Surgery 2022

Analysis of Social Media Patterns in Vascular Disease

Faculty Mentor’s Name: Dr. Scott Robinson
Email: scott.robinson@surgery.ufl.edu
Phone Number: (404) 788-5790
Project Category: Clinical
International Component or Travel: No

Research Project Description:

medical information to the public. Many topics relevant to vascular surgery are discussed on social media platforms, but a robust analysis of who is driving these conversations has yet to be performed. The objective of this project is to analyze the dissemination of information as it pertains to vascular disease over twitter. Using the Symplur platform (a robust healthcare twitter analytics service) we will analyze hashtags related to vascular pathologies such as peripheral arterial disease, venous disease, and abdominal aortic aneurysm. Specifically, we will analyze influencers (eg health care provider, patient, journalist, non-profit organization) and perform a content analysis of various twitter users. Additionally, we will use followerwonk (an additional twitter analytics platform) to identify top influencers in vascular surgery, cardiology, and interventional radiology to determine the relative impact of each specialty on individual social media topics. The medical student will be responsible for data collection and analysis, and preparation of one or more manuscripts for publication.

Urinary Extracellular Vesicle biomarkers for Early Detection and Treatment Response of Pancreatic Cancer

Faculty Mentor’s Name: Dr. Song Han
Email: songhan@ufl.edu
Phone Number: (352) 273-7758
Project Category: Translational
International Component or Travel: No

Research Project Description:

Pancreatic adenocarcinoma (PDAC) is one of the most aggressive and lethal cancers with only 9% 5-year survival, mostly due to the failure of detecting the disease at an early stage for surgery operation.

Extracellular vesicles (EVs) are small membrane-bound nano-particles that are released by all cells, including cancer. In the process of releasing EVs, cancer cells also wrap up small molecules (e.g. RNA, proteins, and metabolites) within the EVs. Such enriched EV-cargo molecules typically represent the pathological status of the cancer cells and express disease signatures. Cancer cells released EVs can also enter the circulation system and appear in blood and urine. These properties make them attractive as candidates for cancer biomarkers discovery.

The innovative strategy for PDAC biomarker discovery proposed here is to study the proteome and metabolome enclosed within patients’ urinary EVs (uEV). uEV as a completely noninvasive sample with concentrated and focused proteins and metabolites (less complex in comparison to plasma or serum) is a promising liquid biopsy newly discovered. The proposed proteomic and metabolic profiling will be performed using modern technology of mass spectrometry. Machine learning computational algorithm will be applied to calculate and define biomarkers (“classifiers”) of integrated proteins and metabolites with the ability of distinguishing PDAC patients from normal individuals and patients with benign pancreatic diseases.

The outcome of this study will broaden and deepen our current knowledge of EV cargo molecules packaging from cancer cells and more importantly, help to move a step further towards utilizing uEV liquid biopsy in clinical practice. Translationally, it will prepare us to develop more delicate diagnostic tool for PDAC detection by using completely noninvasive urine samples. Our long-term goal is to identify EV-enclosed molecules that are specifically and sensitively associated with PDAC and can serve as accurate biomarkers for early PDAC detection and assessment of treatment response, ultimately contributing to improve the patients’ survival.

Assessing the outcomes from Pediatric Burn Scar Laser Therapy

Faculty Mentor’s Name: Dr. Saleem Islam
Email: islam@ufl.edu
Phone Number: (352) 273-8825
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Hypertrophic or even keloid type scars are relatively common after burn injury, and can result in substantial morbidity and functional disability. This is especially problematic in children who are continuing to grow and have psychological issues in addition to the functional ones. Laser scar therapy has shown promise in both reducing the scar thickness and size, as well as allowing enhanced function of joints and other areas to maximize motion. In this project, we propose to study our cohort of children undergoing laser scar therapy to assess aesthetic and functional outcomes. Our hypothesis is that the use of laser therapy leads to a significant reduction in the scar and objectively improves function. We will use validated scar scores to analyze differences. There is no additional funding for this project that is required.

