Final week: Radiology fun and bittersweet goodbye to NYC

Monday: Dr. Prince today gave a very informative lecture about diagnostic radiology. Before the lecture, I was never really interested in radiology. Even though I took a couple classes in image processing that handled medical images to help diagnostics, it was never something interesting to me. In this lecture though, Dr. Prince introduced diagnostic radiology in a case-by-case basis. He asked us to identify the type of images and the body parts shown in the image. Through this process, certain characteristics were drilled in our mind that I don’t think I would forget again. For example, it was confusing between CT images and MRI for most of us but Dr. Prince stated that CT images were mostly lateral images but MRI could be taken from any directional plane. From first glance, a lot of the images appeared to be quite normal, but with Dr. Prince’s guidance, most of us were able to trace the structures of body and eventually identify the abnormality shown in the image and give the correct diagnostics.

One very interesting case I remembered were an MRI image of a pregnant woman. This was the first time I saw an MRI image of pregnant woman and I never knew they allowed radioactive imaging for pregnant woman since everyone was paranoid about the defects of babies that can result from radioactive materials. As far as I knew, I only heard ultrasound that was used during pregnancy. Dr. Prince told us MRI would only be used when there were some significant concerning features they saw in ultrasound images. In this image, the baby can be clearly seen with the head upside-down and placenta attached to the uterus. The image looked perfectly normal at first, but with Dr. Prince’s guidance, we gradually noticed there were some fatty-like material close to the baby’s neck. At first glance, it almost looked at a separate brain, which caused concerns among us since we thought it was an under-developed or defected twin sibling of the baby we already saw. However, Dr. Prince informed us that the condition was cystic hygroma that usually was caused by genetic defects or alcohol/drug use during pregnancy. The size of the cyst was almost same as the size of the baby’s head and was really concerning. Nonetheless, after a little researching on the internet later, I found out that the condition is usually treatable either by surgical removal or chemotherapy after the baby is born. However, the other case of pregnant woman was not so lucky.  The woman had twins but one had a missing placenta and the other had encephaloceles (had brain growing outside of the skull). Dr. Prince said the woman decided to terminate pregnancy and lose both children and they would not be able to survive even though she chose to continue. 

Side note: also after seeing the leakage of breast implant from an MRI image, I think I would never guess a breast implant in my life even though it’s absolutely safe. The image was so bright due to the silicone from the implant and no blood vessel and normal breast tissue could be seen. 

At the end this comes to the end of summer immersion. During this summer, I had the chance to observe in the operating room and ICU talking to patients who were trying to fight the disease; I also got the chance to experience the very border between life and death in the pathology meetings. All of those were something I couldn't expect as a normal scientist and only in the lab. I was surprised and happy to know that there are people thrilled to know about my research and how it could change the life of other patients like them. I really thanked the doctors and residents who were willing to teach and explain to me the anatomy and pathology. I also really thanked those patients who were willing to present themselves as subjects for us to get better understanding of the diseases. Now I m heading back to my lab in ithaca but I will never forget this experience and it will continue to be my encouragement and motivation to make my research meaningful to the biomedical world. 

Immersion Week 8: One Last Hurrah (Surgical Images Below)

Summary: Finished my time in immersion in neurological surgery and interventional radiology.

I started my week on a positive note and after 4 weeks I was able to finally access OLEA and the PACS system and was able to actually look up patient MRI data. Though, because of the wait, I was only able to investigate volumetric changes in a couple patients. So, I was unable to confidently identify any potential cues for glio-progression, but I still enjoyed the experience.

Next, I was able to observe Dr. Souweidane  in neurological surgery and see the removal of two cysts from two different patients using two different methods. The first patient was an older gentleman that reported losing the capability of doing or remembering simple tasks, but didn’t show signs for stroke. So after MRI was conducted it was determined that the gentleman had a large congenital cyst that had begun to grow and press on to different parts of the brain. To remove the cyst, Dr. Souweidane used guided endoscopy to successfully remove the cyst. The second patient was a young girl who had reported that she was having severe migraines and so an MRI was conducted and it was discovered that the child had an unrelated pineal cyst that was most likely benign, but could be an issue later in life and even cause sudden death. So the patient’s parents decided it would be beneficial to remove the cyst.  For this operation, the rear skull cap was removed and the cerebellum moved forward so the cyst could be located and removed. I’ve included pictured to show the exposed brain and location of the cyst. Lastly, I spent time in interventional radiology observing Dr. May’s cases. I was able to observe an inferior vena cava filter being placed with the aid of x-ray. I was able to wear the lead vest and observe from inside the surgical suite. 

