Internal Medicine 2022

Improving post-discharge follow-up of incidental hepatic steatosis in patients admitted to Medicine service

Faculty Mentor’s Name: Dr. Bhagwan Dass
Email: Bhagwan.Dass@medicine.ufl.edu
Phone Number: (352) 265-0680
Project Category: CQI
International Component or Travel: No

Research Project Description:

Non-alcoholic fatty liver disease (NAFLD) is defined as >5% of hepatic steatosis (by imaging or histology) in the absence of excessive alcohol use or other causes of liver disease. This condition may progress to liver cirrhosis and hepatocarcinoma. Hepatic steatosis is a common incidental finding noted on abdominal imaging performed for other indications (such as concern for kidney stones).

Our goal is to explore the prevalence of hepatic steatosis in a population that is infrequently associated with classical risk factors of fatty liver disease. Among patients diagnosed with NAFLD in Western countries, 10%-20% of the population will not have central obesity with a BMI >30. These patients are termed to have “lean-NAFLD.” Current recommendations only recommend screening of hepatic disease in high-risk individuals (age >50 years, type 2 diabetes mellitus, metabolic syndrome), and do not address younger patients without comorbidities. Hence, it is important that incidental findings of hepatic steatosis are followed up by a specialist accordingly as this may be the only clinical clue for investigation of liver disease and the patient may not actively undergo workup otherwise.

The first part of this project will focus on determining the prevalence of incidental hepatic steatosis noted in CT imaging and determining what percentage of this population has elevated LFTs and does not have classical risk factors of metabolic syndrome. Then, the second part of the project will focus on determining what percentage of the cohort from part one had formal follow up with a referring provider, primary care physician vs specialist and developing a screening tool (AST/ALT >40 in obese patients) that could prompt further evaluation by a primary care provider, hepatology referral of further imaging. The project has already been approved with QIPR.

Alzheimer’s Disease Progression Prognosis and Monitoring using EEG and Neurovascular Clinical Data: A Study of Applied Cognition in The Villages

Faculty Mentor’s Name: Dr. Carla VandeWeerd
Email: cvandeweerd@ufl.edu
Phone Number: (352) 247-2493
Project Category: Clinical
International Component or Travel: Yes

Research Project Description:

The UF Health: Precision Health Research Center (PHRC)- The Villages is dedicated to promoting brain health in older adults and has begun a project that focuses on better understanding the utility of an innovative wearable technology to detect and monitor cognitive decline. The Villages FL is the largest active-lifestyle community in the United States, consisting of over 135,000 residents over the age of 55. Due to an aging population, members of our community are at an elevated risk for developing different forms of Dementia such as Alzheimer’s Disease (AD). As of 2021, an estimated 6.2 million Americans age 65 and older are living with Alzheimer’s and within Sumter County, there are approximately 16,000 people living with Alzheimer’s or dementia. As the number of older Americans continues to grow, so will the number of new and existing cases of AD. It is projected that by 2050, the number of people age 65 and older with AD may grow to 12.7 million. These numbers place significance on the development of medical breakthroughs to prevent, slow, or cure AD. Understanding the relationship between aging and brain health can help older adults in our community and beyond maintain and improve their quality of life, by increasing awareness and introducing early interventions to prevent or reduce cognitive impairment.

The individual choosing to collaborate with our center would have an opportunity to participate under the mentorship of Dr. Carla VandeWeerd and senior coordinators at the Center in a unique academic-industry partnership. This is a longitudinal, single-site study to determine the effect size to power an FDA pivotal study on using multimodal EEG and neurovascular measures captured by the Applied Cognition S1 band, and the reaction time measurements captured by the Longevity phone app, as prognostic and monitoring biomarkers of Early AD. In support of this goal, this study will examine the efficacy of 1) using multimodal EEG and neurovascular measures captured by the Applied Cognition S1 band, and 2) the reaction time measurements captured by the Longevity phone app, as prognostic and monitoring biomarkers of Early Alzheimer’s Disease (EAD).

