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Spring 2013 | The Medical I.B.I.S.

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From our Dean

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s Dean of a medical school devoted to providing excellence in education and expanding medical knowledge through research, I am proud to introduce The Medical I.B.I.S., the Miller School of Medicine’s first student-produced publication showcasing how our talented students are advancing medical knowledge through research. There is no more important mission than finding answers for patients who depend on us for new knowledge that leads to medical breakthroughs, both now and in the future, which makes the commitment of so many students to making research an essential element of their education worth applauding. Their interest in improving the lives of people with, for example, colorectal cancer, metabolism disorders, Crohn’s disease or blindness by exploring unanswered questions speaks volumes about the kind of physicians they will be, and the kind of mentors they have found at the Miller School. Research is not only a conduit for life-enhancing treatments; it also can be, as the students highlight in The Medical I.B.I.S., a path to one’s calling. Congratulations to them, and to the student editors, contributors and visionaries who conceived a magazine dedicated to showcasing the Investigation of Basic and Integrative Science by Miller School students.

Pascal J. Goldschmidt, M.D. Senior Vice President for Medical Affairs and Dean University of Miami Miller School of Medicine CEO, University of Miami Health System 2

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From our Editors

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e are proud to present to you the first issue of The Medical I.B.I.S., a publication of the Executive Student Government produced entirely by medical students under guidance of exceptional faculty. The purpose of this publication is to highlight the innovative research efforts of University of Miami Miller School of Medicine students. From basic medical science to clinical studies, this edition features a plethora of cutting-edge, independent research projects. Furthermore, this issue features articles on how to go about doing research as a medical student here at the Miller School as well as information on extramural research opportunities. Selected through an internal peer review process, these featured projects are just a few among numerous outstanding medical student endeavors. In our articles, we highlight the passions, struggles, and triumphs of these students. We encourage our fellow students to keep following their dreams, to think outside the box, and to become future leaders in medical innovation.

Melissa D. Stone Nisha V. Shah Co-Editor-in-Chief Co-Editor-in-Chief sg.mededu.miami.edu/medicalibis

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CAMPUS

university of miami’s medical student research publication

RESEARCHER PROFILES ANTHONY D’ANDREA 8 Determinants of Physical Inactivity in Colorectal Cancer Survivors HONGZHAO JI 10 Increased Skeletal Muscle Volume in Women with Familial Partial Lipodystrophy, Dunnigan Variety SAPIR KARLI 11 Photoreceptor Survival and Tissue Remodeling in Retinal Degeneration KHADIL HOSEIN 12 Fetal Cell Transplants as a Treatment for Severe Chronic Penetrating Ballistic Brain Injury RYAN DAUER 13 Infliximab Re-induction Outcomes After Treatment Failure in Inflammatory Bowel Disease Patients DAVID PECHMAN Pupillometry in Trauma

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STEPHEN BURKS 16 Timeline of Neuronal and Astrocytic Cell Death Following Craniotomy for Acute Subdural Hematoma

CHRISTOPHER RIENAS 20 Epigenetic Regulation of Alcohol Seeking Behavior VINCENT VENINCASA Cataract Surgery and Tears

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PUNAM PARIKH 23 Gender Variability of Fine Needle Aspiration Reliability RYAN MCCORMACK 24 Killing of Intracellular Pathogenic Bacteria by a Pore Forming Protein, Perforin-2: A New Paradigm of Innate Immunity SAMANTHA BLOCK 26 Double Blind Placebo Controlled Study Assessing the Effect of Chocolate Consumption in Subjects with a History of Acne Vulgaris PAUL MCMAHON 27 Post Concussive Symptoms and Outcome Following Mild Traumatic Brain Injury FRANK KUO 28 Traditional Cardiovascular Risk Factors Explain Only a Small Portion of Variation in Carotid Plaque

KIRAN SETHI 18 Access to Pediatric Trauma Centers Improves Survival 4

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FEATURES

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ABOUT THE STAFF Learn about the students and faculty who created The Medical I.B.I.S. RESEARCH AT UM Advice from the editors about how to go about finding research opportunities at the Miller School

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RESEARCH OUTSIDE UM 32 Advice from the editors about how to go about finding research opportunities outside the Miller School

ACKNOWLEDGEMENTS EASTERN-ATLANTIC STUDENT RESEARCH FORUM

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ETHAN YANG PHOTOGRAPHY

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COVER

Designed by Emmanuel Berchmans. From left, Christopher Rienas performs a Western blot; David Pechman uses a pupillometer in Ryder Trauma Center; Shelby Burks holds a spine model; and Kiran Sethi assists in an operation in the Dominican Republic.

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Spring 2013 | The Medical I.B.I.S.

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Meet the Editors

CAMPUS

Vol. 1

Issue 1

Spring 2013

Editors-In-Chief Melissa D. Stone Nisha V. Shah Managing Editors Ashley Lawler Matthew Phillips Faculty Advisor Antonio C. Bianco, M.D., Ph.D. Advisory Board Pascal J. Goldschmidt, M.D. Alex J. Mechaber, M.D. Kartik S. Telukuntla Emmanuel Berchmans Photography Ethan Yang Production & Design Nisha V. Shah Melissa D. Stone Emmanuel Berchmans Maya Bell

The Medical I.B.I.S. is published by the University of Miami Miller School of Medicine Executive Student Government. We reserve the right to edit any submissions, solicited or unsolicted, for publication. This magazine is the work of University of Miami medical students, and the University of Miami is not responsible for its contents. Perspectives expressed by authors do not necessarily reflect the opinions of the University of Miami. We retain the right to reprint contributions, both text and graphics, in future issues as well as a non-exclusive right to reproduce these in electronic form. The Medical I.B.I.S. welcomes comments and feedback. Please send questions and comments to medical.ibis@gmail.com.

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Nisha Shah is a fourth-year medical student currently serving as co-Editor-in-Chief of The Medical I.B.I.S. As a 2011-2012 Research Fellow at Bascom Palmer Eye Institute, Nisha’s projects ranged from exploring the role of local chemotherapy agents for treating retinoblastoma in mice to being involved in a prospective randomized trial comparing anesthetic agents in patients receiving LASIK. Nisha also studied the earlier detection and treatment of radiation-induced retinopathy. She was awarded the Fight for Sight and Melanoma Research Foundation student grants for her translational and clinical research and has published in peer reviewed medical journals. With an interest in photojournalism and design, Nisha served as an Editor of the 2011-2012 Miller School yearbook, The Synapse. She plans to integrate research into her future career in ophthalmology.

Melissa Stone is a second-year medical student currently serving as co-Editor-in-Chief of The Medical I.B.I.S. As an undergraduate, Melissa performed research on characterizing ancillary nonstructural proteins in parvoviruses and before starting medical school, she served as a clinical research coordinator for Phase III clinical trials involving the treatment of recurrent herpes labilais. Presently, Melissa is performing history of medicine research on autism diagnosis from 1943 to 1980. In college, Melissa served as the Editor-in-Chief for the Yale Scientific Magazine and is presently a writing editor for the Miller School’s Humanities in Medicine Journal. Melissa plans on pursuing a career in pediatrics and hopes to embrace medicine through the written word as a medical writer.

Matthew Phillips is a second-year medical student in the M.D./Ph.D. program and will be pursuing graduate work in microbiology at the conclusion of this year. He is currently serving as a Managing Editor for The Medical I.B.I.S. His research ties together aspects of marine biology and human health, focusing primarily on coastal pathogens and environmental microbiology. Matthew has multiple peer reviewed publications and has presented oral and poster presentations at conferences through the international level. He is currently the seated chair of the 2014 Gordon Research Seminar in Oceans and Human Health. Presently, Matthew’s research focuses on identifying sources and classifying human strains of MRSA in marine mammals such as pilot whales. Matthew plans on staying in academic medicine, pursuing a career clinically in infectious disease while simultaneously running a lab focusing on oceans and human health research.

