DEI, Collaborative, & Basic & Translation Research

Nahmias J, Zakrison TL, Haut ER, et al. Call to action on the categorization of sex, gender, race, and ethnicity in surgical research. J Am Coll Surg. 2021;233(2):316-319. PMID: 33964401

This collective makes recommendations to surgical researchers, journals, professional societies, databases and networks about categorizing sex, gender, race and ethnicity, including the use of more expansive categories for gender and more inclusive ones for ethnicity. There should be both a distinct evaluation of and a standardized approach to reporting and publishing these categories in research studies and databases.

Eruchalu C, Etheridge J, Hammaker A, et al, including Nahmias J. Racial and ethnic disparities in operative experience among general surgery residents: a multi-institutional study from the US ROPE Consortium. Ann Surg. 2024 Jan 1;279(1):172-179. PMID: 36928294

An investigation of 20 general surgery residency programs to determine the association between race/ethnicity and caseload revealed that Black residents graduated with lower case volume than nonminority residents throughout the study decade. As this may negatively impact professional development, interventions are needed to promote equitable operative experience and positive culture change.

Winer LK, Kader S, Abelson JS, et al, including Nahmias JT. Disparities in the operative experience between female and male general surgery residents: a multi-institutional study from the US ROPE Consortium. Ann Surg. 2023 Jul 1;278(1):1-7. PMID: 36994704

Similar to the previous study, the association between gender and caseload was analyzed at 20 general surgery programs during an 11-year period. Female graduates had a lower caseload overall, although the gap in operative experience narrowed over the study.

Raoof M, Ituarte PHG, Haye S, et al, including Eng O. Medicare Advantage: a disadvantage for complex cancer surgery patients. J Clin Oncol. 2023 Feb 20;41(6):1239-1249. PMID: 36356283

This study compared the access to care and outcomes in California patients undergoing elective cancer surgery of the lung, esophagus, stomach, pancreas, liver, colon or rectum, depending on their enrollment in Medicare Advantage (MA) or traditional Medicare (TM) plans. Although MA was associated with lower estimated hospital costs, MA beneficiaries had reduced access to high-volume hospitals and increased 30-day mortality for stomach, pancreas or liver surgery.

Sullivan BG, Al-Khouja F, Herre M, et al, including Stamos M. Assessment of medical industry compensation to US physicians by gender. JAMA Surg. 2022 Nov 1;157(11):1017-1022. PMID: 36169943

A retrospective analysis of payments made from the highest-grossing medical supply companies to female and male physicians to assess compensation and engagement disparities based on gender showed that male physicians received significantly higher payments compared with female physicians. This disparity persisted across all medical specialties and academic ranks, and the gender gap continued to widen over the study period.

Yu J, Sullivan BG, Senthil GN, et al, including Senthil M. Prevalence of primary liver cancer is affected by place of birth in Hispanic people residing in the United States: All of Us Research Program Report. Am Surg. 2022 Oct;88(10):2565-2571. PMID: 35854430

An analysis of the NIH All of Us biomedical database determined that non-U.S.-born Hispanic participants have a higher risk of liver cancer compared to U.S.-born participants, and that U.S.-born Hispanic patients with liver, gastric or cervical cancers are younger than those born elsewhere.

Are C, Senthil M, Jayaryaman S, et al. Promoting surgical research in the Global South. Surgery. 2021 Nov;170(5):1587-1588. PMID: 33712308

This commentary addressed the much lower research capacity and capabilities in the Global South (GS) vs. the Global North (GN). The authors noted numerous barriers to promoting surgical research in the GS, including a shortage of trained clinicians, excessive workload and lack of funding, infrastructure, and education platforms. They discussed the actions being taken to promote research in the GS, and the role of partnerships within the GS and between the GS and GN.

Sullivan BG, Qazi A, Senthil M. Cancer screening programs in low- and middle-income countries: strategies for success. Ann Surg Oncol. 2021 Nov;28(12):6918-6919. PMID: 34296357

In an editorial piece, Sullivan, et al. reflected on the importance of cancer screening programs in low- and middle-income countries (LMICs). They emphasized the importance of identifying the cultural, psychosocial, economic and religious barriers, misconceptions and stigma to cancer diagnoses (some of which may be unique to a specific region) and of creating strategies to counter such barriers, in order for screening programs to succeed.

Yeates EO, Juillard C, Grigorian A, et al, including Nahmias J. The coronavirus disease 2019 (COVID-19) stay-at-home order’s unequal effects on trauma volume by insurance status in Southern California. Surgery. 2021 Sep;170(3):962-968. PMID: 33849732

This multi-center study across Southern California retrospectively examined the impact of insurance status and race on trauma volume during stay-at-home orders instituted for the COVID-19 pandemic. Trauma volume increased for those on Medicaid, while it decreased for those with Medicare, private insurance and no insurance. Trauma volume decreased most for Asian patients compared to white, Black and Latino patients, among whom there was no significant difference in the drop in trauma volume.

Ubbaonu CD, Chang J, Ziogas A, Mehta RS, Kansal KJ, Zell JA. Disparities in receipt of National Comprehensive Cancer Network guideline-adherent care and outcomes among women with triple-negative breast cancer by race/ethnicity, socioeconomic status, and insurance type. Cancers (Basel). 2023 Nov 26;15(23):5586. PMID: 38067290

Investigators retrospectively analyzed the adherence to National Comprehensive Cancer Network guidelines in women with triple-negative breast cancer in California. They found that, compared to white patients, Black and Hispanic patients were less likely to receive guideline-adherent care and that Black women had increased disease-specific mortality.

