Surgery

Project Title: Chronic stress and anemia recovery following major trauma

Faculty Mentor’s Name: Dr. Alicia Mohr
Phone: 352-273-5670
Email: alicia.mohr@surgery.ufl.edu

Research Project Description:

Injury-associated persistent anemia is a persistent anemia seen in the absence of acute blood loss and is one manifestation of bone marrow end organ dysfunction that occurs following severe trauma and prolonged critical illness. We have recent data showing that norepinephrine is a key regulator of erythroid progenitor cell growth and mobilization following trauma, although the exact mechanisms involved have yet to be elucidated. Based on our published observations, the overarching hypothesis is that chronic stress and prolonged adrenergic stimulation following injury and hemorrhagic shock are directly responsible for the persistence of injury-associated anemia with impaired differentiation and maturation of erythroid cells, and reduction of chronic stress can improve anemia and alter recovery. This research is supported by the NIH-NIGMS.

The medical student will determine the role of hepcidin and the persistent inflammatory milieu that impairs recovery from injury-associated anemia. These studies will be conducted in Sprague Dawley rats that have undergone our model of lung contusion, hemorrhagic shock followed by either 7 (LCHS/CS-7) or thirteen days of restraint stress (LCHS/CS-14). In addition to survival, we will examine the inflammatory milieu of the bone marrow and bone marrow stroma and compare these findings to our previous work on day 7 after LCHS/CS. The medical student will begin an understanding of reviewing scientific literature and learn basic science laboratory techniques, including cell culture, qRT-PCR, ELISA and western blot. He/she will develop insight on how basic science research can be applied in the clinical arena. The medical student will also perform statistics and report the results from the experiments.

Loftus TJ, Mira JC, Kannan KB, Plazas JM, Delitto D, Stortz JA, Hagen JE, Parvataneni HK, Sadasivan KK, Brakenridge SC, Moore FA, Moldawer LL, Efron PA, Mohr AM. (2018). The post-injury inflammatory state and the bone marrow response to anemia. Am J Respir Crit Care Med 198, 629-638. PMID: 29768025

Millar JK, Kannan KB, Loftus TJ, Alamo IG, Plazas J, Efron PA, Mohr AM. (2017). Persistent injury-associated anemia: The role of the bone marrow microenvironment. J Surg Res 214, 240-246. PMID:28624051

Entry Date: September 16, 2019

Project Title: Association of Bulk Blood Flow with Hemodialysis Arteriovenous Fistula maturation

Faculty Mentor’s Name: Dr. Scott Berceli
Phone: 352-376-1611 EX 6441
Email: bercesa@surgery.ufl.edu

Research Project Description:

Arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis; however, AVFs often fail to mature and hemodynamic factors may contribute to AVF maturation failure although the exact mechanism is still not known. Supported by NIH, we took MRI scans of about 60 patients to extract the fistula geometry and flow rates at 1 week, 6 weeks, and 6 months after fistula creation, then computational fluid dynamics (CFD) simulations were performed to approximate the fistula blood flow characteristics. Wall shear stress (WSS), which is the frictional force applied to the endothelial cells due to the velocity gradient near the vessel wall, has been extracted to examine the association of WSS with fistula remodeling and maturation. However, bulk flow may also play a significant role in fistula remodeling and is rarely investigated. We thus hypothesize that bulk flow is associated with fistula remodeling and maturation. Quantitative helicity-based parameters will be extracted from the already available CFD data files and the association of these parameters with fistula remodeling and maturation will be examined statistically by the medical student.

References:

1. He Y, Terry CM, Nguyen C, et al. Serial analysis of lumen geometry and hemodynamics in human arteriovenous fistula for hemodialysis using magnetic resonance imaging and computational fluid dynamics. J Biomech. 2013; 46.

2. Morbiducci U, Gallo D, Ponzini R, et al. Quantitative Analysis of Bulk Flow in ImageBased Hemodynamic Models of the Carotid Bifurcation: The Influence of Outflow Conditions as Test Case. Annals of Biomedical Engineering. 2010; 38: 3688-3705.

Entry Date: September 24, 2019

Project Title: Clinical Outcomes Research in Pediatric Surgery

Faculty Mentor’s Name: Dr. Saleem Islam
Phone: 352-273-8825
Email: saleem.islam@surgery.ufl.edu

Research Project Description:

Pediatric Surgery is a broad field which allows us to study multiple different outcomes based on clinical care, procedures, or quality based information.

The student will be involved in the selection of the project, designing of the questions and variables to collect, data collection, analysis and creation of the abstract / manuscript.

It is expected that the student will present these data at a national meeting in addition to regional and local meetings as well to help with understanding the research process and methods. In the past decade, each student involved with this research has been successful at attending a national meeting to present their projects.