Exposed cerebellum after lower portion of skull is removed. Top to left.

Exposed cyst next to the pineal gland.

Week 8: The End

Today marks my final entry, and the end to my immersion experience as well as time the end to my time in New York City. Leaving the city and the hospital will be a bitter sweet experience.  I am excited to return to Ithaca and continue my PhD work, but I will miss the people, challenging problems, and clinical work here at New York Presbyterian. This week I focused once again on lab work. First, I finished all remaining experiments and data analysis and second, I made a detailed plan with other members of Dr. Spector's lab on how we would like to continue collaborating and finish the project in the long-term. I truly hope to remain in contact with Dr. Spector and the members, as well as others I have worked with, and continue the work that I begun this summer. Looking back, I was able to make some significant progress on the project this summer and helped the lab overcome so hurdles they faced. The dynamic of engineers working with medical students or clinicians is a unique relationship that I have come to cherish. Overall, the immersion experience has taught me a great deal, and given me important insight to how medical devices, biomaterials, or tissue engineered constructs are actually used in the OR or clinic. This knowledge will surely impact how I approach my own research back in Ithaca. 

The experience as a whole has made our class closer and created some strong relationships at Weill Cornell. The shared experience has shaped us all and given us a great deal of perspective not only in our work, but in the medical field as a whole. At our last dinner, Dr. Wang emphasized once again the importance of always thinking deeper about what you are working in and analytically approaching a problem. All important things to remember as I move forward.

Week 8: In the end

This week ended as fast as it began with research taking over my entire week. My goal this week was to wrap up my research project as well as to visit some additional locations before leaving New York City. While my stay in NYC has been filled with adventures, I really missed the relaxed, quiet life in Ithaca. I am looking forward to hearing crickets outside my window instead of car horns and ambulances and can't wait to get back into my own lab and continue my research thesis.

This week I ran my last sets of drug trials using FAK inhibitors and bladder cancer cell lines. I completed only a small quarter of the project and did not reach as far as I had hoped. I really wanted to be able to finish one combination experiment where I combine chemotherapeutic drugs and FAK inhibitors to determine their synergistic or antagonistic activity. However, being in lab for only 3 weeks has greatly reduced the number of experiments I could complete before the end of the project. I managed to complete a few things here and there but I certainly would have reached far ahead if I had started sooner than I already did. That being said, the time I spent in lab has been truly valuable and taught me some new things.

Outside of lab, I also revisited the OR and observed a few more surgeries. I also plan on visiting Queens and potentially Brooklyn before leaving for Ithaca. This summer immersion experience has left me with wonderful memories and experiences to cherish, as well as so many insights into the clinical world. In the end, I am certain that I will utilize the observations that I've made during the program towards my research thesis and future career.

Week 8: Nuclear Medicine

This is the last week and I need to wrap up my research project, specially the data acquisition as well as do the last observership, which was in the Nuclear Medicine.
NM is a branch of medicine that uses radiation to provide information about the functioning of a person's specific organs or to treat disease. In most cases, the information is used by physicians to make a quick, accurate diagnosis of the patient's illness. The thyroid, bones, heart, liver and many other organs can be easily imaged, and disorders in their function revealed. In some cases radiation can be used to treat diseased organs, or tumors.  The most common radioisotope used in diagnosis is technetium-99 with six hours half life producing 140 Kev. For daily quality control, they use cobalt 57, called sheet source, which has one year half time producing 120 Kev which is close to technetium. For the daily quality control, we started at 7 am and counted four million of sources. Old sheets may produce five Thousand counts per second and new sheets 15,000 counts per second. Then we do the error table using the water and plastic phantom to set the machine's baseline. These daily quality controls is meant to make event and consistent signals. When the crystal get the radiation, emits photon, the detector generate analog current based on photon, and machine transfer the analog signal as digital signal to be stored.For the first scan be used GE nuclear medicine/CT 640 Machine which does nuclear medicine plus CT scan.
A more recent development is Positron Emission Tomography (PET) which is a more precise and sophisticated technique using isotopes produced in a cyclotron. A positron-emitting radionuclide is introduced, usually by injection, and accumulates in the target tissue. As it decays it emits a positron, which promptly combines with a nearby electron resulting in the simultaneous emission of two identifiable gamma rays in opposite directions. These are detected by a PET camera and give very precise indication of their origin. PET's most important clinical role is in oncology, with fluorine-18 as the tracer, since it has proven to be the most accurate non-invasive method of detecting and evaluating most cancers. It is also well used in cardiac and brain imaging.New procedures combine PET with computed X-ray tomography (CT) scans to give co-registration of the two images (PETCT), enabling 30% better diagnosis than with traditional gamma camera alone. It is a very powerful and significant tool which provides unique information on a wide variety of diseases from dementia to cardiovascular disease and cancer (oncology).Positioning of the radiation source within the body makes the fundamental difference between nuclear medicine imaging and other imaging techniques such as x-rays. Gamma imaging by either method described provides a view of the position and concentration of the radioisotope within the body. Organ malfunction can be indicated if the isotope is either partially taken up in the organ (cold spot), or taken up in excess (hot spot). If a series of images is taken over a period of time, an unusual pattern or rate of isotope movement could indicate malfunction in the organ.

