Monash surgeon, researcher and lecturer receives academic promotion

Associate Professor Paul Cashin

Monash Health surgeon Mr Paul Cashin has been recognised for his research and clinical activities, receiving a Monash University academic promotion last month.

Adjunct Clinical Associate Professor Cashin, a senior Upper Gastrointestinal surgeon, is Service Director, General Surgery at Monash Health and Director Medical Services, Jessie McPherson Private Hospital.

An author of numerous clinical papers and book chapters in Upper GI surgery, Associate Professor Cashin’s research focuses on the surgical management of benign and malignant Upper GI disease.

“I oversee the Monash Upper GI and HPB Research Department and have ongoing clinical and laboratory-based research activities into pancreatic cancer, oesophago-gastric cancer and its genomics,” Associate Professor Cashin said.

As well as his clinical and research activities, Associate Professor Cashin lectures Years 3 and 5 Monash medical students, and led the redesign of surgical bedside teaching at Monash Health and its incorporation into the curriculum.

In 2012 Associate Professor Cashin received the Southern Clinical School Final Year Supervisor Award.

Associate Professor Cashin said he is both honoured and humbled on receiving his academic promotion.

“The appointment as an Adjunct Clinical Associate Professor gives recognition to the research and teaching activities of the General Surgery (and its subspecialties) Service at Monash Health,” he said.

“The Department’s involvement in these activities has vastly increased over the last ten years and brought the academic activities and teaching in surgery to a position of prominence.”

Associate Professor Cashin acknowledges the various teams in General Surgery, in particular the Upper GI/HPB team.

“Most importantly I acknowledge Mr Dan Croagh FRACS, the Upper GI/HPB Head of Research whose commitment to research is exceptional and whose energy is amazing,” Associate Professor Cashin said.

I would also like to acknowledge, Professor Julian Smith and Mr Alan Saunder for their wise guidance, support and encouragement.”

“Finally I would like to acknowledge the support of Professor Eric Morand and for his commitment to both excellence in research and for his devotion to undergraduate and post graduate teaching.”

Associate Professor Cashin said the combination of clinical practice, administration, teaching and research is a difficult balance to achieve but immensely rewarding.

Beyond his teaching and research, Associate Professor Cashin holds a number of highly regarded leadership positions, including Chair, Monash Health Antimicrobial Stewardship Committee and the Comprehensive Care Committee.  He is also Clinical Lead, ICS OG Cancer Optimal Care Pathway Design Committee and an elected Board Member, Australian and New Zealand Gastro-Oesophageal Surgery Association (ANZGOSA) (RACS).

He has been an invited speaker at a number of national and international scientific meetings.

Monash gastroenterology research showcased at world’s largest scientific meeting

Dr Ray Boyapati

Monash research into inflammatory bowel disease (IBD) and acute variceal bleeding was presented in two oral presentations recently at the American Gastroenterological Association’s annual scientific meeting in Chicago—the largest international gathering of physicians, researchers and academics in the field.

Monash Health gastroenterologist Dr Ray Boyapati presented his research investigating the role of mitochondrial DNA as a damage associated molecular pattern (DAMP) in IBD. DAMPs are host molecules released from injured cells that can initiate an inflammatory response by binding to targets such as Toll-like receptors (TLRs) that activate immune cells.

In a world-first, Dr Boyapati and his team implicated mitochondrial damage and resultant mitochondrial DAMPs in IBD-related inflammation using multiple lines of evidence.

“We found elevated circulating mitochondrial DAMPs in human IBD and mouse models of colitis,” Dr Boyapati said.

Dr Boyapati’s other findings include the gut being a potential source of these mitochondrial genome fragments and that the cellular targets of mtDNA, such as TLR-9, are present in IBD.  He also found that genetic deletion of TLR-9 is protective in an animal model of colitis.

“Overall, these novel findings suggest a potential new avenue of investigation in IBD pathogenesis,” he said.

Dr Marcus Robertson

Also at the scientific meeting, Monash University’s Dr Marcus Robertson presented research relating to risk stratification of patients presenting with acute variceal bleeding.

A common emergency in patients with liver cirrhosis and portal hypertension, acute variceal bleeding has a published inpatient mortality risk of 14-43% despite current standards of care and remains a common cause of death in patients with cirrhosis.

Dr Robertson investigated whether patients presenting with acute variceal bleeding could be accurately risk assessed by a risk stratification score in the emergency department which may facilitate intensive treatment in those patients at highest risk and ultimately improve patient survival.

“By examining over 160 patients presenting to Monash Health and Austin Health with variceal bleeding, we found that the AIMS65 risk stratification score (a simple score which assigns 1 point for each of the following: albumin level < 30g/L, INR > 1.5, altered mental status, systolic blood pressure < 90mmHg and age > 65 years) very accurately predicts inpatient mortality,” Dr Robertson said.

“No patient with an AIMS65 score of 0 passed away, while patients with an AIMS65 score of 3 or 4 had a mortality rate of 34% and 57% respectively."