Ashley Lawler is a third-year medical student currently serving as Managing Editor of The Medical I.B.I.S. As an undergraduate, Ashley performed research on endocrine disruption and the effects of hormone-mimicking contaminants in the American alligator. In 2010, she worked with the Foundation for Anesthesia Education and Research, studying behavioral predictors of emergence delirium in pediatric patients. In 2012, she served as an HHMI-NIH Research Scholar in the Cloister Program, studying pharmacogenomics of ovarian cancer cell chemotherapy resistance. Ashley also has a passion for writing, having received a Bachelor of Arts in English from the University of Florida, and is currently working on a project correlating poetry with heart sounds. Ashley plans to pursue a career in academic medicine and basic research.

Antonio C. Bianco, M.D., Ph.D., is a professor of medicine and Chief of the Division of Endocrinology, Diabetes and Metabolism at the University of Miami Miller School of Medicine. and serves as the faculty advisor for The Medical I.B.I.S. Dr. Bianco obtained his M.D., Ph.D. and clinical training in internal medicine and endocrinology in Sao Paulo, Brazil. His work has established the importance of the local control of thyroid hormone action via deiodination, as well as fundamental cellular and molecular properties of the deiodinases (D1, D2 and D3). He has also obtained insights into the three-dimensional structure of the deiodinase-ubiquitination complex, demonstrating that ubiquidation-deubiquidation constitutes a posttranslational on/off switch controlling thyroid hormone action in the settings of development, health and disease. sg.mededu.miami.edu/medicalibis

Spring 2013 | The Medical I.B.I.S.

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Determinants of Physical Inactivity in Colorectal Cancer Survivors CAMPUS

by melissa stone

Anthony presenting his project at the American Public Health Association’s 140th Annual Meeting & Expo in San Francisco last October. Image courtesy of Anthony D’Andrea. 8

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efore starting medical school, Anthony D’Andrea spent a year conducting research, analyzing minimally invasive surgical techniques for the treatment of advanced colorectal surgical disease. He was impressed by the innovative treatments for colorectal cancer that, not only would eliminate the cancer, but could also return cancer

amazed to learn that my “I was

research showed that

smoking and obesity were not predictive of physical activity in colorectal cancer survivors.”

survivors back to their normal quality of life without a colostomy bag and without problems of incontinence. As a student in the combined medical degree and master of public health program at the University of Miami, Anthony sought to combine that interest in state-of-theart medicine with public health. Despite lower mortality rates from colorectal cancer due to better screening and treatment modalities, Anthony believes that colorectal cancer continues to be a public health issue. The population of survivors is growing and living longer. Therefore, more research needs to be

done on how to optimize their quality of life. Anthony comes from a bi-racial background and is the first in his family to attend college, so he was interested to see how sociodemographic parameters such as race and ethnicity may influence quality of life in colorectal cancer survivors. He started working with David Lee, Ph.D. and his team at UM’s Department of Epidemiology and Public Health to analyze the determinants of physical inactivity in colorectal cancer survivors. According to Anthony, “I came in knowing basic statistics and public health principles, but working with Dr. Lee and his research group, I found myself applying the concepts learned from my courses in medicine and public health. Also, it was very important to have a good team with a good mentor when conducting this research - people who are willing to teach. I am very fortunate to have that.” For this project, Anthony took information from the National Health Interview Survey (a federal survey representative of the entire United States population) to identify 2,378 people who self-reported a previous diagnosis of colorectal cancer. Anthony and his team performed multivariable analyses to identify demographic and behavioral predictors of leisure-time physical activity in colorectal cancer survivors. He found that women, the elderly (>70 years), minorities (Hispanics, blacks), and the less educated (< high school education) were less likely to comply with leisure time physical activity recommendations. And interestingly, he found that heavy drinkers were more likely to be physically active than light and moderate drinkers. In particular, Anthony was surprised to find that smoking and obesity were not predictive of physical activity. Anthony is currently writing a research manuscript, for which he will be first author. He hopes that this research will further knowledge in improving quality of life for colorectal cancer survivors, and plans on using this research experience in his future career, possibly in gastroenterology or colorectal surgery.

Anthony Park D’Andrea Degree Program: M.D./M.P.H. Expected Graduation: 2015 Honors: presented at the American Public Health Association 140th Annual Meeting & Expo in San Francisco, October 2012 Mentor: David J. Lee, Ph.D. Other Interests: Student Government M.D./M.P.H. Liaison, Co-Coordinator M.D./M.P.H. Gross Anatomy Course, M.D./M.P.H. Intern at the Miami-Dade County Health Department Future Goals: public health, gastroenterology or colorectal surgery sg.mededu.miami.edu/medicalibis

Spring 2013 | The Medical I.B.I.S.

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Increased Skeletal Muscle Volume in Women with Familial Partial Lipodystrophy, Dunnigan Variety CAMPUS

by ashley lawler

Hongzhao at his lab bench. Image courtesy of Hongzhao Ji.

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ongzhao “Joe” Ji, Class of 2014, decided to take a research year after his second year of medical school to dedicate more time to his goal of entering academic medicine. He participated in the Doris Duke Charitable Foundation Clinical Research Fellowship Program, and chose to work in the laboratory of Abhimanyu Garg, M.D. at UT Southwestern Medical Center in Dallas, Texas.

“This year has been an invaluable experience for my future career in academics.” Bolstered by his interest in disorders of metabolism and obesity, Joe studied a disorder called Familial Partial Lipodystrophy, of Dunnigan variety (FPLD). This disorder, due to a mutation in the LMNA gene, manifests as a loss of subcutaneous fat in the majority of the body. It is also accompanied by diabetes and high levels of circulat10

The Medical I.B.I.S. | Spring 2013

ing triglycerides and cholesterol. While it is known that FPLD causes loss of fat, it has been questionable whether the seemingly increased muscle size represents an actual increase in muscle mass, or simply appears that way due to the fat loss. Joe gathered a number of women with FPLD and took MRI scans of their entire bodies. Using these scans, he and his collaborators analyzed the cross sections of certain segments of their bodies, combining multiple cross sections to produce a muscle volume, and compared them to body mass index and age-matched women without the disease. A Dual X-ray Absorptiometry Scan was also performed on all of the women. This test works by passing x-rays of two wavelengths through the body to determine fat, muscle, and bone mass. This test gives an estimate of the amount of muscle mass in a certain area of the body. The outcomes of the study are still awaiting publication, however, the investigators believe that the results will serve to further characterize the disorder of FPLD and its effects on skeletal muscles. They also hope the results will lead to new questions regarding the involvement of skeletal muscle in other disorders of metabolism. Joe’s personal favorite part of this project involved developing a technique for analyzing and calculating muscle volume, based on cross-sectional areas from multiple MRI slices. He believes that his research year as a Doris Duke fellow provided him “invaluable experience for his future career in academics.”

Hongzhao Ji Degree Program: M.D. Expected Graduation: 2014 Honors: presented at the World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease; research conducted under the Doris Duke Clinical Research Fellowship Mentor: Abhimanyu Garg, M.D. Other Interests: health policy, cycling, SPARK Future Goals: academic medicine sg.mededu.miami.edu/medicalibis


Photoreceptor Survival and Tissue Remodeling in Retinal Degeneration

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By Nisha Shah

he retina is a thin multi-layer tissue at the back of the eye that is essential for vision. Degenerative diseases of the retina, such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD), may impair vision and lead to blindness. Damage of photoreceptors (the light-sensing cells) and pathologic remodeling are major findings in degenerated retinas. This remodeling is a major obstacle to current therapeutic treatments. The focus of Sapir Karli’s project, conducted at the McKnight Vision Research Center under the mentorship of Abigail Hackam, Ph.D., is to explore the Wnt signaling pathway, a critical intercellular communication pathway involved in neuroprotection. Sapir used a mouse model of retinal degeneration to examine the role of Wnt signaling in both photoreceptor protection and remodeling, and whether activating or inhibiting the Wnt signaling pathway altered photoreceptor death and remodeling. Her findings indicated that activation of the Wnt signaling pathway may provide neuroprotection by reducing photoreceptor death and remodeling. “To me the most exciting aspect of conducting research is to find results that have some clinical meaning. Know-

“This experience is

teaching me some of the therapeutic obstacles the field is

facing, the process it takes to overcome those obstacles, and the amazing benefits that come out of collaborative

work.”