Check out this videos:

Week 8

For my final week, I divided my time between the pathology suite and finishing up my part in the research project, gathering the last few cases necessary to move on.  So I again shadowed the pathology residents, some I hadn't spoken to yet, primarily in grossing.  I was able to attend a conference for a specialty I hadn't attended yet, CVT, and was able to see some very interesting cases.  My final signout for breast was also very interesting; it took most of the morning because there were so many cases and most of them were very difficult to diagnose, meaning I was able to see as the pathologists and residents exchanged ideas to determine a consensus.  One of the cases was for the surgery I attended last week, so I had an easier time following the discussion, which I appreciated.

It's hard to believe that the summer went by so quickly, but here we are.  I enjoyed my time here immensely, and I appreciate the opportunity.  I am especially grateful that I was assigned where I was.  Everyone was friendly and patient, taking the time to explain everything they did regardless of how simple the concepts were to them.  In the end, the people truly made a difference, and I don't think I would have had the experience I did without them.

Week VIII: The End

Technically, it should be the end of the summer immersion. But for me, it seems more like a start. This week I started to contribute something real to the review work. I worked with another senior medical student as co-investigators to do the meta-analysis. The so-called meta-analysis is meant by its name. It is a method to study both the quantitive and qualitative data/result from the chosen literature for a larger statistical impact. We searched all the possible literature and screened through them to validate the ones that were considered as inclusions. Then we had two discussions with our advisor and identified the comparison method/result we made among different MR imaging modalities. We also confirmed my future involvement in this project. Another piece of good news was that my IRB got approved, and I was able to conduct more humans related research. I am grateful I could start to build my collaboration with my clinical advisor.

On Friday, I was fortunate to talk with Dr. Kuceyeski to learn about her research during the farewell reception. From her, I learned something about machine learning application to the field of neuroscience, which was impressive. For always, I feel comfortable and welcome talking with staff and students in WCMC. They are patient and helpful. I am deeply indebted to people who encouraged and helped me during this summer: the technical staff in MRI control rooms, the doctors I shadowed, the fellows I talked to, the medical students I learned from, and so on. It would be a beautiful piece of memory in my life.

Besides the joy of learning from the Immersion, I also love to explore the city a lot. I walked four of the bridges on the east side: Williamsburg Bridge, Brooklyn Bridge, Ed Koch Queensboro Bridge, and Manhattan Bridge. It was fun seeing around during the spare time. I will come back whenever possible for the collaboration and the taste of the city life.

Week 8

It's hard to believe that this was the last week of the immersion term.  This week I was again able to spend time in the OR, clinic, and working on research.  The highlight of this week for me was the last surgery I saw.  This was a particularly interesting hip revision surgery for an implant which was both infected and loose.  This surgery was definitely on of the more complex ones I have seen and contained a lot of interesting techniques including an osteotomy.  The original implant was removed and replaced with a temporary spacer cemented in with antibiotic containing cement.  After about 3 months this spacer will be removed and replaced with a permanent implant.  This surgery was a clinical example of a lot of the research I have been exposed to throughout the immersion term.  Dr. Bostrom's lab is currently doing a lot of work looking into implant infection in a mouse model to both better understand it and improve treatment of infected implants.  To see an infected implant revision in a patient really helped me to better understand the motivation for this research and appreciate its clear clinical relevance.  I think this particular experience kind of encapsulates this immersion experience for me in a nutshell.  Going into the OR and clinic to see patients who are in pain and struggling due to the disease we are studying provides powerful motivation for our research in Ithaca to improve our understanding and treatments for OA.  Seeing the clinical side of things also allows you to more clearly see where important holes in our understanding of the disease progression occur and where currently treatment methods fall short and could be improved upon.

