Week 3: Eleana

 This week was an eventful one. We started the week shadowing in neuropathology. We got a lesson in different types of brain cancer and anatomy of the brain. On Wednesday our experimental plan was approved and I began by making some alginate gels for our experiment that starts on Tuesday. I then try to autoclaved materials as well. I ended up having to go back to Ithaca to get some materials in order to properly do the experiment for next week. On Monday, I performed a craniotomy on a mouse and a brain dissection for practice. Lastly, I got to work with some imaging software called HALO, to segment some immunofluorescence histology and am working on a new module to segment histology images.

Week 3 - Arina

 This week, we finished working on surgeries for the cohort of our experimental mice. I’m glad I had the chance to do this: at this point I feel significantly more confident as a mouse surgeon than I did at the beginning of June. I also attended another lab meeting and got more context for one of the ongoing projects in the Liston lab. In addition to lab work, this week I got to see a clinical procedure. On Wednesday, I saw a MRI-guided focused ultrasound ablation. It was done in an Alzheimer’s patient to help stabilize tremors. It was remarkable to see just how significantly the patient’s control of motor function improved after. The precision is stunning too. I know that the brain region targeted in this procedure is adjacent to other important regions (e.g. speech-related), so the clinician has to be extra careful about not accidentally damaging those areas. Next week, I am looking forward to getting started on 2P imaging in the Liston lab, and hopefully getting to see some more clinical work. 

Week 3-Meichi

This week, I had the opportunity to engage in discussions with members of Dr. Newman’s lab about the details of the ongoing immersion projects. It was incredibly insightful to hear different perspectives on the project and explore what aspects of it could be particularly interesting and worthy of further investigation. The exchange of ideas with the team sparked new thoughts about the potential avenues for research and also how our my future research could contribute to a deeper understanding of breast cancer treatment.

I also attended the ICSBCS Breast Surgery Didactic Lecture. Dr. Mark Robson’s presentation on the management of women with a monogenic breast cancer predisposition was particularly fascinating. He shared statistical data comparing the effectiveness of different management strategies, providing a picture of how clinical guidelines are developed and tailored for individuals at higher risk for developing breast cancer. This lecture emphasized the importance of preemptive care and early interventions, particularly for those with a genetic predisposition but who have not yet been diagnosed with cancer. Dr. Robson’s approach to developing risk management plans for these patients was eye-opening, highlighting strategies that aim to either prevent cancer or mitigate its effects if it does occur.

Moreover, I attended a breast cancer case discussion conference. It was enlightening to see how doctors collaborate to make clinical decisions regarding patient treatment. The decision engaged many factors ranging from evaluating diagnostic data to discussing treatment options. I found it fascinating to learn about the tools and methodologies that help medical professionals weigh the pros and cons of various treatment options. 

Week 3 Anuj

 This week was another interesting week featuring a few robotic organ removals (prostates and kidneys), several imaging (cystoscopies), and some patient consultation shadowing. Another key feature in robotic surgery that I noticed this week was the rapid temperature sensing and control used in the cauterizing forceps/scissors. The instant heating and cooling of the instrument with real-time audio feedback assist the surgeons in making precise cuts. Besides, I made more progress on the wide-view cystoscope project and completed some preliminary design aspects. I will be ordering the design parts next week and using Weill Cornell's 3D printed services to fabricate a few housing materials for the camera used for the cystoscope. Hopefully, by the end of the week, we will have a decent prototype if all things go well. 

Week 3- Zuzanna

This week I was able to see some surgeries which was very interesting as it was the first time I had observed any. I was able to observe breast cancer related surgeries, including a masectomy and lupectomy.  It was definitely shocking at first to see the surgeries and the removal of tissue, but after watching a few I was able to recognize what the steps were and what they were aiming to do. Each surgery was a little different, due to either the preferences of the patient or the methods of doctors involved. First, I saw a bilateral masectomy, and I was surprised how many people were involved, from nurses to PAs, to pathology and oncology and plastic surgery- it was quite tight in the room! Some patients prefer to have breast reconstruction done, but this patient also had her implants removed and with her specific history, preferred not to reconstruct. Another surgery I saw only removed a mass, but required removal of the nipple due to the proximity. The next one however removed only a mass, but without affecting the nipples. It was really interesting how many methods of removal there are, but even the methods of tumor localization. Some patients had a radioactive seed locating the mass, some had a staples, and some had wires sticking out of their chest locating that. I did not realize how many methods there are for localization but it depends partly on the patient and partly on the radiologists preferred method of marking a tumor. Watching the whole process really gave me an idea of the morphology of the disease and methods of resection. My research in Ithaca concerns making immunotherapeutic hydrogels to place next to tumors to improve immune infiltration, and seeing these surgeries gave me an idea of how realistic applying those may be given various situations.