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Sapir at her lab. Image courtesy of Sapir Karli. ing that your conclusions offer a step in the process to finding clinical therapies is priceless,” says Sapir. By decreasing photoreceptor death and the pathologic remodeling that cause vsion loss in retinal degeneration, these findings may contribute to therapies for retinal degeneration. Many medical students find their calling after performing research in a field they’re passionate about. “Ophthalmology is a career option for me, so doing research in the field has enabled me to experience it in a non-clinical setting, seeing it from a different point of view,” she says. Sapir will be presenting her project at this year’s EasternAtlantic Student Research Forum.

Sapir Karli Degree Program: M.D. Expected Graduation: 2015 Honors: presented at ESRF 2013 Mentor: Abigail Hackam, Ph.D. Other Interests: traveling, spending time with family and friends Future Goals: undecided Spring 2013 | The Medical I.B.I.S.

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Fetal Cell Transplants as a Treatment for Severe Chronic Penetrating Ballistic Brain Injury CAMPUS

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by ashley lawler

hadil Hosein, Class of 2014, has been preparing for his career in neurosurgery by starting out small—on rat brains. Part of his current research project has involved “emulating the operating room atmosphere, albeit on a much smaller scale,” by performing delicate surgeries transplanting neural precursor cells (NPCs) into injured rat brains.

“It is a privilege to be involved in the beginnings of

breakthrough treatment.”

this

The work uses a chronic penetrating ballistic brain injury rat model, akin to a human cranial gun-shot or foreign object penetrating injury. The aim of the study was to uncover if a special synthetic growth factor available at the The Miami Project to Cure Paralysis was sufficient to keep transplanted cells alive in injured rat brains. The

injured rats were then divided into four groups—one group that received no stem cell transplant and thus served as a control, and three groups that received NPCs genetically modified to produce green fluorescent protein and secrete a synthetic neurotrophic factor: multineurotrophin. The genetically modified cells were stereotactically injected into the penumbra, or area surrounding the brain injury. The rats recovered from the surgery and were allowed to rest. Rats were sacrificed at 1, 6, and 8 weeks post-transplantation to determine how long cells survived. Using standard histology and microscopy, Khadil could see a robust graft even after 8 weeks of transplantation. The cellular processes extended to the injury site, about 3 millimeters. Most of the cells had differentiated into neurons as they expressed neuronal markers. Khadil was personally interested in this project because of the potential of repairing the injured brain with cells. Such work has been very challenging in the past and remains uncharted territory. He believes strongly that this is “the future direction of treatment for chronic traumatic brain injury,” and feels privileged to be working on this project. He presented his work as an oral presentation at ESRF this year.

Khadil Hosein Degree Program: M.D. Expected Graduation: 2014 Honors: oral presentation at ESRF 2013, poster at the Miller School’s 21st annual Neuroscience Research Day Mentor: Ross Bullock, M.D., Ph.D. Other Interests: intramural and club soccer, Christian Medical Association, Student National Medical Association Future Goals: neurosurgery

Khadil in the Bullock lab. Image courtesy of Khadil Hosein. 12

The Medical I.B.I.S. | Spring 2013

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Infliximab Re-induction Outcomes After Treatment Failure in Inflammatory Bowel Disease Patients BY Matthew Phillips

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he diagnosis of Crohn’s disease, or ulcerative colitis, is a life-changing experience. No one knows this better than Ryan Dauer, who was diagnosed with Crohn’s disease in 2005. While 1.4 million people are currently living with inflammatory bowel disease (IBD) in the United States, very few (if any) take Ryan’s proactive approach to not only advancing the treatment of his own disease, but quite possibly the future treatment and care of others with this diagnosis. Currently a second-year medical student at the Miller School who plans to pursue a career as a gastroenterologist, Ryan is involved in research on the use and maintenance of therapies involving antibodies to treat this disease. Infliximab (IFX), an anti-TNF blocker, is a chimeric monoclonal antibody that has been shown to be effective in treating IBD. Unfortunately, over time patients develop antibodies against IFX, which cause the patients to not only lose their therapeutic response to the medication, but also to develop infusion reactions. These patients need to be switched to another medication. Prior research has shown that discontinuing IFX leads to a progressive decline in these detrimental antibodies, leaving the possibility open for restarting this very effective treatment, especially when other medications have failed. Ryan’s work looks into this possibility, utilizing a retrospective

Ryan Dauer Degree Program: M.D. Expected Graduation: 2015 Honors: to be presented at the Digestive Disease Week conference in May 2013 in Orlando, FL; accepted to the American Gastroenterological Association Institute Mentors: Andres Yarur, M.D.; Maria Abreu, M.D. Other Interests: DOCS Little Haiti Health Fair Director, Blackwell Training Aide, Med-Peds Interest Group, SCOPE, Medical Students in Action Future Goals: gastroenterology sg.mededu.miami.edu/medicalibis

Ryan at UMMSM. Image courtesy of Ryan Dauer. cohort study to see how IBD patients who have been off IFX for at least 6 months respond to reinitiating this treatment. In his study, anti-IFX antibody levels were obtained from patients before re-starting IFX and during follow-up to make sure that they would not develop an immune reaction. Response to IFX treatment was assessed retrospectively as per the treating physician’s judgment. Out of 17 patients, 14 initially responded to treatment, 11 of whom had a sustained response. These results suggest that even after patients lose their response and treatment is discontinued, re-introduction of IFX after a drug hiatus can be performed and is effective. Ryan says he plans on continuing research throughout his career, believing that “doing research is so important because, as a clinician, I can only treat one patient at a time, but through research I can influence hundreds, if not thousands, of patients.” That very well could be an understatement, however, as the scope of Ryan’s work extends beyond just the treatment of IBD. Biologics are becoming a mainstay in the treatment of inflammatory conditions and have potential in almost every field of medicine. Understanding their limits and use, with research such as Ryan’s, is essential and provides a backbone for the future of modern medical therapies. Spring 2013 | The Medical I.B.I.S.