Predictors of venous thromboembolism following ventral hernia repair. Analysis of the Abdominal Core Health Quality Collaborative databse

Faculty Mentor’s Name: Dr. Mazen Al-Mansour
Email: mazen.al-mansour@surgery.ufl.edu
Phone Number: (352) 265-0761
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Background: Venous thromboembolism (VTE) is an uncommon but serious complication following ventral hernia repair (VHR). It is unclear if hernia-specific or procedure-specific factors significantly contribute to the risk of developing postoperative VTE following

Hypothesis: Hernia-specific and procedure-specific factors can predict VTE after VHR

Methods: Retrospective cohort study of patients who underwent VHR and included in the Abdominal Core Health Quality Collaborative (ACHQC). The patient will be stratified into those who developed postoperative VTE and those who did not. Propensity score matching will be performed to correct for confounding factors. Hernia-specific and procedure-specific factors will be compared between the two cohorts to assess their ability to predict postoperative VTE

Role of medical student: The student will be responsible to perform a literature search, write a study protocol, submit an IRB proposal, write and submit an abstract to a surgical meeting (e.g. SAGES, Americas Hernia Society), present at the surgical meeting if the abstract was accepted and write and submit a manuscript for publication.

Funding: no funding is needed for this project.

Mechanisms and therapeutic strategies of post-lung transplant injury and aortic aneurysms

Faculty Mentor’s Name: Dr. Ashish Sharma
Email: Ashish.Sharma@surgery.ufl.edu
Phone Number: (352) 294-8660
Project Category: Basic
International Component or Travel: No

Research Project Description:

My laboratory focuses on defining the molecular and signal transduction mechanisms of acute lung injury (i.e. ischemia-reperfusion injury or primary graft dysfunction) after lung transplantation as well as investigating the pathophysiology of aortic aneurysms. The main focus of our research is to decipher the contribution of myeloid-derived suppressor cells in acute lung injury and aneurysm formation, delineating the therapeutic potential of specialized proresolving lipid mediators in mitigating pulmonary and vascular inflammation, as well as to implement mesenchymal stem cell-derived extracellular vesicles as a therapeutic strategy in aortic aneurysms and primary graft dysfunction after lung transplantation.

Predictors of enterotomy following ventral hernia repair. Analysis of the Abdominal Core Health Quality Collaborative databse

Faculty Mentor’s Name: Dr. Mazen Al-Mansour
Email: mazen.al-mansour@surgery.ufl.edu
Phone Number: (352) 265-0761
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Background: Accidental enterotomy is a rather common and serious complication following ventral hernia repair (VHR) and was shown to be associated with worse surgical outcomes. The clinical predictors of this serious complications have been thoroughly investigated.

Hypothesis: Certain clinical factors can predict the likelihood of iatrogenic enterotomy during VHR

Methods: Retrospective cohort study of patients who underwent VHR and included in the Abdominal Core Health Quality Collaborative (ACHQC). The patient will be stratified into those who developed an iatrogenic enterotomy and those who did not. Propensity score matching will be performed to correct for confounding factors. Clinical factors will be compared between the two cohorts to assess their ability to predict iatrogenic enterotomy

Role of medical student: The student will be responsible to perform a literature search, write a study protocol, submit an IRB proposal, write and submit an abstract to a surgical meeting (e.g. SAGES, Americas Hernia Society), present at the surgical meeting if the abstract was accepted and write and submit a manuscript for publication.

Funding: no funding is needed for this project.

Usability and clinical implementation of automated, perioperative decision-support

Faculty Mentor’s Name: Dr. Tyler Loftus
Email: tyler.loftus@surgery.ufl.edu
Phone Number: (864) 888-7404
Project Category: Translational
International Component or Travel: No

Research Project Description:

This project will assess the efficacy of teaming patients and surgeons in shared decision-making for prehabilitation though a mobile application. Preoperative risk assessments promote patient engagement in shared decision-making and prehabilitation, but time-consuming manual data entry requirements impair their clinical implementation. Our working hypothesis is that teaming patients and surgeons in shared decision-making for prehabilitation though a mobile application will be associated with increased patient satisfaction regarding the patient-surgeon relationship, greater participation in prehabilitation, and increased value of care. We will deploy mobile device applications embedded with a validated surgical risk assessment platform to provide prognostic information and recommend prehabilitation activities for major elective surgery patients.

