Paula Lee

Overview:

  • Teaching interests involve responsibilities as the Gynecologic Oncology Fellowship Program Director
  • Clinical interests involve sentinel lymph node techniques, radical surgeries, minimally invasive surgery including advanced laparoscopy and robotics
  • Scholarly interests involve global health initiatives, novel surgical techniques/therapies, palliative care

Positions:

Associate Professor of Obstetrics and Gynecology

Obstetrics and Gynecology, Gynecologic Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2000

Tulane University

Residency, Ob/Gyn

Duke University

Grants:

PP LNM 01 FILM - A Randomized, Prospective, Open Label, Multicenter Study Assessing the Safety and Utility of PINPOINT® Near Infrared Fluorescence Imaging in the Identification of Lymph Nodes in Subjects with Uterine and Cervical Malignancies who are

Administered By
Duke Cancer Institute
Awarded By
Novadaq Technologies Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.

BACKGROUND: Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. METHODS: We enrolled 140 English-speaking patients ≥60 yr old scheduled for noncardiac surgery under general anaesthesia in an observational cohort study, of whom 52 underwent neuroimaging. We measured cognition; Aβ, tau, p-tau levels in CSF; and resting-state intrinsic functional connectivity in six Alzheimer's disease-risk regions before and 6 weeks after surgery. RESULTS: There were no significant APOE4-related differences in cognition or CSF biomarkers, except APOE4 carriers had lower CSF Aβ levels than non-carriers (preoperative median CSF Aβ [median absolute deviation], APOE4 305 pg ml-1 [65] vs 378 pg ml-1 [38], respectively; P=0.001). Controlling for age, APOE4 carriers had significantly greater preoperative functional connectivity than non-carriers between several brain regions implicated in Alzheimer's disease, including between the left posterior cingulate cortex and left angular gyrus (β [95% confidence interval, CI], 0.218 [0.137-0.230]; PFWE=0.016). APOE4 carriers, but not non-carriers, experienced significant connectivity decreases from before to 6 weeks after surgery between several brain regions including between the left posterior cingulate cortex and left angular gyrus (β [95% CI], -0.196 [-0.256 to -0.136]; PFWE=0.001). Most preoperative and postoperative functional connectivity differences did not change after controlling for preoperative CSF Aβ levels. CONCLUSIONS: Postoperative change trajectories for cognition and CSF Aβ, tau or p-tau levels did not differ between community dwelling older APOE4 carriers and non-carriers. APOE4 carriers showed greater preoperative functional connectivity and greater postoperative decreases in functional connectivity in key Alzheimer's disease-risk regions, which occur via Aβ-independent mechanisms.
Authors
Browndyke, JN; Wright, MC; Yang, R; Syed, A; Park, J; Hall, A; Martucci, K; Devinney, MJ; Moretti, EW; Whitson, HE; Cohen, HJ; Mathew, JP; Berger, M; MADCO-PC Investigators,
MLA Citation
URI
https://scholars.duke.edu/individual/pub1496919
PMID
34535274
Source
pubmed
Published In
Bja: British Journal of Anaesthesia
Published Date
DOI
10.1016/j.bja.2021.08.012

Placental uterine artery embolization followed by delayed hysterectomy for placenta percreta: A case series.

We describe outcomes of patients with suspected placenta percreta treated with placental uterine artery embolization (P-UAE) followed by delayed hysterectomy. This is a prospective case series of subjects from 2005 to 2018 with suspected placenta percreta who underwent P-UAE at the time of cesarean delivery followed by delayed hysterectomy. Both scheduled and unscheduled surgical cases were included. Maternal characteristics, surgical approaches, intra- and postoperative outcomes were abstracted from medical records. In total, twenty-two subjects were included. Median (interquartile range, IQR) delivery gestational age was 34.6 (31.9, 35.7) weeks, occurring as scheduled in 17 (77.3%) subjects and unscheduled in 5 (22.7%). Delayed hysterectomy was performed as scheduled in 17 (77.3%) subjects at a median (IQR) 40.5 (38.0, 44.0) days after delivery, and 5 (22.7%) subjects had a hysterectomy prior to scheduled date, median (IQR) 27.0 (17.0, 35.0) days after delivery. Indications for the 5 unscheduled hysterectomies included bleeding (n = 3) and suspected endometritis (n = 2). Three subjects (13.6%) received a blood transfusion (1, 3, 3 units) during delivery, and 7 (31.8%) were transfused during delayed hysterectomy (median [IQR] 2 [1,3] units). Three (13.6%) subjects had bladder resection at the time of hysterectomy; 1 (4.5%) had an unintentional cystotomy and 1 (4.5%) had a ureteral injury. P-UAE followed by delayed hysterectomy appears to be a safe and feasible, although appropriate patient selection and close surveillance are imperative, as 22.7% of patients underwent unscheduled hysterectomy.
Authors
Gatta, LA; Lee, PS; Gilner, JB; Weber, JM; Adkins, L; Salinaro, JR; Habib, AS; Pabon-Ramos, W; Strickland, KC; Ronald, J; Erkanli, A; Mehdiratta, JE; Grotegut, CA; Secord, AA
MLA Citation
Gatta, Luke A., et al. “Placental uterine artery embolization followed by delayed hysterectomy for placenta percreta: A case series.Gynecol Oncol Rep, vol. 37, Aug. 2021, p. 100833. Pubmed, doi:10.1016/j.gore.2021.100833.
URI
https://scholars.duke.edu/individual/pub1493074
PMID
34368412
Source
pubmed
Published In
Gynecologic Oncology Reports
Volume
37
Published Date
Start Page
100833
DOI
10.1016/j.gore.2021.100833