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Pupillometry in Trauma CAMPUS

By Nisha Shah

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s a child, David Pechman dreamed of becoming a pilot for the United States Navy. He eventually earned a private pilot’s license during high school to increase his odds of acceptance into flight school. Pechman attended Amherst College with plans of applying to the Navy following graduation. “I loved science and took courses that interested me,” said Pechman. As an undergrad, David was a neuroscience major and took medically focused classes but never seriously considered medical school until he took a course entitled ‘The Neurobiology of Disease,” which featured a series of lectures by physician-scientists who presented their work and described the way their studies have changed practice and improved outcomes. David recollects, “I wanted to do what they did. I wanted to be a doctor and to conduct clinical research that made a difference in patient care.” He found his calling during his trauma surgery rotation as a third-year medical student. He has been active in various research projects throughout medical school and, most notably, one of them is a project involving a more precise measurement of pupil size in patients who undergo head trauma. David’s project, under the mentorship of trauma surgeon Fahim Habib, M.D., measures serial assessments of pupillary size and reactivity in head trauma patients by using a portable dynamic infrared pupillometer (NeurOptics Npi-100 pupillometer). His project seeks to find a more objective way to measure pupil size by detecting the borders of the iris and pupil reactivity through fixed intensity and duration light waves. The aim was to show that the pupillometer is more accurate and precise than manual examination, and that the improved examination may allow for better diagnostic and therapeutic decisionmaking. In Part I of the study, 101 patients were examined for pupil size and reactivity with three manual examinations and three pupillometer examinations. The mean standard deviation for manual assessments was 0.76mm while the mean standard deivation for pupillometer measurements was 0.21. The differences were statistically significant. Additionally, his study found discordance in 14

The Medical I.B.I.S. | Spring 2013

approximately 28% of subjective and objective assessment of pupillary reactivity. These study findings suggest that assessment with a pupillometer is significantly more precise and beneficial than subjective assessment in determining pupil size for these patients. He has presented these findings at the Society of Critical Care Medicine in San Juan, Puerto Rico. The next part of the study aims to see the relationship between changes in pupil size and reactivity with computed tomography (CT) scan results and the presence sg.mededu.miami.edu/medicalibis


“I wanted to do what they (physician-scientists) did. I wanted to

be a

doctor and to conduct

clinical research that made a

difference in

patient care.”

and progression of intracranial pathology. “Ultimately, we hope that the pupillometer will serve as a screening tool to potentially reduce the number of CT scans required,” says Pechman, who hopes to incorporate this type of research into a career in medicine. Image above shows David on the trauma helicopter landing pad and was taken by Ethan Yang. Image to the right shows David using the pupillometer at the trauma bay and is courtesy of David Pechman. sg.mededu.miami.edu/medicalibis

David Pechman Degree Program: M.D./M.B.A. Expected Graduation: 2013 Honors: oral presentation at the Society of Critical Care Medicine in San Juan, Puerto Rico, in January 2013 Mentor: Fahim Habib, M.D. Other Interests: private pilot, Co-Director of ESRF, academic societies trainer Future Goals: surgery Spring 2013 | The Medical I.B.I.S.

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CAMPUS

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The Medical I.B.I.S. | Spring 2013

Stephen at The Miami Project to Cure Paralysis. Image courtesy of Stephen Burks.

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Timeline of Neuronal and Astrocytic Cell Death Following Craniotomy for Acute Subdural Hematoma BY MATTHEW PHILLIPS

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cute subdural hematoma (ASDH) significantly contributes to mortality following traumatic brain injury. During an ASDH, blood slowly accumulates between the brain and skull, eventually leading to compression of the brain and a decrease in oxygen supply. This blood clots and then needs to be removed surgically. Unfortunately, after clot removal, oxygen flow is rapidly restored, leading to a special type of injury called a reperfusion injury. Research currently being done by third-year medical student Stephen “Shelby” Burks is shedding light onto how brain cells die during these reperfusion injuries.

“I hope to continue research in the field of neurotrauma, as it poses compli-

cated clinical problems without many therapy options.” sg.mededu.miami.edu/medicalibis

Utilizing a rat model, ASDHs were induced and extracellular fluid was sampled at four time points: early ischemic phase, craniotomy phase, early reperfusion phase, and late reperfusion phase. The extracellular fluid was then analyzed for different proteins, and using specific protein levels, Shelby was able to determine when the cells were dying. These protein markers are leaked from different types of dying cells and increases in these markers corresponded to when a given cell type was dying from the reperfusion injury. Shelby found that neuronal cells die first, followed by astrocytes, the helper cells. These findings imply that neurons are likely more susceptible to oxidative stress from reperfusion injury. Shelby’s experiment offers novel information regarding the mechanism underlying injury with subdural hematoma. Importantly, the study elucidates the period when neurons are the most vulnerable, and at which point neuroprotective therapies (such as hypothermia), might be applied to improve outcomes. Shelby, who began studying traumatic brain injury in college, has since become passionate about neurosurgery and plans to pursue it as a career (performing the surgeries was one of his favorite parts of doing this research). “I hope to continue research in the field of neurotrauma, as it poses complicated clinical problems without many therapy options.” His work has been published in the Journal of Neurotrauma.

Stephen Burks Degree Program: M.D. Expected Graduation: 2014 Honors: published in The Journal of Neurotrauma, poster at the National Neurotrauma Conference 2012 Mentor: M. Ross Bullock, M.D., Ph.D. Other Interests: Anatomy TA Coordinator, Neurosurgery Interest Group, Miami Beach Run Club Future Goals: neurosurgery Spring 2013 | The Medical I.B.I.S.

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Access to Pediatric Trauma Centers Improves Survival CAMPUS

U

by melissa stone

pon entering medical school, Kiran Sethi, a second-year student at the Miller School, quickly realized that she was interested in a future career combining her love of caring for children and the anatomy and precision in surgery. She sought out Carl Schulman, M.D., Ph.D., M.S.P.H., Associate Professor of Surgery and Director of the William Lehman Injury Research Center, and his research fellow, James Davis, M.D. Together, they developed a research hypothesis involving the effects of access to pediatric trauma centers (PTCs) and since the spring of 2012, Kiran has been testing this hypothesis. Conducting the background research for this project greatly impressed Kiran: “It was surprising that we don’t have standard statewide pediatric trauma networks the way trauma networks exist for adults – people assume that kids can be easily treated at an adult trauma center but they can’t.” Kiran recognized how unequipped most adult trauma center (ATCs) were at handling pediatric patients. Previous studies had shown when pediatric patients were treated at ATCs, they had a greater number of unnecessary procedures and an increased risk of mortality. Even most ambulances were not well equipped to handle pediatric patients, not having the correct sizes of equipment, for example, for the anatomy of a child. Although some states had realized this was true and created incentives for hospitals to become PTCs and standardized the grading of these trauma centers, just as

Kiran Sethi Degree Program: M.D. Expected Graduation: 2015 Honors: presenting research at the Eastern-Atlantic Student Research Forum 2013 Mentor: Carl I. Schulman, M.D., Ph.D., M.S.P.H.; James Davis, M.D. Other Interests: J. Weiss Social Medicine Pathway, Medical Humanities Interest Group, MedPals, UMMSM Academic Societies, Florida Medical Association-Political Action Committee Future Goals: pediatric surgery 18

The Medical I.B.I.S. | Spring 2013

“It is unimaginable that having an accident with a child in one state as opposed to another state changes their risk of mortality. I hope that through my research, I can encourage

this to

change.” is universally practiced for ATCs, this was limited to only a few states. Kiran believes that all states need a greater standardization of PTCs. Kiran used the Fatality Analysis Reporting System as a database to collect information about motor vehicle crashes between 2005 and 2008 where a patient between the ages of 0 and 14 had died. Through these criteria, she had over 6,779 data points and compared them to PTCs that existed during the same time period. She discovered sg.mededu.miami.edu/medicalibis


Kiran performing her first “mini” surgery on a medical service trip to the Dominican Republic in March 2012. Photo taken by Jatin Anand. that the lack of access to a PTC (determined by distance from PTC) very strongly correlated with a higher mortality rate. She was shocked to see that the correlation was strongly linear with few outliers. Through this analysis, she also controlled for whether it was an in-hospital death or a death on-scene, and both parameters correlated with distance to a PTC. Kiran also was interested in what state had the greatest mean fatalities. She found that California was the highest and Rhode Island the lowest. Kiran is continuing to work on this project and is trying to expand her findings. She is currently collaborating on a cluster-risk analysis to see how PTC location correlates with socioeconomic status, ethnicity, etc. Kiran believes that we desperately need more PTCs but we don’t necsg.mededu.miami.edu/medicalibis

essarily need more PTCs where we are building them. She plans on having a detailed analysis to show where we need more PTCs and where we don’t. Furthermore, she would like to derive a formula that can predict mortality risk for a pediatric car crash patient in a given location. Although she already has some significant results, she wants to expand the project before writing a manuscript for publication. Kiran believes that her research has shown that access to PTCs is a nationwide problem that needs to be addressed, and she hopes that her data will support the creation of a national PTC-verification system that will lead to the establishment of more PTCs and standardized networks to manage them. Spring 2013 | The Medical I.B.I.S.