The medical student would conduct usability testing of the mobile application and participate in the interpretation and presentation of results as an author on all related manuscripts.

The mobile application is funded by an R01 that is under review for renewal.

Relevant publications:

Bihorac A, Ozrazgat-Baslanti T, Ebadi A, Motaei A, Madkour M, Pardalos PM, Lipori G, Hogan WR, Efron PA, Moore F, Moldawer LL, Wang DZ, Hobson CE, Rashidi P, Li X, Momcilovic P. MySurgeryRisk: Development and Validation of a Machine-learning Risk Algorithm for Major Complications and Death After Surgery. Ann Surg. 2019 Apr;269(4):652-662. doi: 10.1097/SLA.0000000000002706. PMID: 29489489; PMCID: PMC6110979.
Brennan M, Puri S, Ozrazgat-Baslanti T, Feng Z, Ruppert M, Hashemighouchani H, Momcilovic P, Li X, Wang DZ, Bihorac A. Comparing clinical judgment with the MySurgeryRisk algorithm for preoperative risk assessment: A pilot usability study. Surgery. 2019 May;165(5):1035-1045. doi: 10.1016/j.surg.2019.01.002. Epub 2019 Feb 18. PMID: 30792011; PMCID: PMC6502657.
Loftus TJ, Ruppert MM, Ozrazgat-Baslanti T, Balch JA, Efron PA, Tighe PJ, Hogan WR, Rashidi P, Upchurch GR Jr, Bihorac A. Association of Postoperative Undertriage to Hospital Wards With Mortality and Morbidity. JAMA Netw Open. 2021 Nov 1;4(11):e2131669. doi: 10.1001/jamanetworkopen.2021.31669. PMID: 34757412; PMCID: PMC8581722.

“Barking Dogs Don’t Bite” – Outcomes from Animal Mauling and Bites in Children

Faculty Mentor’s Name: Dr. Saleem Islam
Email: islam@ufl.edu
Phone Number: (352) 273-8825
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Animal bites or mailings are not very common in children, however they may result in devastating consequences. The purpose of this project is to assess the outcomes from this trauma in children at UFHealth and analyze the patterns of injury as well as recommend appropriate treatment strategies.

Is a Blinded Trial of temporary Gastric Stimulation Better at assessing Long term response?

Faculty Mentor’s Name: Dr. Saleem Islam
Email: islam@ufl.edu
Phone Number: (352) 273-8825
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Gastric Electrical Stimulation (GES) is a novel therapy for patients with intractable nausea and vomiting as well as gastroparesis, however the long term outcomes in cases without a trial has been disappointing. We have the largest series of GES application in children in the world at UFHealth, and in the past three years switched the temporary trial to a blinded one to try and improve patient selection. This study will analyze this experience and see if blinding has been useful.

Understanding the Evolution of Research in Pediatric Surgery in North America

Faculty Mentor’s Name: Dr. Saleem Islam
Email: islam@ufl.edu
Phone Number: (352) 273-8825
Project Category: Literature Review
International Component or Travel: No

Research Project Description:

Research is critical for the improvement in patient care and the progression of understanding diseases and pathology. However, resources and opportunities play a large role in the ability to conduct systematic studies. Our hypothesis is that research in pediatric surgery has changed from basic science to more clinical, and that existing basic science / experimental studies are being performed at a small number of institutions. These data will be very important in understanding the environment and direct future efforts.

We will systematically study the output of pediatric surgeons using their NCBI profiles and publications as well as federally funded projects and compile them in a database which will be used to have multiple presentations and at least two publications.

The Role of Selenium and Selenoproteins in Erythropoiesis following Trauma

Faculty Mentor’s Name: Dr. Alicia Mohr
Email: alicia.mohr@surgery.ufl.edu
Phone Number: (352) 273-5670
Project Category: Basic
International Component or Travel: No

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 that trauma and critical illness create a prolonged adrenergic and inflammatory milieu that alters the interaction between developing erythroblasts and the central macrophage in the final stages of erythropoiesis contributing to impaired iron function and the persistence of anemia. This research is supported by the NIH-NIGMS.