I also continued to shadow in clinic this week and we had a few very interesting cases where I learned more about how chemotherapy and immunotherapy can be combined, or even given consecutively, but with certain risk factors that can make it difficult for a patient and doctor to decide next steps with the risks and benefits.

In the lab I continued to analyze some cancer organoid images and some next steps in the project.

Week 3: Kirtana

At Dr. Prince's lab this week, I did image segmentation of muscles from abdominal MRIs. This will now be used as training data to improve the AI model used for interpreting MRI scans. I also learnt how to conduct an abdominal MRI which was very cool. I started on a new project to determine poorly segmented images in order to further improve the training data.

With Dr. Choi, I discussed the details of the lung cancer project. We came up with a plan to implement the PLCO model on our data while also trying to form a new model which may be a better fit. I worked on a project proposal this week to solidify my aims and anticipated manuscript timeline.

Overall, it was a productive week with many learning experiences. I am hoping to focus more on the lung cancer project next week and start my data analysis.

Week 3: Anais

This week started off with another OR day.  This time, we got to see two different myomectomy surgeries, one robotic and one abdominal.  I even scrubbed in for the first surgery and was able to see it more closely.  It was very cool to see how the surgical robot was controlled and what went into preparing the incisions. Also interestingly enough, the myomectomies seemed more tricky than the hysterectomies we saw last Friday.  I was also glad to see the surgeries to day side by side and be able to compare them.  This week, I also shadowed Dr.Fenster in her private clinic.  Once again, it was very interesting to see the interactions between doctors, nurses and patients.  Because uterus related problems and fertility can be an emotional topic, I noticed how well they were able to calm down the patient and create a welcoming and safe space.  I also got to see a wide array of different treatment options and discussions.  Pei Wen and I also presented on our literature review updates and discussed ways to apply current methods to the research goals of Dr.Fenster’s and Dr.Wolf’s collaboration.

Week 3: Allison

 Early this week I was able to see how mice with glioblastoma receive radiation therapy. It's a specialized machine for small animal irradiation that first takes a CT scan, so the administration of the x-rays is very precise to the tumor. I also received training on how to extract and process mouse brains for RNA-seq. I was introduced to a resident in neuropathology, who took me to shadow Dr. Liechty for his morning cases as he diagnosed brain tumor biopsies. After being in breast pathology last week, it was very interesting to see the different features of each cancer type and contrast which additional stains are ordered to diagnose cancers from different areas of the body. The rest of my time this week mainly entailed having meetings with Dr. Demaria and Dr. Vanpouille-Box, as well as speaking with people in the lab to finalize experimental plans and make sure we have the supplies to start experiments next week!

Week 3: MJ

This week started off with me being recruited to donate blood to be a healthy control in a Lupus study. The study is interested in microRNAs and other non-coding RNAs, which is a special interest to me because my own research looks at how non-coding RNAs regulate skeletal muscle regeneration. I then went to our weekly meetings, where a professor here presented on using AI in fertility to predict aneuploidy and pregnancy outcomes. I also attended HSS research's weekly seminar, where a visiting professor from Yale presented on treating skin conditions that cause fibrosis in the middle layer of the skin. I also met with members of the Donlin lab to discuss my research project this summer, which involves analyzing bulk RNA sequencing data of CD4/8 mutants to look at specific pathways and genes that are up/down regulated and could be involved in inclusion body myositis. Additionally, I presented a journal club for the Donlin lab on muscle fiber heterogeneity beyond myosin heavy chain isoforms. In the clinic, I shadowed Dr. Fernandez as he saw patients with various muscle disorders, such as dermatomyositis, inclusion body myositis, and rhabdomyolysis. 

Week 3: Brenda

This week, I had the opportunity to meet with my colleague at Cornell, Salman. At Cornell, I work in collaboration with Dr. Bonassar, and through Salman, I receive bone samples taken from the knee joint by Dr. Andreas Gomoll, Dr. Sabrina Strickland, and Dr. Scott Rodeo. Salman took Hamilton and me to observe an arthrotomy knee osteochondral allograft with fresh articular cartilage to the left patella, performed by Dr. Gomoll, essentially a procedure where damaged cartilage and bone on the patella (kneecap) are replaced with a fresh osteochondral allograft from a deceased donor. It was fascinating not only to observe the surgical technique but also to learn how the samples I use in my Ph.D. research are collected.

At the clinic, I also shadowed a particularly interesting case: a patient who had undergone total knee arthroplasty without initial complications, but began experiencing periprosthetic joint infections (PJI) three years post-operation. In the lab, we’ve been revisiting bacterial culture methods for Staphylococcus aureus and E. coli. We prepared bacterial solutions, submerged knee implants in them, and used crystal violet staining to visualize the resulting biofilm. Aside from that, I’ve been reviewing lab protocols and refreshing my technical skills.