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CAMPUS

Epigenetic Regulation of Alcohol Seeking Behavior by matthew phillips

Christopher Rienas Degree Program: M.D. Expected Graduation: 2015 Honors: poster presentation at ESRF 2013 Mentor: Claes Wahlestedt, M.D., Ph.D.; Andrea Johnstone, Ph.D. Other Interests: Musical Director of Doctorâ&#x20AC;&#x2122;s Note, Caneshare, Psychiatry Student Interest Group Future Goals: psychiatry

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The Medical I.B.I.S. | Spring 2013

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Christopher performing research in the laboratory of Dr. Wahlestedt. Image courtesy of Christopher Rienas.

E

pigenetics is at the forefront of modern genetic research. Without altering the DNA sequence, epigenetic signaling pathways chronically regulate gene expression based on human interaction with the external environment. These pathways can become dysregulated, however, and possibly lead to diseases ranging from cancer to schizophrenia. The diversity of diseases linked to epigenetics is attributed to how altered activity, in even one epigenetic enzyme, can change the expression of many genes, leading to complex pathologies in the effected cells. In this sense, epigenetic enzymes are the biochemical gate keepers of genetic expression, making them an attractive target for novel therapies in the treatment of disease. Alcoholism (and addiction in general) has been linked to epigenetic dysregulation and could profoundly benefit from research into mechanisms and possible treatments involving epigenetics. Christopher Rienas, a second-year medical student and future psychiatrist, is “interested in both the understanding of the neurobiological basis of addiction and drug dissg.mededu.miami.edu/medicalibis

covery in the area of psychiatry.” These research interests fit perfectly with his current work looking into several epigenetic enzymes and their role in alcoholism. Utilizing a rodent model of chronic alcoholism, Christopher found that a specific epigenetic enzyme (KDM6B) was dysregulated in both the prefrontal cortex (PFC) and nucleus accumbens of alcohol-exposed “post dependent” rats. This is significant because these two regions are believed to be involved in reward signaling and addiction. Furthermore, in a cohort of postmortem human brain tissue, KDM6B mRNA was found to be differentially expressed within a region of the PFC of alcoholics compared to controls. This further strengthens Christopher’s findings, showing that the epigenetic dysregulation caused by alcoholism is found across species. “Psychiatry is a field in need of more effective therapies. I believe that epigenetics will be the new front in psychiatric medicine,” states Christopher, calling epigenetics an “Occam’s razor” of our genetic understanding of disease. Indeed, in psychiatric illness where multiple neurotransmitters and regions of the brain are dysregulated simultaneously, therapy targeting a single enzyme would very well be the simplest solution for a very complex problem. Christopher presented his research at this year’s Eastern-Atlantic Student Research Forum. Spring 2013 | The Medical I.B.I.S.

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Cataract Surgery and Tears CAMPUS

By Nisha Shah

A

fter refractive error, cataract surgery is the most common cause of blindness worldwide. Hence, research related to cataract surgery is vital as a public health measure. Vincent Venincasa feels that the need for cataract surgeries will only increase as our population ages, and he sought to explore one of the most common complaints associated with this procedure: dry eyes.

“More patients

will undergo cataract surgeries in the future and will bring their concerns to all

of their doctors – not

just ophthalmologists.”

Under the mentorship of Anat Galor, M.D., Vincent’s retrospective study analyzed parameters in 29 patients at the Miami VA Healthcare System who underwent cataract surgery. He compared the severity of dry eye in the operated to the non-operated eye in patients who had cataract surgery three or more months prior. The study

Vincent Venicasa Degree Program: M.D. Expected Graduation: 2015 Honors: publication in The Scientific World Journal (PMID: 23401671) Mentor: Anat Galor, M.D. Other Interests: Sight Savers health fair coordinator, academic societies tutor, painting Future Goals: med-peds or ophthalmology 22

The Medical I.B.I.S. | Spring 2013

Vincent at the ophthalmology clinic. Image courtesy of Vincent Venincasa. found no significant difference between the patients’ eyes in terms of tear osmolarity, tear breakup time, corneal staining, Schirmer’s testing, morphologic and qualitative eyelid, and meibomian gland function. Overall, Vincent’s findings suggest that patients undergoing cataract surgery can be counseled that their eye dryness in the operated eye will mirror that of the non-operated eye three months after cataract surgery. Vincent has published this study as first author in the January edition of The Scientific World Journal. “This study will enhance the doctor-patient relationship and allow ophthalmologists to have a better discussion with patients regarding cataract surgeries’ recovery and side effects, “ says Vincent. Furthermore, Vincent believes that regardless of his chosen specialty, this project will have given him a firm understanding of how to go about conducting clinical research. sg.mededu.miami.edu/medicalibis


Gender Variability of Fine Needle Aspiration Reliability

A

by ashley lawler

fter spending time shadowing within the Division of Endocrine Surgery during her first three years of medical school, Punam Parikh decided that she wanted to devote a full year to surgical research. This year, she has embarked on a full year as a clinical research fellow within the DeWitt Daughty Family Department of Surgery, where she primarily performs surgical endocrinology research with John Lew, M.D. It was important to Punam to incorporate her longtime commitment to social medicine into her specific interests in surgical endocrinology. While working clinically with patients on the wards, Punam felt particularly moved by patients battling with the diagnosis of thyroid malignancy. She therefore chose to work on a project examining the

“Research profoundly influences the manner in which healthcare professionals manage patients both clinically and surgically.” reliability of current biopsy guidelines of large thyroid nodules (≥4cm) in men versus in women. While fine needle aspiration (FNA) is the accepted standard way to biopsy smaller thyroid nodules, clinicians disagree over whether larger thyroid nodules can be biopsied by aspiration or should be more aggressively studied

with surgical resection. Specifically, this study questions whether gender should be considered when selecting which method of biopsy to use in a particular patient. More than one thousand patients who underwent FNA for biopsy and ultimately total thyroidectomy (removal of the thyroid) were retrospectively reviewed. Results of the biopsy were correlated with the final histopathology, or diagnosis, as determined by the pathology from the thyroidectomy. Importantly, the FNA false-negative rate for thyroid malignancy was 0% in men and 17% in women. Further, FNA was less predictive of malignancy in women compared to men with thyroid nodules ≥4cm, and the statistically determined diagnostic accuracy of FNA in males with large nodules was greater than in females with large nodules. Overall, these data suggest that FNA may be less reliable in women than in men, and advocate using a more aggressive approach that includes surgical resection for definitive diagnosis in women with large thyroid nodules. Punam’s research is one extension of her belief in surgical research as one of the cornerstones of medical practice, in that it “profoundly influences the manner in which healthcare professionals manage patients both clinically and surgically.” Her dual commitment to social medicine and surgical endocrinology will continue to shape her future career and research endeavors.

Punam Parikh Degree Program: M.D. Expected Graduation: 2014 Honors: presented at the Florida Medical Association conference in Boca, Raton, FL in July 2012; Association of Women Surgeons’ 31st Annual Conference for Medical Students and Residents in Chicago, IL in October 2012 Mentor: John I. Lew, M.D., F.A.C.S. Other Interests: Surgical Specialties Interest Group, ESCape to India President, ENT Interest Group President, Musical Esemble for the Enrichment of Medicine Future Goals: surgical endocrinology, social medicine sg.mededu.miami.edu/medicalibis

Punam with her mentor, Dr. Lew, presenting her poster at the FMA conference. Image courtesy of Punam Parikh. Spring 2013 | The Medical I.B.I.S.