The medical student will determine the role of selenium and selenoproteins in the persistence of injury-associated anemia. As efficient ROS scavengers, the role of selenoproteins in maintaining redox homeostasis in erythrocytes and erythropoiesis is expected to be critical. In fact, selenium appears to play a significant role in pathological erythropoiesis. These studies will be conducted in Sprague Dawley rats that have undergone our polytrauma model followed by either sevens days of restraint stress. In addition to these basic science studies, analysis of human trauma samples can provide the framework for translation to the bedside. The medical student will begin an understanding of reviewing scientific literature and learn basic science laboratory techniques. He/she will develop insight on how basic science research can be applied in the clinical arena.

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

Apple CG, Miller ES, Kannan KB, Stortz JA, Cox M, Loftus TJ, Parvataneni HK, Patrick M, Hagen JE, Brakenridge S, Efron PA, Mohr AM. (2020). Vitamin D status is associated with hepcidin and hemoglobin concentratoins in patients with severe traumatic injury. J Trauma Acute Care Surg epub Jul 28. PMID:32769953

Analysis of Extracellular Matrix Remodeling in Pathogenesis of Vascular Disease

Faculty Mentor’s Name: Dr. Scott Berceli
Email: bercesa@surgery.ufl.edu
Phone Number: (352) 548-6470
Project Category: Basic
International Component or Travel: No

Research Project Description:

Pathologic extracellular matrix (ECM) remodeling is implicated in a variety of vascular pathologies. Aortic dilatation during abdominal aneurysm formation is a result of degradation of elastin and collagen in the artery wall. Progression of atherosclerosis involves active remodeling of the ECM, with high rates of collagen turnover potentially leading to plaque instability and rupture. Peripheral arterial disease also induces significant remodeling of distal ischemic tissue beds, resulting in progressive skeletal muscle fibrosis. Recent advances in molecular biology have enabled interrogation of tissues to detect focal sites of ECM turnover. Collagen hybridizing peptide (CHP) is highly specific probe that binds to unfolded collagen chains, allowing for targeting of tissues undergoing ECM turnover.

The objective of this project is to utilize CHP in understanding ECM turnover and its contributions to vascular disease. This objective will be achieved using the following specific aims:

Aim 1: Assess ECM turnover in skeletal muscle after induction of ischemia.
Aim 2: Characterize collagen degradation in aortic tissue during aneurysm formation.

The medical student will develop immunofluorescence and immunohistochemistry protocols for staining mouse and human tissues with CHP and other ECM markers. Additionally, the student will compare CHP levels in tissue homogenates and circulating blood samples.

This project will be Co-supervised by Dr. Scott Robinson.

Validation of Chest Imaging in Pediatric Trauma

Faculty Mentor’s Name: Dr. Brian Yorkgitis
Email: brian.yorkgitis2@jax.ufl.edu
Phone Number: (904) 244-3416
Project Category: Clinical
International Component or Travel: No

Research Project Description:

This project will involve a retrospective chart review of pediatric trauma patients examining the utilization of chest CT. Using work by Stephens et al J Pediatr Surg 2017, this decision tool will be applied to pediatric trauma patients to validate the tool. The work will involve chart review that can be done remotely with EPIC access. Zoom or in person (Jacksonville) meetings will be used to facilitate the student’s research knowledge and guide the project.
Background: Efforts to identify pediatric trauma patients in need of advance imaging using ionizing radiation include clinical decision tools. This help minimize radiation exposure to pediatric patients to prevent long term sequelae from this exposure. Chest imaging guidelines have been proposed but lack validation externally, particularly at a mixed adult and pediatric trauma center.
Hypothesis: Application of the previously described rule chest CT in pediatric patient will perform well in our population to identify those children needing CT to alter patient course.
Methods: Retrospective chart review
Funding: none
Relevant publications: Stephens CQ, J Pediatr Surg 2017; Moore MA, Radiologic Clinics 2011; Moll EM, Pediatr Emerg Care 2020

Decision Regret in Patients Undergoing Vascular Surgery

Faculty Mentor’s Name: Dr. Samir Shah
Email: samir.shah@surgery.ufl.edu
Phone Number: (352) 273-5484
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Background

Patients facing elective vascular surgery frequently choose between options with substantially different tradeoffs. For example, patients with lower extremity peripheral arterial disease may be choosing between surgical bypass, minimally invasive endovascular treatment, or symptom control without procedures. These have different profiles of complications, durability of symptom resolution, and expected recovery. Decisions can lead to regret because of, for example, the belief that an alternative choice would have led to a better outcome.