Overall, this has been a great experience!  I was so impressed with the hard work and dedication of all of the doctors, PAs, nurses, research staff, and everyone else at HSS.  Everyone was so helpful and welcoming to me. Dr. Bostrom was a wonderful mentor and I am very grateful to him for making this such a wonderful experience for me.  I learned a lot from him and had a great experience shadowing him over the past 8 weeks.  It was also fun to live in NYC for a while and I tried to take advantage by exploring the city, culture, and museums.  While it was definitely interesting to see the clinical side of things but I think I am now ready to get back to a research focus in Ithaca.

Eight Entry: To all who wish to prosper

The summer went by fast. Amidst the days spent in the operating room, the long hours in the molecular biology labs, the relentless hot morning and the long subway rides, I learnt a lot. From the reason behind my overwhelming fear of getting lost in the crowd, the increasing need to redefine my identity, the racial divide present in this country's economy, the laborious hours of the medical staff, the altruistic passion of some doctors, to the reason why I decided to complete a PhD, I learnt a lot. None of the motivational speeches or well crafted literary works of renowned philosophers, scientists and humanists, could have taught me better than the first-hand experience I gained this summer participating in this program. The ingenuity in the instrument design, the creativity in the treatment options, the steadfastness of doctors in providing care, and the insatiable thirst for knowledge of those around me, have been my daily routine for eight weeks now. It is not so hard to believe the summer came and went amidst all these experiences.  The knowledge I gathered not only about myself but also about the medical practice and patient-care will not go wasted. 

My last week here was spent wrapping up the works I completed and formulating ones I am excited to undertake back in Ithaca. The time I spent reflecting on the purpose of my research, its audience and ultimately the people it hoped to helped gave me new purpose and aspirations. I probably will not have another experience like this but I can say with certainty that I will have an even better one now that I have experienced what it is like to work alongside those who save lives on a daily basis. The attention to details, the clear vision, the unshakable faith and confidence in the skills they developed is to me what makes hospital staff the highly respected professionals they are. Those same characteristics are those I hope to gain and emulate throughout my PhD career. 

In all things considered, I had a great summer, one which will be etched in my memory for a long time. So to all who wish to prosper, let us make good use of the experience we gained here. 

Seventh Entry: A Sneak peek

For these last two weeks, I decided to focus my posts on experience relating to the research work and how my time in NYC has helped me come to terms with the path I hope to walk. In fact, I enrolled into the Cornell BME program with a clear plan of where my life was headed and what it would look like in a series of five years milestones. After successfully completing my PhD, I hoped to start a career in Pharma working in R&D, managing various aspects of drug discovery and re-purposing. However, working in the Transplant program here, I found a very important niche of the Pharma industry I would like to focus on. That is Clinical trial planning and data analysis. The idea came to me after the conversations I had with my direct supervisor. As she introduced me to the department and gave access to their daily meetings, I got a first hand experience to the discussion which goes on between Pharmaceutical companies and Hospital staff when implementing clinical studies aimed at assessing the efficacy and safety of specific formulations.  

The exchange brought to light the fact that there is a disconnect between how clinical trials are planned by Pharmaceutical companies and how hospital professional conduct their daily care. For example, the metrics given by Pharmaceutical reps in assessing disease progression were either textbook ideas or very limited. The clinical staff kept updating the metrics and proposing additional diagnostic tests as the discussion went on. Although the exchange was fruitful in laying out a more applicable plan for conducting the study, it clearly pushed its completion back a couple of months due to the unforeseen variables unaccounted for during the planning on the Pharma side of the table. The experience opened my eyes to very important aspect of the drug development and commercialization process I had never paid much attention to. 

Clearly there is a lot to be done in planning better clinical trials and streamlining the process. This is in itself an opportunity I would not have had a chance to uncover had I not participated in the Summer Immersion experience. Now, I am paying a lot more attention to how Pharmaceutical companies plan their clinical trials and the composition, background and experience of the team in charge of the process. What I hope to learn is where the disconnect originates and how with my PhD training and some additional advanced work I could fill the gap between industrial planning and actual medical practice.  