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Killing of Intracellular Pathogenic Bacteria by a Pore Forming Protein, Perforin-2: A New Paradigm of Innate Immunity CAMPUS

T

by matthew phillips

he ability to rid cells of intracellular bacteria is an essential part of natural immunity. Most cells have several mechanisms for doing this – most notably, autophagy (literally translated means “to eat self”), where the cell breaks down the bacteria by lysosomal machinery, and through the secretion of antimicrobial compounds. In phagocytic cells (like macrophages, whose job it is to ingest invading bacteria), the removal of bacteria within the cell is thought to be mediated by reactive oxygen species and other oxidative mechanisms within the phagolysosome (cellular compartment made from the ingestion of the bacteria). This is the old paradigm. Current fourth-year M.D./Ph.D. student Ryan McCormack is working to redefine the current school of thought on intracellular, natural immunity. Ryan’s project focuses on characterizing the function of the protein, Perforin-2. Since this protein is similar to other pore forming proteins, which classically play a major role in the immune response, Ryan honed in on anti-bacterial properties of Perforin-2. The scope of this project is far larger than it initially appears. Perforin-2 is a highly conserved protein, being found in everything from sponges to humans over the past 400 million years. Even within a single organism, this protein is required for

Ryan McCormack Degree Program: M.D./Ph.D. Expected Graduation: 2017 Honors: published in the Journal of Innate Immunity (PMID 23257510); presented at the Federation of American Societies For Experimental Biology Summer Research Conference; 1st place ESRF 2013 Oustanding Basic Science Poster Presentation Mentor: Eckhard Podack, M.D., Ph.D. Other Interests: academic medicine Future Goals: infectious disease 24

The Medical I.B.I.S. | Spring 2013

“... novel project that allowed me to combine my previous experiences in molecular biology with my interest in the immune system. the killing of pathogenic, intracellular bacteria in all cells including epithelia, endothelia, fibroblasts, myoblasts, astrocytes, neuroblasts, and phagocytes. In addition to the ubiquitous nature of Perforin-2, Ryan’s work has shown that it is effective at perforating and eliminating a wide spectrum of bacteria present within the intracellular compartment of cells. Utilizing microbiological, electron microscopy, and biochemical techniques, Ryan has shown that Perforin-2 effectively neutralizes pathogenic bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), Mycobacteria and Salmonella. This research has established a new paradigm for clearance of intracellular sg.mededu.miami.edu/medicalibis


bacteria in all cells by natural immunity. Ryan was initially attracted to this work because of how it was a â&#x20AC;&#x153;novel project that allowed me to combine my previous experiences in molecular biology with my interest in the immune system.â&#x20AC;? He says that his favorite part is how his research is directly creating new knowledge. This

work has been presented at the FASEB Summer Research Conference on Biology of the immune system and the 2nd Prato Conference on Pore Forming Proteins. It has also been published in The Journal of Innate Immunity.

Ryan in his lab. Photo taken by Ethan Yang. sg.mededu.miami.edu/medicalibis

Spring 2013 | The Medical I.B.I.S.

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Double Blind Placebo Controlled Study Assessing the Effect of Chocolate Consumption in Subjects with a History of Acne Vulgaris CAMPUS

BY ASHLEY LAWLER

W

hether chocolate exacerbates acne has been a long-debated topic in dermatology. No study had been found in the literature assessing the effect of pure chocolate on acne vulgaris prior to the University of Miami’s pilot study, published in the Journal of the American Academy of Dermatology. Samantha Block, Class of 2013, has a passion for research and decided to get involved in an expansion of this pilot study, testing whether chocolate exacerbates acne specifically in males between ages 18-35 with a history of acne vulgaris. Fourteen subjects were enrolled in this prospective, double-blind, placebo-controlled study and thirteen completed it. Subjects were randomly assigned to swallow capsules filled either with 100% cocoa, gelatin, or

Samantha at her poster at ESRF 2013. Image courtesy of Samantha Block. 26

The Medical I.B.I.S. | Spring 2013

Samantha Block Degree Program: M.D. Expected Graduation: 2013 Honors: presented at ESRF 2013; American Academy of Dermanatology 2012 Annual Meeting; currently under review at the Journal of Clinical and Aesthetic Dermatology Mentor: Brian Berman, M.D., Ph.D.; Jonette Keri, M.D., Ph.D. Other Interests: Dermatology Interest Group, DOCS Future Goals: psychiatry a combination of cocoa and gelatin. Acneiform lesions were counted at baseline, day 4, and day 7. Acneiform lesions were defined as comedones, papules, pustules, and nodules. Interestingly, a statistically significant increase in the mean number of total acneiform lesions was detected on both day 4 and day 7 compared to the mean number at baseline. Additionally, a positive correlation existed between the amount of chocolate each subject consumed and the number of lesions they developed. Importantly, Samantha and her collaborators concluded that chocolate exacerbates acne, in a dose-dependent manner, in males ages 18-35 with a history of acne. For Samantha, the most “challenging and exciting” aspect of this study was figuring out a way to creatively make the study double-blind and placebo-controlled. “Hand-filling capsules with cocoa, gelatin, or a combination of both, also provided the study team with some good laughs,” she states. This project was presented both at the ESRF this year and at the American Academy of Dermatology’s Annual Meeting. Samantha concludes: “being able to work cohesively with other members of the study team to design, perform, and hopefully publish this study was a wonderful experience.” sg.mededu.miami.edu/medicalibis


Post Concussive Symptoms and Outcome Following Mild Traumatic Brain Injury by ashley lawler

P

aul McMahon completed his third year of medical school with a strong conviction to become a neurosurgeon. However, he wished to pursue his research interests more deeply, before the frantic rush of residency applications and interviews during his fourth year of medical school. As a recipient of the prestigious Doris Duke Clinical Research Fellowship from the National Institute of Mental Health, Paul is currently devoting a year to studying mild traumatic brain injury (mTBI) at the University of Pittsburgh Medical Center. Paul is part of a massive effort undertaken at three major medical centers to collect and analyze the data for all TBI patients, with the ultimate goal of better understanding the long-term effects of the condition. Historically, mTBI has been considered a relatively benign condition, with few, if any, serious consequences. In part due to the increase in head trauma during the Afghanistan

and Iraq wars, recent studies suggest this dogma may not be correct. For this study, patient data was collected prospectively at the time of hospital admission, and again at 3, 6, and 12 months for follow-up. Initial data included patient background, past medical history, and diagnostic testing. Additionally, a battery of functional outcome scores was applied each time the patient was assessed thereafter. Importantly, this study revealed that following mTBI, many patients continue to develop and experience symptoms for much longer than previously thought, and do not follow a linear recovery pattern. Despite the fact that patients are considered “functional” based on their scores at 6 and 12 months, 82% are still experiencing symptomatology from their injury at those time points. Further, average symptoms reported are higher at 12 months than at 3 months. This study elucidates the importance of identifying mTBI patients, and recognizing that they may benefit from continued treatment and care even up to a year following their injury. For Paul, this project has been a “seamless combination of my interests in research, trauma, and neurosurgery,” and he finds personal fulfillment in working toward the understanding of an often-misunderstood disease. This year of research has given him exposure to his future field, and has equipped him with a unique skillset that he will bring to it. Paul presented his research at the 2013 Eastern-Atlantic Student Research Forum.

Paul McMahon

Paul outside his lab at the University of Pittsburgh Medical Center. Image courtesy of Paul McMahon. sg.mededu.miami.edu/medicalibis

Degree Program: M.D. Expected Graduation: 2014 Honors: oral presentation at ESRF 2013 Mentor: David O. Okonkwo, M.D., Ph.D. Other Interests: DOCS Hurricane Response, DOCS Health Fairs, Surgical Specialties Interest Group, Project Medishare Future Goals: neurosurgery Spring 2013 | The Medical I.B.I.S.