Entry Date: September 25, 2019

Project Title: Evaluation of Risk Factors for Postoperative Outcomes in Thoracic Aortic Disease

Faculty Mentor’s Name: Dr. George Arnaoutakis
Phone: 352-273-5508
Email: george.arnaoutakis@surgery.ufl.edu

Research Project Description:

This clinical project will involve studying the robust aortic disease center database here at UF, identifying risk factors for poor outcomes following aortic dissection or aneurysm repair. The project will also offer the opportunity for student(s) to observe open heart surgery and shadow in busy clinic seeing preoperative and postoperative evaluation.

Entry Date: September 20, 2019

Project Title: Surgical treatment of GERD in lung transplant patients

Faculty Mentor’s Name: Dr. Alexander Ayzengart
Phone: 352-265-0761
Email:Alexander.Ayzengart@surgery.ufl.edu

Research Project Description:

Lung transplantation is a radical but life-saving treatment option for patients with end-stage lung diseases, such as idiopathic pulmonary fibrosis, COPD, and scleroderma. The most common cause of chronic allograft dysfunction is obliterative bronchiolitis, a process of fibrosis that starts in the small bronchioles of the transplanted lungs. Gastroesophageal reflux disease (GERD) has been postulated to induce bronchiolitis and lung rejection by aspiration of gastroesophageal contents. Early anti-reflux surgery (fundoplication) after lung transplantation, before worsening lung function, has been shown to preserve lung allograft function. The medical student will analyze a case series of patients who underwent laparoscopic partial fundoplications post lung transplantation, to determine the degree of improvement in their GERD. This project will involve literature review, chart review & analysis, attendance of GERD/GI/Lung Transplant conferences, and case observations in the OR.

Entry Date: October 1, 2019

Project Title: Clinical Pathways for Improved Patient Outcomes in Pediatric Surgery

Faculty Mentor’s Name: Dr. Robin Petroze
Phone: 352-273-8825
Email: robin.petroze@surgery.ufl.edu

Research Project Description:

This project will use evidence-based medicine to help develop clinical pathways in pediatric surgery to improve the efficiency and patient experience as well as to optimize clinical outcomes. Using outcomes data within the department, the student will help to identify common pediatric surgical problems in which we aim to improve our diagnostic and treatment efficiency in a multidisciplinary approach. An example would be appendicitis in which we aim to decrease the number of nonvisualized appendix on ultrasound by a) improving selection criteria for imaging based on evidence-based guidelines, b) standardizing reporting, c) providing algorithms and clinical pathways for care. The student will be involved in pathway development and/or implementation and evaluation.

Entry Date: October 30, 2019

Project Title: Patient-Centered Outcomes: Addressing Opioid Prescription Patterns in Pediatric Surgery

Faculty Mentor’s Name: Dr. Robin Petroze
Phone: 352-273-8825
Email: robin.petroze@surgery.ufl.edu

Research Project Description:

On October 26, 2017 the acting secretary of Health and Human Services declared the opioid crisis a public health emergency. This declaration reflected the extent to which opioid abuse and dependence have taken a toll on our society, both in the number of human lives lost (~42,000 people died from opioid overdoses in 2016 alone) and the destruction of families and communities. Overprescribing opioids after surgery has been singled out as a contributing factor to the epidemic, and while it is widely accepted that physicians should be more judicious when prescribing opioids, there has been no consensus on a standard for exactly how many opioids that entails following surgery. This study will specifically look at prescription trends for outpatient pediatric surgery as well as evaluate patient factors such as access to a pharmacy and cost in an effort to develop locally-adapted guidelines for opioid prescriptions in pediatric surgical patients.

The student will work with a senior student to complete a retrospective review and develop a prospective study. The PI will assist with all IRB submission. The student is expected to participate in abstract presentation and manuscript preparation.

Entry Date: October 30, 2019

Project Title: Clinical outcomes in pediatric surgery in low-resource settings (Global Health)

Faculty Mentor’s Name: Dr. Robin Petroze
Phone: 352-273-8825
Email: robin.petroze@surgery.ufl.edu

Research Project Description:

As efforts to support pediatric health globally have made improvements in early childhood deaths due to infectious and diarrheal disease, the impact of noncommunicable disease, including surgical disease, becomes more important. This project entails partnering with surgeons in a low-resource setting to support their clinical research interests, mostly through retrospective chart review. Specific projects in pediatric surgery will focus on the development of an outcomes database for neonatal surgery, surgical nutrition, surgical infection, and post-surgical outcomes. All students will be paired with a local medical or public health student. This MSRP project aims to introduce students interested in global health to a curriculum of global health equity and provide an introduction to global health research in a collaborative fashion.

Entry Date: October 30, 2019

Project Title:Medical student career choice: Who is the influencer?