Week 8

As I expected, the last week in New York was a mix of both excitement and sadness.  In terms of research, I was able to culminate my projects and am leaving in a position that opens possibilities for collaborations between my current lab in NYC and my main lab in Ithaca.  Although I am leaving some ongoing projects, I was happy to hear by the members of the lab that they would still want my input.  Overall I feel like this was a fantastic experience.  I feel like I was coming into this immersion term being able to thoroughly understand my field of research, however I learned a lot and now am a much better scientist. 

Socially, this immersion term has made our first year class stronger and a tighter community.  This week was hectic trying to get everything organized for our departure.  I tried to do some of my favorite things in the city one last time, and I cannot wait to come back into the city in the near future either to continue my research or a long-term job.

Week 8

In the final installment of my blog posts about my sweet but short time being immersed, I will document both my final acts and my final thoughts on the program. I started the revision process for my manuscript, sending it to the authors, editing the figures and captions, and continuing to discuss future collaborations with my mentor. In addition, I tried to spend as much time as possible in the clinic and OR since this opportunity may not present itself again in the duration of my Ph.D. In the final procedure I observed in the OR, the patients was a fit, young person who had intact cartilage over an osteochondral lesion. Therefore, Dr. Kennedy chose to operate using a "trap door" procedure instead of completely removing the cartilage and using bone marrow stimulation or AOTs. However, during the procedure it became clear that the current surgical tools were inadequate for the operation. Afterwards, we discussed a new surgical tool set that we hope to collaborate with industry to manufacture. In the coming weeks I hope to submit my manuscript, and continue seeking advise from the professional clinicians I have had the pleasure to work with. Overall, I have acquired both professional networks and friends, and it is sad to leave. However, I look forward to my future research and collaborations.

Pce. Lve. Rebecky.

Week 8 : INR and Cardio Thoracic

I spent this week briefly in Interventional Neuroradiology (INR) and Cardio Thoracic Department.

In INR I shadowed doctors evaluating artery-venous fistula in the brain by using fluoroscopy. The fistula was causing blood to flow from the artery back up through superior sinus (SS), causing pressure buildup in the brain. The doctors reached a conclusion to block section of the SS because, as the patient was young they concluded that the brain would develop other vessels to transport the SS venous blood out of the brain.

Figure 1: Superior Sinus in the brain (Source: http://www.slideshare.net/saeed45/venous-sinuses)

In Cardio Thoracic Department I was able to observe application of Robotics in performing surgery on a leaking mitral valve (Figure 2) (Thanks to Andrea De Micheli for taking me to these doctors who he was shadowing).

Figure 2: Mitral valve (Source: http://www.daviddarling.info/encyclopedia/M/mitral_regurgitation.html)

After placing the patient under anesthesia, Echo cardiogram was used to evaluate the status of the mitral valve (MV).  The Ultrasound Doppler was inserted in the esophagus and live images of the mitral valve were obtained and MV status evaluated.

Perfusion machine/pump was used to circulate the blood in the patient by bypassing the heart. Femur vein was accessed from the perfusion machine for venous blood and femur artery was accessed for arterial blood. The aorta was blocked by a balloon to stop blood circulation through the heart. The heart was then arrested by using Potassium solution through the coronal arteries which feed the heart muscles. At this moment the perfusion machine took over the heart’s function.

Prior to perfusion, four openings were made through the chest for the two robot arms (left and right), the camera, and the operation port, where stitches and the scissors could be passed.

The doctors accessed the MV by opening the left atrium.

During the procedure the surgeons first stitched up atrium appendage which was supposed to close after birth but was still open in this patient.

They then stitched two cords at A2 to the papillary muscles to repair MV leak. The surgeons then stitched together A3P3 to increase cooptation area. Finally, they put a ring around the MV, to decrease its circumference, by stitching through the annulus and the ring.

 Figure 3: Mitra valve anatomy (Source: http://www.mitralvalverepair.org/content/view/50/)

After the stitching, tests were done to evaluate the repair, by filling the ventricle with saline and see if there were any leaks. Then the heart was brought back to function by using pacemaker, and further leak tests and repair were done. Then some other tasks were carried out to restore the patient.

I was also able to shadow doctors performing repair of the aorta arch graft which was leaking. This was open chest surgery.