Week 3: Pei Wen

This week, I was most astonished by the robot-assisted and open surgery myomectomies, surgical procedure to remove uterine fibroids, we observed early in the week. Coincidentally, both myomectomies were performed on the same day, so it was especially interesting to compare and contrast both strategies for myomectomies. Compared to the minimally invasive hysteroscopic fibroid removals we observed in our first week, these myomectomies were more time-intensive, taking 3-4 hours each and required more precise and deeper cuts as the fibroids were larger in these cases. In the context of the robot-assisted surgery, it was reminiscent of the hysterectomies performed last week where the internal abdomen and uterus were accessed through a small incision at the umbilicus supplemented with additional smaller port sites to accommodate the robotic arms. For the technology itself, I was surprised by the resolution, depth, and precision the robot and associated interface offered. While Dr. Fenster is accustomed to robot-assisted surgeries, she mentioned tactility and pressure sensitivity were features that were lacking for this approach. For the surgery itself, I was surprised by the many layers of tissue of the uterus and how deep the incision needed to be to remove the fibroid in this case. As such, I was unsure about the suturing process, but I learned that, contrary to my initial assumption of a single pass, the closure was performed in multiple passes, beginning with the deepest layer and progressing outward. In the context of the open surgery approach, the process was comparatively more invasive, requiring a few centimeters incision at the abdomen. Surprisingly, there was less bleeding compared to the robot-assisted approach. Dr. Fenster informed us that most patients prefer open surgery, as it was considered more cosmetically pleasing. However, recovery is typically faster in robot-assisted cases. 

Week 3: Adam

 This week I spent some time in Dr. Spector's outpatient clinic shadowing pre-operative planning and post-operative follow-up appointments. In the clinic I also learned more about skin grafting and the wound healing process. This translated well to the OR, since I was able to watch some skin grafts be placed over surgical sites from tumor resections. I also watched a DIEP flap breast reconstruction, which is a very interesting procedure where skin, fat, and blood vessels from the abdomen were used to rebuild a patient's breasts after a bilateral mastectomy. The DIEP reconstruction is a microsurgical procedure, since individual blood vessels in the tissue are reconnected in order to supply blood to the reconstructed breast. They also performed a microneurorrhaphy on the patient, connecting some of the nerves from the abdomen to potentially provide sensation to the reconstructed tissue. This was the first microsurgery I have seen and it was really interesting to watch. In Dr. Spector's lab this week, I learned how to use the microtome to section tissue from paraffin blocks, and also learned how to stain with hematoxylin and eosin to visualize tissue microanatomy. This will be useful to confirm the results of the immunofluorescent staining later. 

Week 3: Teagan

This week, I had a good mix of clinical and research experiences. In the OR, I was again able to watch a total knee replacement and a total hip replacement, along with some total knee revisions. The reason these total knee revisions were needed was due to a recent implant recall that caused many of a company's implants to be faulty as a result of improper packaging. This improper packaging degraded the polyethylene in the implants, causing osteolysis in patients' bones. Each of the three knee revisions was slightly different; one was particularly difficult for the surgical team because the bone was especially osteoporotic. This situation is far from being resolved as Dr. Bostrom continues to have pre-operative appointments discussing the need to move forward with revision surgery as a result of this recall with other patients, I saw some of these during my time at the clinic this week. Another experience that I had in the clinic was that I sat in on a consultation for a patient who, through surgical intervention (double hip and knee replacement), would regain the ability to walk. It was inspiring to see the impact that these implants can have on patients' lives. 

On the research side, I completed my mouse training, which now grants me access to the Faxitron imaging equipment. I also purchased all the necessary materials to 3D print the jig that will hold the mouse's limbs during imaging. I also got the mouse femurs that I dissected earlier this summer Faxitron imaged by a member of the lab, and I analyzed them in ImageJ to better scale the design of my device. I also attended a meeting about Qupath and how to effectively utilize that technology as a model for the lab's experimental analysis. The person training us was informative on how the system can be utilized at a lower level as a tool that can only be used by the person who trained the data, vs. optimizing the training and code to be a model whose technology can be used across people in the lab since the programing is more robust. Qupath is a program that could be of potential use to my lab work back in Ithaca as well!

Week 3: Joe

Hamilton and I performed more sectioning and H&E staining for the collagenase-based model of tendinopathy. We were able to visualize the patellar tendon in embedded mouse knees, taking photos to begin preparing for ImageJ analysis. I applied for a grant to work on a research project across Ithaca and HSS, making use of HSS' excellent resources for musculoskeletal research. 