Faculty Mentor’s Name:Dr. Janice Taylor
Phone:352-273-8825
Email:janice.taylor@surgery.ufl.edu

Research Project Description:

Recruitment and mentoring of medical students for their career goals is becoming a popular topic in medical peer-reviewed literature. Published studies have looked at what influences students’ specialty choices based on rotation involvement, having a mentor, being involved with research, grit score, and emotional intelligence, among other factors. There is nothing yet published looking at how residents vs attendings influence the career choice of medical students. Across specialties, this can have implications for team dynamics and improving student experience with different team members.

This will be a survey-based project, which the MSRP student will develop, pilot, refine, and distribute. The student will also gain experience with IRB protocol writing, and data analysis of the survey results. The project results will be submitted to local, regional, and national meetings, with the goal of publication in a peer-reviewed journal.

Entry Date: November 22, 2019

Project Title:Improving Patient Satisfaction and Patient-Centered Care in the Children’s Hospital

Faculty Mentor’s Name:Dr. Moiz Mustafa
Phone:352-273-8825
Email:moiz.mustafa@surgery.ufl.edu

Research Project Description:

Patient satisfaction and patient-centered care are increasingly being emphasized and scrutinized in health care.

Interested students will have the opportunity to work on topics and projects related to patient satisfaction and patient-centered care. One specific area for improvement focuses on physician and nursing communication with patients. This project will seek to 1) investigate perceptions of current communication methods from the perspective of both patients and health care providers, 2) propose, develop, and implement patient-centered techniques for communication, and 3) analyze and critique the implemented communication tools and techniques. Students interested in patient advocacy as well as improving health care delivery should apply.

Students will have the opportunity to develop the project concept and design, as well as presentation of results. The goal for individual accomplishment for the student would be the production of an abstract for presentation at a meeting and manuscript for ultimate publication.

Entry Date: December 2, 2019

Project Title:Pediatric Quality and Patient Safety Improvement

Faculty Mentor’s Name:Dr. Moiz Mustafa
Phone:352-273-8825
Email:moiz.mustafa@surgery.ufl.edu

Research Project Description:

Quality and Patient Safety are burgeoning topics in health care.

Students interested in pursuing these areas of research are invited to join in quality improvement and patient safety efforts in the Division of Pediatric Surgery and within the Children’s Hospital. Research topics are broad and student input and ideas are encouraged. Potential areas for study and implementation include 1) antibiotic stewardship in surgical patients 2) improved efficiency and throughput of surgical care to decrease lengths of stay and readmission rates 3) improved efficiency of surgical care with standardization to decreases costs of care and burden on the health care system, specifically operative costs and OR efficiency 4) improved interdisciplinary communication and coordination of care for maximal patient benefit and increased satisfaction within the health care system for patients and providers.

Students will have the opportunity to develop the project concept and design, as well as presentation of results. The goal for individual accomplishment for the student would be the production of an abstract for presentation at a meeting and manuscript for ultimate publication.

Entry Date: December 2, 2019

Project Title:Evaluation of Risk Factors for Postoperative Outcomes in Thoracic Aortic Disease

Faculty Mentor’s Name:Dr. George Arnaoutakis
Phone:352 273 5508
Email:george.arnaoutakis@surgery.ufl.edu

Research Project Description:

This clinical project will involve studying the robust aortic disease center database here at UF, identifying risk factors for poor outcomes following aortic dissection or aneurysm repair. The project will also offer the opportunity for student(s) to observe open heart surgery and shadow in busy clinic seeing preoperative and postoperative evaluation.

Entry Date: September 20, 2019

Project Title: Molecular determinants of ethnic disparities in non-alcoholic fatty liver disease

Faculty Mentor’s Name:Dr. Ali Zarrinpar
Phone:(352) 594-4111
Email: Ali.Zarrinpar@surgery.ufl.edu

Research Project Description:

Non-alcoholic fatty liver disease (NAFLD/NASH) is an alarming public health problem with no FDA approved drug treatment, huge economic burdens and wide ethnic disparities. Hispanics have disproportionately higher rates of NAFLD than non-Hispanic whites and African Americans. Our group is focused on uncovering the cellular and molecular determinants of this health disparity. We have recent data demonstrating that the expression of CIDEC and CEACAM1, two key proteins in adipose tissue lipolysis and hepatic insulin clearance, is reduced in Hispanic individuals. The hypothesis of this NIH-NIMHD funded study is that the low expression levels of these molecules in Hispanics is associated with a higher efflux of adipose tissue free fatty acids and an increased hepatic de-novo lipogenesis and steatosis.

The medical student will work with a multidisciplinary team to retrieve visceral fat and liver biopsies from Hispanic, non-Hispanic White and African American patients undergoing liver or bariatric surgery. They will determine CIDEC and CEACAM expression in these samples, as well as isolate and culture primary human adipocytes and primary human hepatocytes for gain and loss of function studies that will ultimately elucidate the impact of adipocyte-specific CIDEC in the regulation of hepatic CEACAM1 and steatosis. The student will gain important experience with basic science laboratory techniques, including cell culture, qPCR, immunohistochemistry, histology and scientific literature review. He/she will develop critical insight into experimental design in translational research.