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Traditional Cardiovascular Risk Factors Explain Only a Small Portion of Variation in Carotid Plaque CAMPUS

by melissa stone

F

rank Kuo has been interested in imaging since his undergraduate years. As an electrical engineering major at UCLA, Frank has sought to combine his passion for medicine with his background in engineering and programming. Frank’s capstone project in undergrad was on image processing and he also worked in a bioinformatics laboratory at UCLA and performed computational neuroscience research in the lab of Vance Lemmon, Ph.D., and John Bixby, Ph.D., at The Miami Project to Cure Paralysis. In the Lemmon-Bixby lab, Frank studied neuronal regeneration, explaining the different transcriptome profiles of the central and peripheral nervous system. However, with this vast knowledge in basic science research and knowing that clinical research is the gateway for basic science to impact patients, Frank wanted experience in the clinical arena. Frank approached Tatjana Rundek, M.D., Ph.D., Professor of Neurology and Director of the Clinical Translational Research Division. Dr. Rundek is particularly interested in environmental and genetic risk factors of atherosclerotic phenotypes determined by vascular ultrasound. Under her supervision, Frank decided to work on an epidemiologic project examining various factors that contribute to one of the main phenotypes of early atherosclerotic phenotypes, carotid plaque area, which is a strong predictor of vascular events. For his project, Frank analyzed data collected from the Northern Manhattan Study (NOMAS). Based at the Neurological Institute of Columbia University, NOMAS is a large prospective epidemiology study of stroke risk factors among minorities living within the same community of northern Manhattan. It has been funded by the NIH/NINDS for over 20 years. Ralph Sacco, M.D., Professor and Chair of Neurology, is a PI of NOMAS and 28

The Medical I.B.I.S. | Spring 2013

Dr. Rundek has been a NOMAS investigator for more than 10 years. After Drs. Sacco and Rundek relocated from Columbia University to the University of Miami, NOMAS was administratively moved to Miami while subject recruitment and follow-up continues in New York. The NOMAS has enrolled more than 3,000 participants and has collected a wide range of demographic, clinical, sociodemographic, laboratory and DNA data. From this data, Frank used a set of criteria to identify two models of factors associated with cardiovascular disease. The first model was composed of traditional vascular risk factors: age, sex, low-density lipoprotein cholesterol,

“My engineering

background has drawn me

towards anything involving medicine and technology – image processing, bioinformatics, radiology, and now in this project, ultrasound.”

diabetes mellitus, pack years of smoking, blood pressure, and treatment for blood pressure. The second model was composed of both traditional risk factors and less traditional risk factors, including homocysteine, white blood cell count, moderate drinking, high school education, socioeconomic status, and low-density lipoprotein to high-density lipoprotein ratio. Frank took these sets of risk factors and correlated them to carotid artery total plaque area. Carotid artery total plaque area has been shown in past studies to be an important marker of increased cardiovascular risk, putting sg.mededu.miami.edu/medicalibis


people at risk for heart disease and stroke. The carotid artery total plaque area was measured for NOMAS patients using ultrasound. Through statistical analysis and working with statisticians, Frank discovered that both the traditional set of risk factors and the less traditional risk factors, independently, explained only about 20% of the total plaque area, indicating that the total plaque area in the carotid artery is largely unexplained by the risk factors examined by these models. The other contributing factors might be mostly genetic and this is something that Frank hopes to look at in the future by examining the associations between genetic polymorphism and carotid atherosclerotic plaque using a genome-wide association study approach. A large set of other environmental and behavioral factors were not examined in these analyses. Although Frank did look at some environmental factors, such as socioeconomic status and high school education, there are many other unaccounted non-genetic factors that might contribute to atherosclerotic plaque burden, which also warrants further study. It is important to identify the factors for cardiovascular disease because if the factors are treatable, then we can decrease the incidence of debilitating and devastating medical conditions, such as heart disease and stroke. Many of the factors identified by Frank can be controlled, such as hypertension and smoking use, and he hopes that by eventually identifying most of the causative agents for cardiovascular disease, we can practice effective preventative medicine. One of the reasons that Frank was initially drawn to this project was its unique use of ultrasound. He believes that ultrasound, an inexpensive, quick, radiation-free, and non-invasive technique, is underutilized in preventative medicine. Just as a patient is screened for breast cancer by mammography, he hopes that eventually patients can be effectively screened for cardiovascular and cerebrovascular risk by ultrasound. Frankâ&#x20AC;&#x2122;s project was presented at the International Stroke Conference 2012 in New Orleans and at the Eastern Student Research Forum 2012 at the Miller School. He is also the first author of the publication in Stroke. Having completed this phase of the project, Frank is currently dedicating a year as a research fellow at the National Institutes of Health (NIH) Medical Research Scholars Program Fellowship. At the NIHâ&#x20AC;&#x2122;s National Cancer Institute, Frank is performing molecular imaging research with hopes of developing new imaging agents to aid in diagnosis and monitoring responses of therapies. He plans on applying for residency in radiology next year. sg.mededu.miami.edu/medicalibis

Frank at the National Institutes of Health Clinical Center where he is currently taking a research year working for the Molecular Imaging Program of the National Cancer Institute. Image courtesy of Frank Kuo.

Frank Kuo Degree Program: M.D. Expected Graduation: 2014 Honors: published in Stroke (PMID 22550054), awarded the 2012 American Heart Assoc. Student Scholarship in Cerebrovascular Disease and Stroke, presented at the International Stroke Conference Mentor: Tatjana Rundek, M.D., Ph.D. Other Interests: Miller School Academic Society Mentor and Tutor, ESRF Publications Chair, Secretary of Radiology Association of Young Scholars, Intramural Basketball Future Goals: radiology, academia medicine Spring 2013 | The Medical I.B.I.S.

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Finding Research Opportunities at the University of Miami CAMPUS

By matthew phillips

Finding basic science research can be a daunting task, but there are plenty of opportunities to do medical research here at the Miller School. These opportunities are easier to find than you expect. STEP 1: FINDING A MENTOR

A

ssemble a list of principle investigators (PIs) you would be interested in doing research with. There are several ways to go about this. The easiest way is to email one of the teaching faculty with some combination of the phrases, “I’m a medical student,” “I enjoyed your class,” and “Can you recommend any researchers doing work in this field?” Most are more than happy to help out, and some will even invite you to work in their own lab! A majority of the departments have sections under the list of faculty about the faculty members’ research. You can get to the various departments via the UM Medical Education website at med.miami.edu

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The Medical I.B.I.S. | Spring 2013

(under the “About Miller” tab, option “Departments and Centers”) or by simply searching the department name and University of Miami in Google. Another avenue to take is to use SciVal (http://www. experts.scival.com/miami). SciVal is a great way to browse faculty. Plus it gives a wealth of information. If you have someone in mind, type their name into the search. If not, click on the department in which you are interested in doing work. It will give you a list of current faculty, along with the number of publications they have, a preview of the trend in publications (for example: if they have been publishing more recently it will look like a slope trending upwards), and it will also show you how many grants have been awarded to that investigator. Grants and publications are important things to keep in mind because they can show how active a lab is. When you select one of the experts it will take you to his or her overview page. There is a ton of great information here including the topics on which the PI has been publishing (listed under “Profile”), a detailed trend showing how many papers in each of the profile topics have been published recently, and a list of “Similar Experts,” which shows you who else is doing similar work (you can also look at each expert’s “research network” to see who they have worked with in the past.) Browsing around SciVal to get a list of potential researchers is an excellent way to expand your search and give you an idea about research in each laboratory.