Final Week

It is with mixed emotions I write this last blog post.  New York City has been my enjoyable and energetic home for these past couple months, however I now have to return to Ithaca.  While I will miss many of the amenities and constant activity of the big apple, Ithaca has a relaxing pace of life that gives me the energy I need to thrive at research and live a healthy lifestyle.  New York has such a fast paced mentality that I felt like I haven't slept this entire trip, as I was trying to cram in as many research and New York experiences as possible in the short seven weeks.  While in Ithaca I would allow myself to recoup and sleep in on the weekends, this summer I have been on a tight schedule, trying to rush to places like Brooklyn early in the morning to get to scenes before they are mobbed by the New York public.

This past week I shadowed one last surgery, to give my brain something to chew on for the trip home.  While the scheduled surgery was something I had witnessed many times prior, the case itself was unique and even the surgeon claimed he had never seen anatomy as we saw in the patient.  The patient was undergoing a laminectomy and transforaminal lumbar interbody fusion (TLIF) to treat spinal stenosis by decompressing nerve roots and then fusing relevant vertebrae.  Once enough bone and soft tissue was removed to visualize the nerve roots, we noticed there were more than 2 nerve roots at the L5/S1 spine level, crossing in a tangled mess that made it impossible to implant an interbody cage that would normally help stabilize the spine during fusion.  Due to this complication, Dr. Hartl had to implant autologous bone and bone graft material to fill the disc space after discectomy.  While radiology is important to help diagnose ailments and prepare for surgery, on the spot decisions must be made in surgery to ensure the best outcome for the patient.  It is understandable why surgeons need to go through long durations of schooling and training; they need to be prepared to deal with the vast array of anatomical or unexpected complications without second guessing their instinct.

The weather for my departure today is fitting; there is heavy downpour with thick cloud cover that makes the city thick with humidity.  Had there been bright sun with a nice breeze, I would've rather skipped the packing and scurried to central park for a long run through the endless expanse of grass and gardens.  I cannot feel too meloncholy, I know the city will always be here and there are jobs aplenty.  I will soon be back, breathing the air where citizens from the far ends of the earth travel to see glimpses of our great American city and begin new lives in search of the American Dream.

Thank you for everything New York, it has been a pleasure.

View of the New York Skyline

 Empire State Building (Left) and Chrysler Building (Right)

Prologue: Week 8

This is the final week of Immersion. Overall, I was exposed to research and clinical observation in the fields of plastic surgery, oncology, and neurosurgery. This week I finalized the algorithm I have been working on and tested it on various images collected by members of the lab. I look forward to using this algorithm to analyze data and contribute to the progress of the experiments. 

Dr. Prince hosted an interactive talk on Monday. It was formatted as follows: each student who attended was given a small case to examine in which he presented an image of a medical condition and we were to try to identify the imaging modality, relevant anatomy, and physical condition in the case. This was a good exercise in learning the process by which conclusions are derived from medical images of patients.

I attended the neurosurgery clinic this week and observed some final surgeries. Two procedures in particular stood out to me. The first procedure entailed endoscopic removal of a colloidal cyst from the third ventricle of a patient's brain. I have been extensively lectured on endoscope technology in my undergraduate curriculum so it was refreshing to see how truly powerful this technology can be in the OR. With a single, small incision in the skull, the surgeon was able to remove a cyst (which had been causing symptoms of headache, dizziness, and memory loss in the patient) without disrupting the integrity of the brain tissue. This, to me, represents an outstanding case of the coordination between biomedical engineering and medicine. The second case was the removal of a tumor from the brain of a pediatric patient. This surgery was much more risky and invasive, as a larger incision was made in order to access the tumor. One of the challenges with this type of tumor, although the tumor was not identified as malignant, is to remove all of it within one surgical procedure. 

One of the most notable differences between the clinical and research worlds that I have identified is the push for translational research. I have observed that in order to push work to a translational forum or a clinical trial there is often a fine balance between basic (in vitro) studies and higher-risk animal or clinical trials. I am interested in learning how regulatory committees and groups attempt to standardize this procedure to produce the best possible outcome. This concept would be an interesting thing for future students to note during the Immersion term. 

This will be my final mention of NYC food. First, I would recommend the gnocchi from 1742 Wine Bar and the falafel pita from Abaleh. Finally, we enjoyed some pretty great ice cream from Sedutto. Pictured here is the blueberry flavor.