Entry Date: December 16, 2019

Project Title: Phenotypic precision medicine to optimize combination therapy to treat liver cancer

Faculty Mentor’s Name:Dr. Ali Zarrinpar
Phone:(352) 594-4111
Email:Ali.Zarrinpar@surgery.ufl.edu

Research Project Description:

Multiple therapeutic drug combinations are often used to achieve effective and safe treatments for cancers. However, more often than not, these combinations are devised through trial and error, with many associated hurdles and risks. Most often dose escalation is used to determine the maximum-tolerated-dose for each drug, which is then employed in the combination. This approach fails to pinpoint drug-dose ratios that mediate optimal treatment outcomes.

To address this challenge, we have developed a computational approach termed Phenotypic Precision Medicine (PPM) to systematically pinpoint optimal treatment combinations. As a result, optimal combinations can be uncovered in a smaller number of tests, and the “bench-to-bedside” translation is simplified by re-optimizing at each stage of that translational development. The medical student participating in this study will help validate PPM combination therapies by testing their efficacy in a pre-clinical disease model of orthotopic hepatocellular carcinoma xenografts in mouse livers using cell lines and biopsies of patient tumors.

The student will gain valuable experience with multiple basic science laboratory techniques, including microsurgery and tumor implantation in mice, non-invasive tumor imaging methods, cell culture, protein and gene expression analysis, histology, microscopy and scientific literature review. He/she will also develop critical insight into experimental design in translational research.

Entry Date: December 16, 2019

Project Title: New Pediatric Trauma Center Effect on Established Pediatric Trauma Center

Faculty Mentor’s Name: Dr.Brian Yorkgitis
Phone: (904) 244-3416
Email: brian.yorkgitis2@jax.ufl.edu

Research Project Description:

With pediatric trauma volume, much lower than adult, a decrease even small, could result in decrease patient care experience for trauma team members. It has been shown that new trauma centers opening in the adult population negatively affects existing trauma center volumes including a decrease in number of severely injured trauma patients.
This retrospective, chart review project will examine the effect of a new pediatric trauma center on the total volume, procedures as well as degree of injury severity and ICU management of an existing pediatric trauma center.

We hypothesized that an existing trauma center will see less total volume and less severe trauma patients. This will have effect on the training of resident physicians as they will see a decreased total volume and severe trauma patients. This may also have an economic impact on an existing trauma center.
The PI of this study in in Jacksonville. The majority of the study can be completely remotely with minimal travel needed to Jacksonville.

Entry Date: December 17, 2019

Project Title: Pelvic Fracture Outcomes in the Elderly

Faculty Mentor’s Name: Dr. Alicia M. Mohr MD FACS FCCM
Phone: (973) 986-2632
Email: ALICIA.MOHR@SURGERY.UFL.EDU

Research Project Description:

Retrospective registry review of all patients admitted with pelvic fractures from January 2014 until December 2019. The purpose of this study is to describe the differences in demographics, injury pattern, transfusion needs, and outcome of pelvic fractures in older vs younger patients. We hypothesize that age would be an important discriminator in the outcomes of elderly patients with pelvic fractures. The medical student would lead this project, review charts and set up a database which should lead to abstract presentation and publication.

Entry Date: April 20, 2020

Project Title: Outcomes of aortobifemoral bypass with and without simultaneous visceral artery bypass

Faculty Mentor’s Name: Dr. Samir Shah
Phone: (352) 273-5484
Email: samir.shah@surgery.ufl.edu

Research Project Description:

Aortobifemoral bypass (ABF) is a complex operation used to treat extensive aortoiliac occlusive disease with or without associated aneurysmal degeneration. It is a high-risk operation. Patients sometimes also have accompanying clinically significant visceral occlusive disease (i.e. disease in the renal, celiac, or superior mesenteric arteries). This may manifest as uncontrolled hypertension or as mesenteric ischemia. Simultaneous bypass to one or more of these visceral vessels at the time of ABF has the advantage of addressing multiple problems but potentially at the cost of increasing risk of mortality and morbidity. It is unknown whether the outcomes of patients undergoing simultaneous visceral artery bypass at the time of ABF are similar to those undergoing ABF only, which is important for medical decision-making. We hypothesize that mortality will be similar between the two groups but there will be higher morbidity, operative time, and operative blood loss. We will examine this question with a retrospective analysis of cases performed at UF. The medical student will identify cases, review charts, extract data, and help with analysis. He will also be expected to synthesize the findings into a submission for presentation at a regional/national meeting and create a manuscript for publication.

Entry Date: May 8, 2020