The FILM Trial: A randomized phase III multicenter study assessing near infrared fluorescence in the identification of sentinel lymph nodes (SLN)

Authors
Frumovitz, M; Plante, M; Lee, PS; Sandadi, S; Lilja, JF; Escobar, PF; Gien, LT; Munsell, MF; Abu-Rustum, NR
MLA Citation
Frumovitz, M., et al. “The FILM Trial: A randomized phase III multicenter study assessing near infrared fluorescence in the identification of sentinel lymph nodes (SLN).” Gynecologic Oncology, vol. 149, Elsevier BV, 2018, pp. 7–7. Crossref, doi:10.1016/j.ygyno.2018.04.023.
URI
https://scholars.duke.edu/individual/pub1467136
Source
crossref
Published In
Gynecologic Oncology
Volume
149
Published Date
Start Page
7
End Page
7
DOI
10.1016/j.ygyno.2018.04.023

333 Standardization of caregiver and nursing perioperative care on gynecologic oncology wards in a resource-limited setting

Authors
Wong, J; Mulamira, P; Arizu, J; Nabwire, M; Driwaru, D; Mugabi, D; Nabulime, S; Nankya, E; Batumba, R; Okoth, A; Namugga, JL; Ajeani, J; Nakisige, C; Ueda, SM; Havrilesky, LH; Lee, PS
MLA Citation
Wong, J., et al. “333 Standardization of caregiver and nursing perioperative care on gynecologic oncology wards in a resource-limited setting.” Poster, BMJ Publishing Group Ltd, 2020. Crossref, doi:10.1136/ijgc-2020-igcs.285.
URI
https://scholars.duke.edu/individual/pub1474770
Source
crossref
Published In
Poster
Published Date
DOI
10.1136/ijgc-2020-igcs.285

Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.

BACKGROUND: Postoperative cognitive dysfunction (POCD), a syndrome of cognitive deficits occurring 1-12 months after surgery primarily in older patients, is associated with poor postoperative outcomes. POCD is hypothesized to result from neuroinflammation; however, the pathways involved remain unclear. Unbiased proteomic analyses have been used to identify neuroinflammatory pathways in multiple neurologic diseases and syndromes but have not yet been applied to POCD. OBJECTIVE: To utilize unbiased mass spectrometry-based proteomics to identify potential neuroinflammatory pathways underlying POCD. METHODS: Unbiased LC-MS/MS proteomics was performed on immunodepleted cerebrospinal fluid (CSF) samples obtained before, 24 hours after, and 6 weeks after major non-cardiac surgery in older adults who did (n = 8) or did not develop POCD (n = 6). Linear mixed models were used to select peptides and proteins with intensity differences for pathway analysis. RESULTS: Mass spectrometry quantified 8,258 peptides from 1,222 proteins in > 50%of patient samples at all three time points. Twelve peptides from 11 proteins showed differences in expression over time between patients with versus withoutPOCD (q < 0.05), including proteins previously implicated in neurodegenerative disease pathophysiology. Additionally, 283 peptides from 182 proteins were identified with trend-level differences (q < 0.25) in expression over time between these groups. Among these, pathway analysis revealed that 50 were from 17 proteins mapping to complement and coagulation pathways (q = 2.44*10-13). CONCLUSION: These data demonstrate the feasibility of performing unbiased mass spectrometry on perioperative CSF samples to identify pathways associated with POCD. Additionally, they provide hypothesis-generating evidence for CSF complement and coagulation pathway changes in patients with POCD.
Authors
VanDusen, KW; Li, Y-J; Cai, V; Hall, A; Hiles, S; Thompson, JW; Moseley, MA; Cooter, M; Acker, L; Levy, JH; Ghadimi, K; Quiñones, QJ; Devinney, MJ; Chung, S; Terrando, N; Moretti, EW; Browndyke, JN; Mathew, JP; Berger, M; MADCO-PC Investigators,
MLA Citation
VanDusen, Keith W., et al. “Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.J Alzheimers Dis, vol. 80, no. 3, 2021, pp. 1281–97. Pubmed, doi:10.3233/JAD-201544.
URI
https://scholars.duke.edu/individual/pub1475476
PMID
33682719
Source
pubmed
Published In
J Alzheimers Dis
Volume
80
Published Date
Start Page
1281
End Page
1297
DOI
10.3233/JAD-201544

Research Areas:

Palliative Care
Placenta Accreta
Placenta Percreta
Sentinel Lymph Node