Week 8: Goodbye New York City

As the program was coming to an end, I tried to observed other procedures outside the interventional radiology department. Dr. Pua was able to arrange an observership with Dr. Stiles from the department of cardiothoracic surgery. It was an exciting opportunity since I have no experience in the field. The first patient I observed suffered from hiatal hernia. Before this case, not even in my wildest imagination, I would expect the stomach to be able to push through someone diaphragm and into the chest region. In order to treat this case, the team of doctors pulled his stomach into the abdomen, which left me in awe. Another interesting case occurred during the replacement of esophageal stent from a patient who underwent esophagectomy. The physicians explained in detail the complicated case to me. I was very surprised that a patient can survive a total esophagectomy since the stomach needs to be pulled up to the chest region.

Finally, aside from observing cases in the operation room, I continued my research in predicting the outcomes of patients with traumatic brain injury (TBI). From my preliminary results, it seems that my small sample size of patients was preventing the GRNN from making accurate prediction. However, even though the summer immersion ended, I will continue working on this project during my free time in Ithaca. I will ensure that my data have been correctly processed. In addition, I will try different training schemes for the machine learning algorithms. By comparing the results of different methods, I hope to gain a better understanding of my dataset and to determine whether or not is feasible to create a model for TBI.

I can’t believe this was the last week of the summer immersion. It was a bittersweet experience. One part of me was really happy to go back to Cornell in order to complete my doctorate degree. I was also very excited to move into my new house in Ithaca with my new housemates and our cats (Kylie+2 new kitties!). However, I missed the city. After all, I spent 3 years of high school in Queens and 4 years of undergraduate in Long Island. This area was a placed I called home for many years. Woes aside, I am very grateful to have met a wonderful team of clinicians and researchers who have mentored me throughout this period of time. I am also very grateful for what New York City had to offered. I have lost count of all the places I have been with friends and family during this short summer. It was truly an unforgettable experience.

New York

concrete jungle where dreams are made of

Week 7

In my second to last week of immersion my goal was to finish a draft of my manuscript so I could spend the last week editing. I was able to observe more surgeries in the OR including a peroneal tendon reconstruction and microfracture of an osteochondral lesion. When I was not in the clinic, I was working on the manuscript. I had to meet with Dr. Deyer again to go over a new grading system for the cartilage lesions. We decided that the initial grading system was not the best choice, and moved to use the International Cartilage Repair Society scoring system Since we had already gone through all of the patients previously, we were more efficient this time around. In addition, Dr. Deyer took the time to show me what to look for on the MRI scans in order to grade the lesions. Afterwards, I spent most of my time reading literature in the field in order to write the discussion. I finished a copy of my manuscript at the end of the week and received the final statistical reports from Robin. On Monday I will give Dr. Kennedy and Yoshi my draft and start the editing process next week. It's exciting that I have been able to complete a study in my short time here!

Week 7

In the clinic this week, I sat in on rounds with ID fellows and also got the chance to see some in-patients in addition to the out-patients from the general ID clinic.  The most interesting case my clinician and I discussed was that of a patient who contracted malaria during a trip abroad.  After returning to the US, the patient started to develop febrile symptoms and was prescribed two courses of the same broad spectrum antibiotic, on separate occasions, since a definitive diagnosis was never made until the patient decided to seek out an ID specialist at the NY Presbyterian.  Since antibiotics are generally not effective for treating malaria, the patient’s symptoms would return after each course was finished.  Interestingly enough, the particular broad spectrum antibiotic (not named due to potential publication) that was prescribed neutralized almost all erythrocytic stages of plasmodium falciparum but left the exoerythrocytic gametocytes viable.  This essentially means that patients infected with p. falciparum who take this particular antibiotic will be able to temporarily suppress the symptoms of malaria but remain infectious, since the uptake of gametocytes by Anopheles mosquitoes is responsible for the transmission of malaria.  This is the first time this phenomenon has been observed clinically so the clinicians from the ID department are looking to publish a paper in the New England Journal of Medicine, which is pretty exciting.  I had the opportunity to look at the blood smears from the patient and sure enough, banana-shaped gametocytes (see below) could be found easily but the other stages, not so much. 

For my research project, I’ve finally been able to amplify all seven beta subunits of the falciparum proteasome and will send out the last two subunits for sequencing next week.  I will also be starting a mini-exploratory project my last week which will involve mimicking the mechanical filtration of the spleen in vitro using a matrix of metallic microspheres.  I will provide more details regarding this mini-project in my next post.  If successful, this biomimetic filtration technique will be a useful research tool for studying diseases where the mechanical properties of red blood cells are altered.