Responsibilities:

The PHRC is expecting capable individuals to assist with clinical research data management, sample collection and processing, interpretation of data, and developing statistical models, data collection systems, and other strategies that optimize statistical efficiency and quality. This allows for the rapid dissemination of information about cognitive health through publications, conferences, and policy briefs. This individual will be required to follow regulatory standards while developing targeted databases and participating in existing cognitive health research data analytics. We also expect to inform public policy through dissemination activities (e.g., research abstracts, manuscripts, data briefs) to briefly explicate clinical data to various professional and lay community groups. Other responsibilities of this position include participant recruitment, which is an important aspect of the project. The individual will brainstorm and execute community outreach techniques, assist with survey completion, and host community events. The Center will provide support and guidance to students undertaking this work, alongside exposure to industry and community partners, with broad aims to:

Specific Aim 1: Understand the relationship and health implications of diseases affecting brain health, including assisting in examining research questions based on early findings from the study.

Specific Aim 2: Submit an academic work product (e.g. data brief, manuscript, conference abstract) for review under the mentorship of Dr. VandeWeerd and senior research members of the PHRC.

Abnormal metabolism in neuroendocrine tumor cells

Faculty Mentor’s Name: Dr. Charlie Khemtong
Email: chalermchai.khemtong@medicine.ufl.edu
Phone Number: (352) 273-8646
Project Category: Basic
International Component or Travel: No

Research Project Description:

Pheochromocytomas (PCCs) and paragangliomas (PGLs) are neuroendocrine tumors forming in the adrenal medulla and extra-adrenal ganglia, respectively. About 25% of all PCC/PGL patients have a malignant form of tumors harboring mutations in a TCA cycle enzyme succinate dehydrogenase subunit B (SDHB). The impaired TCA cycle is associated with metabolic alterations such as increased glutamine oxidation. Our lab, in collaboration with Dr. Hans Ghayee, is investigating altered metabolic pathways in these cancer cells using stable isotope tracer carbon-13 combined with nuclear magnetic resonance (NMR) and mass spectrometry. The eventual goal of this study is to identify metabolic biomarkers that can be targeted for the diagnosis and treatments of neuroendocrine tumors. The student will have hands-on experience in cell culture, biochemical assays, stable isotope tracers, and metabolic analysis using NMR and mass spectrometry.

Treatment of congenital and acquired defects in mitochondrial energy metabolism abolism mitochondrial energetics

Faculty Mentor’s Name: Dr. Peter Stacpoole
Email: pws@ufl.edu
Phone Number: (352) 273-9599
Project Category: Clinical
International Component or Travel: No

Research Project Description:

We have developed a small molecule that uniquely activates a mitochondrial enzyme responsible for the efficient conversion of substrate fuels into ATP and, hence, is essential to cellular homeostasis and organismal life. We are conducting 2 federally-funded, multicenter clinical trials with this compound: 1) a phase 3 trial in young children with loss-of-function mutations in this enzyme and 2) a phase 2 trial in adults with recurrent glioblastoma multiforme, the commonest and deadliest primary brain cancer in adults. Students would learn about the scientific and regulatory processes in developing clinical trials, the pharmacology of this novel investigational drug and how knowledge of the fundamental biochemical perturbations of diseases can be translated into specific, targeted therapies. A general review of this drug is found in James, M. O. and Stacpoole, P.W. Pharmacol. and Therapeutics 170: 166-180, 2017.

The Risk Factors for Recurrence of ROP after Intravitreal Injection of Bevacizumab

Faculty Mentor’s Name: Dr. Jinghua Chen
Email: jinghuachen@ufl.edu
Phone Number: (352) 273-8787
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Background
Retinopathy of prematurity (ROP) is one of the leading cause of preventable blindness in children. Its incidence increases with increasing survival of extremely preterm babies. ROP may cause total vision loss in as many as 2% to 4% of those weighing less than 2 pounds at birth. Despite current therapies, ROP continues to be a highly debilitating disease. Despite increasing worldwide use of anti-vascular endothelial growth factor agents for treatment of retinopathy of prematurity (ROP), there are recurrence of ROP in babies who received injection of Bevacizumab. And these babies require supplement of laser photocoagulation.

Method
We are going to review all the data of the babies who had been treated at NICU of UF Shands Hospital between Jan 2012 and Feb 2022 to compare the gestational age, birth weight, systemic condition and comorbidity between the babies who were just treated by Bevacizumab injection and who were treated by both Bevacuzumab and laser photocoagulation.

Significance
This project may provide important information to help pediatric ophthalmologists and retinal specialists to follow up and retreat the babies with high risk of recurrence of ROP.