2010.01306.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Feagans J, Victor D, Moehlen M, Florman SS, Regenstein F, Balart LA, Joshi S, Killackey MT, Slakey DP, Paramesh AS. Interstitial pneumonitis in the transplant patient: consider sirolimus-associated pulmonary toxicity. J La State Med Soc 2009; 161:166-172. [PMID: 19772040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Interstitial pneumonia in a transplant patient can have a varied etiology. Sirolimus (Rapamycin; Rapamune) is a popularly used immunosuppressant in solid organ transplantation that has anecdotally been associated with pulmonary toxicity. Sirolimus-induced pulmonary toxicity consists of a range of syndromes that is characterized by the presence of organizing pneumonia, interstitial pneumonitis, pulmonary alveolar proteinosis, focal fibrosis, or by the presence of alveolar hemorrhage. Diagnosis can be challenging and is usually made by exclusion of other etiologies. In this report we present two cases of sirolimus-associated pulmonary toxicity with a review of the literature.
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Affiliation(s)
- Jacob Feagans
- Tulane University, Department of Internal Medicine, New Orleans, USA
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Killackey MT, Gondolesi GE, Liu LU, Paramesh AS, Thung SN, Suriawinata A, Nguyen E, Roayaie S, Schwartz ME, Emre S, Schiano TD. Effect of ischemia-reperfusion on the incidence of acute cellular rejection and timing of histologic hepatitis C virus recurrence after liver transplantation. Transplant Proc 2008; 40:1504-10. [PMID: 18589139 DOI: 10.1016/j.transproceed.2008.03.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 03/11/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Because of a critical shortage of deceased donor (DD) livers, more extended criteria allografts are being utilized; these allografts are at increased risk for ischemia-reperfusion injury (IRI). We assessed whether, in a large cohort of patients transplanted for hepatitis C virus (HCV) either via a DD or live donor (LD), there was a relationship between the degree of IRI and the frequency and timing of acute cellular rejection (ACR) and histologic HCV recurrence. METHODS During an 8-year study, patients were separated into four groups based on peak alanine aminotransferase (ALT) levels and three groups based on severity of IRI on postreperfusion liver biopsy. RESULTS The mean follow-up time of 433 DD and 44 LD recipients was 1212 days. We noted a strong correlation in DD between peak ALT and the histologic degree of IRI (P = .01). There was no difference in the incidence or grade of ACR among the four groups. There was no correlation between the severity of IRI and the incidence or time to histologic recurrence of HCV. CONCLUSIONS The magnitude of peak ALT correlated with the severity of IRI on postreperfusion liver biopsy. Among this large HCV cohort, there was no correlation between the severity of IRI and the incidence or timing of histologic HCV recurrence or incidence of ACR.
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Affiliation(s)
- M T Killackey
- Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, USA
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Paramesh AS, Zhang R, Fonseca V, Killackey MT, Alper B, Slakey D, Florman S. Pancreas transplantation--a controversy in evolution. J La State Med Soc 2007; 159:319-329. [PMID: 18390270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pancreas transplantation has been mired in controversy throughout its existence. Arguments have erupted regarding its actual indications, the way the surgical procedure should be performed, its benefits, and today, the concept of pancreas islet cell transplantation remains controversial as well. If diabetic patients had a choice between life long insulin therapy and a major operation with immunosuppression afterward, what would they choose? The answer may not be as easy as one thinks. Pancreas transplantation has come a long way. This manuscript discusses the history of pancreas transplantation, how the indications are starting to be defined, evolution of the surgical procedure, current success rates of this procedure, the current scenario of pancreas islet transplantation, and newer developing technologies.
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Hendrickson RJ, Killackey MT, Watson TJ, Johnstone DW, Feins RH. Image of the month. Small left apical pneumothorax, left tube thoracostomy, and a prominent right central pulmonary artery. Arch Surg 2004; 139:1017-18. [PMID: 15381623 DOI: 10.1001/archsurg.139.9.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Richard J Hendrickson
- Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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