sg.mededu.miami.edu/medicalibis


STEP 2: COLLABORATING

O

nce you have a couple PIs in mind, you then need to start soliciting these researchers to take you into their lab. But first, make sure you have an updated CV. Then email the first few PIs on your list stating that you are interested in doing research and that you are interested in their research (be specific). Make sure to attach your CV. However, keep in mind that most PIs are extremely busy and may not get back to you right away. If you haven’t heard back in a week, feel free to send them another email. You can also try alternative modes of communication (the telephone!). If you have no luck with the first few PIs after about a week and a half, send emails to the next few on your list. When you do finally get ahold of a PI, meet with the PI and find out more information – but don’t be afraid to shop around for labs. It is not unreasonable to meet with 3-4 PIs over the course of a couple of weeks, compare research experiences, and then choose one PI to work with. But if you are doing this, just tell the PI at the end of the meeting that you are very interested in their research but you are meeting with a few other PIs to see your options and you’ll let them know within a couple of weeks. Also, as they describe what jobs are needed around the lab, remember to be flexible! You may not be able to find your “dream” research project, but if you get into a good lab it will still be worth it. Additionally, when you are accepted into a lab, email the professor asking, “Are there any journal articles you would like me to read to better prepare me for working in your lab?” This will show initiative and an interest in their work, both things that PIs appreciate.

STEP 3: DISCUSSING GOALS AND TIME

M

ake sure you discuss with your mentor your goals, whether it’s getting involved in a basic science project, a clinical project, such a chart review, or both. Set up a timeline so that the project can be completed in a timely manner. Remember that these mentors are also your potential career advisors and letter writers as well. You want to be on the same page as them. For clinical research, it is often best to contact attendings in the department you are interested in, and they may ask you sg.mededu.miami.edu/medicalibis

to get in touch with some of their residents who may be working on a project. If you are interested in history of medicine research, you can consult the student section of the American History of Medicine Association website for tools and recommendations. For medical ethics research, you can consult the UM Ethics Programs website for faculty members to mentor you. And to get ideas about medical humanities works and projects, you can review the Miller School’s Humanities in Medicine Journal. If you are still having trouble, there are people whose job it is to help you out. For example, Joyce Biederman and the Office of Students Services can be great resources. Doing research is an extremely rewarding addition to your education, and the Editors of The Medical I.B.I.S. highly recommend it to everyone. Good luck!

Key Tips

(1) SciVal is a great resource to search the recent publications and research involvement of mentors (2) Shop around for mentors, and find one that understands your goals (3) Be proactive and show enthusiasm! Spring 2013 | The Medical I.B.I.S.

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Finding Research Opportunities Outside the University of Miami CAMPUS

By ashley lawler Though there is a plethora of excellent research going on at at the Miller School, there are also many advantages to pursuing research at other institutions throughout the country. Aside from being able to travel and receive funding, performing research outside the Miller School allows you to also make valuable connections in your chosen field. Whether you choose to do a research project during summer break or take a year off, careful consideration should be put into your own goals and priorities before selecting a program. These lists are not exhaustive, and though these programs are all currently active, students should check the current status of a program the year that they intend to apply, as program activity can vary year to year. It is typically best to begin researching programs around October, in order to have all components of your applications ready by the due dates, usually around January or February. Research experience during medical school, whether serving as an initial steppingstone into a research residency and career, or just as a summer introduction to a chosen field or institution, enriches the standard medical curriculum and equips students with invaluable insight and mentorship. We’ve done some research and put together a list of off-campus research opportunities for either the year or just the summer.

More programs for consideration can be found at the following websites: • aamc.org/students/medstudents/cim/clinicalandresearchopportunities • med.upenn.edu/mdresearchopps/yearout.shtml#year • ps.columbia.edu/education/academic-career-planning/research-global-healthopportunities/fellowships

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The Medical I.B.I.S. | Spring 2013

sg.mededu.miami.edu/medicalibis


SUMMER Programs NIH Summer Internship Program in Biomedical Sciences

DESCRIPTION Program is 8 weeks long and includes lectures featuring distinguished NIH investigators, career/professional developmental workshops, and Summer Poster Day.

Carolyn L. Kuckein Student Research Research support for continuous 8 to 10 weeks of 30+ hrs/wk or Fellowship through Alpha Omega 12 months over 1-2 years of approximately 4 hrs/wk for clinical Alpha investigation, basic laboratory research, epidemiology, social science/ health services research, leadership, or professionalism. One nomination per school is accepted. Medical Student Anesthesia Summer Eight-week summer program for students interested in academic Research Fellowship anesthesiology. Capstone is student presentation at the Anesthesia Society Association annual meeting. American Association of Neurologic Student receives a stipend to work in a neurosurgical laboratory Surgeons Summer Research mentored by an American Association of Neurologic Surgeons Fellowship investigator for one summer. Memorial Sloan-Kettering Cancer An eight-week program for students with a career interest in the field Center Medical Student Summer of oncology and biomedical sciences. Fellowship Research Program Infectious Disease Society of America Stipend and mentorship for a clinical or basic science research Medical Scholars Program project focused on pediatric or adult infectious diseases. Medical Student Research Program Research to be performed at any NIH National Institute of Diabetes, in Diabetes Digestive, and Kidney Diseases funded institution.

Year-long Programs

DESCRIPTION

National Institutes of Health (NIH) Medical Research Scholars Program (MRSP) Howard Hughes Medical Institute Medical Research Fellows Program

Year-long mentored clinical, basic, or translational research performed at the main NIH campus in Bethesda, MD. Student selects project and mentor after acceptance. Housing is provided. Year-long research at any (even here at UM) academic or nonprofit institution in the United States (except for the NIH in Bethesda, MD). Student applies with chosen mentor and written project proposal. Howard Hughes Medical Institute Year-long research at HHMIâ&#x20AC;&#x2122;s Janelia Farm Research Campus in Janelia Farm Program Ashburn, VA, that focuses on neuronal network function or imaging at cellular and molecular level. Sarnoff Fellowship Program in Year-long cardiovascular or cerebrovascular research in a biomedical Cardiovascular Research research facility in the U.S., other than the medical school in which the applicant is enrolled. Student does not need to have selected mentor or project when applying. Centers for Disease Control and Year-long fellowship in applied epidemiology designed to enhance Prevention (CDC) Experience Applied population health perspective. Student spends the year at the CDC in Epidemiology Fellowship Atlanta, GA. Fogarty International Clinical Year-long mentored clinical research training experience at a top NIHResearch Scholars Program funded research center in a developing country. Doris Duke International Clinical Year-long fellowship to conduct mentored clinical research in a Research Fellowship developing country. Fulbright U.S. Student Program Provides funding for international educational exchange and research in a country outside the U.S. sg.mededu.miami.edu/medicalibis

Spring 2013 | The Medical I.B.I.S.

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CAMPUS

The Eastern-Atlantic Student Research Forum (ESRF) is a four-day international symposium held at the Miller School each year. This is a great opportunity for medical students to share their research. Go to uresearch.miami.edu/esrf for more information.

Winners from ESRF 2013 shown here are, from left, Nikesh Shah, Wael Bahnan, David Siefker, Shailee Patel, and Catherine Gordon. Ryan McCormack not pictured. Image courtesy of David Pechman.

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The Medical I.B.I.S. | Spring 2013

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Special thanks to our photographer Ethan Yang, M.D./Ph.D. student facebook.com/coorush â&#x20AC;&#x153;Photography has endowed me with an understanding of the lives of others around the world. Sometimes it feels like a handshake, like a key into time and the moment, and shows them you are ready to be amazed and inspired.â&#x20AC;?

sg.mededu.miami.edu/medicalibis

Spring 2013 | The Medical I.B.I.S.

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UMMSM Medical IBIS Journal  

The Medical I.B.I.S. is a new magazine to highlight University of Miami Miller School of Medicine students and their research.

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