Understanding postoperative decision regret (DR) is important for two reasons. First, decision-making may be heavily influenced by the desire to avoid regret. Second, DR may be a useful patient-centered outcome. As such, we seek to understand DR and its connection to patient- and clinical features including postoperative complications, health literacy, decisional conflict, and surgery type.

Hypothesis

We hypothesize that 1) there will be moderate levels of DR among patients undergoing elective surgery for aortic aneurysms, dialysis access, and lower extremity arterial disease, 2) patients with open surgery will have higher levels of regret compared to those undergoing endovascular surgery, and 3) patients with higher levels of decisional conflict and those who had complications will have more DR.

Methods

Patients who have undergone elective procedures for aortic aneurysm, lower extremity peripheral arterial disease, dialysis access, and cerebrovascular disease will be identified using the division of vascular surgery’s database and the UF integrated data repository. We will extract appropriate patient and procedural characteristics from the chart. We will contact patients within 1 year of surgery during a clinic visit or via telephone to administer validated instruments measuring DR, decisional conflict, and other variables of interest.

Role

The student would work with patients to administer instruments to measure decision regret, shared-decision making, etc. The expectation would be to collect data and help analyze the data, which should be completed during the summer. I expect the student to present the data at a regional or national meeting and publish in a peer-reviewed journal under my mentorship.

Funding

Any funds needed for data collection/analysis will be provided.

Relevant Publications

Brehaut JC, O’Connor AM, Wood TJ, Hack TF, Siminoff L, Gordon E, Feldman-Stewart D. Validation of a decision regret scale. Med Decis Making. 2003 Jul-Aug;23(4):281-92. doi: 10.1177/0272989X03256005. PMID: 12926578.

Wilson A, Ronnekleiv-Kelly SM, Pawlik TM. Regret in Surgical Decision Making: A Systematic Review of Patient and Physician Perspectives. World J Surg. 2017 Jun;41(6):1454-1465. doi: 10.1007/s00268-017-3895-9. PMID: 28243695.

Becerra Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and Predictors of Decision Regret about Health Care Decisions: A Systematic Review. Med Decis Making. 2016 Aug;36(6):777-90. doi: 10.1177/0272989X16636113. Epub 2016 Mar 14. PMID: 26975351.

Center Specific Determinants of Quality in Abdominal Organ Transplantation

Faculty Mentor’s Name: Dr. Ali Zarrinpar
Email: ali.zarrinpar@surgery.ufl.edu
Phone Number: (352) 265-0606
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Solid organ transplantation has made tremendous strides in the last fifty years in both patient and graft survival. Transplantation has become standard of care in the treatment of end stage organ disease. At least partly due to the fact that grafts constitute a limited, national resource, center-specific outcomes are highly monitored and made publicly available by the federal government. In this manner, centers are not merely held to a baseline standard, but rather, they are compared to all other centers every year. We propose to review outcomes at transplant centers in the US and investigate factors that are correlated with graft and patient survival and waitlist mortality.

Genetic Determinants of Immunosuppression Dose and Drug Level Stability After Liver Transplantation

Faculty Mentor’s Name: Dr. Ali Zarrinpar
Email: ali.zarrinpar@surgery.ufl.edu
Phone Number: (352) 265-0606
Project Category: Translational
International Component or Travel: No

Research Project Description:

Dosing immunosuppression after solid organ transplantation is highly dependent on a wide number of factors, including the genetic variability in both donor and recipient organs. We have obtained genotypes of ~60 donor-recipient pairs after liver transplantation and monitored the dose and drug level stability in the recipients. The question is how the pharmacogenomics of donors and recipients affect our ability to reach and maintain adequate immunosuppression dosing in these patients.