Garcia-Aguilar J, Patil S, Gollub MJ, et al, including Carmichael JC. Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy. J Clin Oncol. 2022;40(23):2546-2556. PMID: 35483010

This was a prospective, randomized phase II trial, comparing disease-free survival (DFS) in 324 patients with stage II or III rectal adenocarcinoma treated with induction chemotherapy, followed by chemoradiotherapy or chemoradiotherapy, and then by consolidation chemotherapy and either total mesorectal excision or watch-and-wait on the basis of tumor response. No differences were found between groups in local recurrence-free survival, distant metastasis-free survival or overall survival. The authors concluded that organ preservation is achievable in half the patients with rectal cancer treated with total neoadjuvant therapy, without an apparent detriment in survival.

COVIDSurg Collaborative; GlobalSurg Collaborative (Kansal K, Jutric Z, Chin T). SARS-CoV-1 2 infection and venous thromboembolism after surgery: an international prospective cohort study. Anaesthesia. 2022 Jan;77(1):28-39. PMID: 34428858

In a substudy of an international, multicenter, prospective cohort study of elective and emergency patients undergoing surgery during October 2020, the rate of postoperative venous thromboembolism (VTE) was found to be higher among patients with perioperative or recent SARS-CoV-2 infection, compared to those with previous or no infection. In addition, in those with SARS-CoV-2, VTE was independently associated with increased 30-day mortality.

Purdy AC, Smith BR, Amersi F, et al. Characteristics associated with outstanding general surgery residency graduate performance, as rated by surgical educators. JAMA Surg. 2022 Oct 1;157(10):918-924. PMID: 35947371

Almost 300 recent surgical residency graduates were evaluated for their performance, based on 21 characteristics that identified as typical of outstanding graduating surgical residents. Surgical judgment and leadership skills had the highest correlation with better overall performance. Assessment of only three qualities (surgical judgment, leadership and medical knowledge) was required to predict overall resident performance ratings.

Maheswari Senthil’s laboratory collaborates closely with Christopher C.W. Hughes’ laboratory in the UC Irvine Department of Molecular Biology and Biochemistry for translational research to model peritoneal carcinomatosis. Their project, “A Vascularized Microphysiological System (MPS) Platform for Modeling Peritoneal Carcinomatosis,” recently received R01 funding from the National Cancer Institute, with the goal to establish a microphysiological system platform to help identify improved therapies for peritoneal carcinomatosis. Hughes and Senthil are co-PIs on the project.

Hirohito Ichii’s lab focuses on diseases of the pancreas and their complications. The disease targets are pancreatitis, Type 1 and Type 2 diabetes (T1DM and T2DM), autoimmunity, and diabetes complications such as kidney damage. The research covers the transplantation of islets to treat T1DM, drugs that prevent or reduce damage to pancreatic cells in both T1DM and T2DM, various techniques that improve the quality and quantity of islet isolation, kidney transplantation and organ preservation. Ichii’s lab is equipped to perform cell and tissue culture, animal surgeries, drug administration and bench work in vitro analysis, and to participate in writing for scientific journals/conferences.

Reed Ayabe’s laboratory focuses on modeling and treating biliary tract cancer, which affects a disproportionate number of patients in Orange County. A vascularized tumor model developed in collaboration with Maheswari Senthil, MD, and Christopher Hughes, PhD, will be used to study the role of nuclear export proteins and their binding partners in cholangiocarcinoma pathogenesis, and to produce a scalable platform for novel drug testing.
 

Many of our faculty members have participated in basic and translational research efforts. Some key publications include:

Kumar T, Nee K, Wei R, et al, including Lin E. A spatially resolved single-cell genomic atlas of the adult human breast. Nature. 2023 Aug;620(7972):181-191. PMID: 37380767

Researchers at UC Irvine constructed the comprehensive Human Breast Cell Atlas to evaluate non-epithelial cell types in breast tissue for their cell type and spatial mapping. They identified perivascular, endothelial and immune cell populations, highly diverse luminal epithelial cell states, and distinct molecular differences between ductal and lobular regions.

Nee K, Ma D, Nguyen QH, et al, including Lin E. Preneoplastic stromal cells promote BRCA1-mediated breast tumorigenesis. Nat Genet. 2023 Apr;55(4):595-606. PMID: 36914836

UC Irvine research demonstrated that precancerous stroma in BRCA1+/mut may elevate breast cancer risk through the promotion of epithelial proliferation and an accumulation of luminal progenitor cells with altered differentiation.

Vallejos PA, Gonda A, Yu J, et al, including Senthil M. Plasma exosome gene signature differentiates colon cancer from healthy controls. Ann Surg Oncol. 2023;30(6):3833-3844. PMID 36864326

Exosome-based liquid biopsies were obtained from patients with metastatic and nonmetastatic colon cancer and healthy controls to detect differentially expressed genes (DEGs). An exosome gene signature of 445 DEGs in cancer samples, distinct from the controls, was identified, of which 58 were found to be overexpressed in colon tumors.

Li S, Vaziri ND, Swentek L, et al, including Ichii H. Prevention of autoimmune diabetes in NOD mice by dimethyl fumarate. Antioxidants (Basel). 2021 Jan 29;10(2):193. PMID: 33572792

In this study, dimethyl fumarate (DMF), an Nrf2 activator, was given to nonobese diabetic mice in models of both spontaneous and accelerated models of diabetes mellitus. In both groups, DMF reduced the onset of diabetes, as well as pro-inflammatory cytokine levels and insulitis.