I spent more time in the clinic this week, watching two arthroscopic procedures in the knee and a shoulder joint replacement. Both arthroscopic procedures involved the use of two unique tools: one to shave down large chunks of fibrotic tissue and a cauterizing device used to smooth the surface. Notably, two Stryker employees were present for the shoulder joint replacement to guide the on-site construction/customization of the shoulder implant. I'm looking forward to the next week of research and surgeries!

Week 3: Hamilton

This week, I observed a partial patellar allograft replacement surgery. The procedure addressed significant cartilage degradation by replacing nonfunctional tissue with donor graft material. I was struck by the precision and adaptability involved—surgeons used an array of tools resembling those in a mechanical workshop, including carts of rods, sizing guides, drills, and bone saws to tailor the donor tissue to the recipient site. The hands-on, tool-driven nature of the procedure highlighted the intersection of engineering principles and surgical practice.

On the research side, I successfully prepared several murine patellar tendon sections using a microtome, which will be used for downstream H&E staining to evaluate tissue structure and morphology. 

Week 3: Orren Shachaf

This week, both clinical and research work picked up. During Dr. Moore’s Medicaid clinic—which she holds once a month—I saw some particularly difficult cases, including one 49-year-old woman with bilateral frozen shoulder (also called adhesive capsulitis), which is characterized by joint stiffness and subsequent pain that results in limited motion, either through stiffness or as a pain response.  Another one of these cases was a 21-year-old male who had had acute lymphoblastic leukemia and, as a result of his sustained use of steroids (which decrease immune system activity), developed avascular necrosis in his knee and got a total knee replacement; at the clinic—two years after his knee replacement—his knee was nearly double the width of this calf, and he had about 10-15 degrees of motion, making it extremely difficult for him to walk and perform other normal, daily tasks. He had been referred to Dr. Moore, since she performs arthroscopic knee surgeries for fibrotic tissue cleanup, but the amount of scar tissue in his knee joint would be too time-consuming for her to perform arthroscopically; further, Dr. Moore noted some calcification behind his patella (heterotopic calcification), which was most likely the biggest factor inhibiting his motion. Ultimately, he will likely need to get a fully new total knee replacement, which was a really unfortunate conclusion. In addition to in-clinic patient interactions, I observed three arthroscopic knee surgeries, which were all cleaning up fibrotic tissue formation following prior knee surgeries. 

Week 3: Aidan

This week I observed more MR guided focused ultrasound ablation cases, as well as two more surgical procedures. The focused ultrasound cases are so exciting every time - they are able to precisely ablate a 3mm sphere of brain tissue called the Ventral Intermediate Nucleus (VIM) of the thalamus. This helps reduce/eliminate tremors permanently. This weeks cases were bilateral - meaning that it was the second MRgFUS procedure, targeting the other half of the brain (patients receive their first treatment 9-15 months prior). Symptom relief is immediate, with the only known side-effect being temporary nausea and in rare cases some numbness in fingertips/facial regions. Recurrence of tremors occurs is ~10% of patients, and is theorized to be due to an incomplete ablation of the VIM, but little is understood about what causes the recurrence. Recently, Dr. Kaplitt submitted a paper to JAMA regarding bilateral MRgFUS. Many in the field are cautious about the side effects of performing symmetrical ablation. However, Dr. Kaplitt has found that in his patients, performing the procedure bilaterally improves patient symptoms without any additional consequences to unilateral ablation.  

Week 3: Amelia

This week I continued my mouse surgeries, and we're making good progress towards a group of 20 mice with cranial windows for 2P imaging. I also attended another lab meeting, and this provided more excellent context for me about the Liston Lab's previous and ongoing work, specifically related to how depression may be related to systemic and chronic inflammation. This week I was also able to see the clinical side of the hospital for the first time. I observed two of Dr. Kaplitt's procedures: one was MRI-guided focused ultrasound (MRgFUS) ablation targeting the ventral intermediate nucleus of the thalamus for helping with tremors. The other was a bilateral implantation of a deep brain stimulator (DBS) into the globus pallidus internus (GPI), for advanced Parkinson's disease. In both of these procedures, the patient is awake so that their tremors can be assessed as the protocol goes on, and it was incredible to see the extent to which tremors decreased throughout these procedures. 

Week 3: Nina

In the third week of immersion, I got to see my first robot-assisted surgery. I saw a living donor liver transplant surgery using the Da Vinci 5 surgical robot. It was really amazing seeing how the machine looks and operates in real life. While I have seen videos of the robot being used, I was shocked at how fine the resolution of the camera was and how precise each of the probes were in removing tissue. I also was surprised by the incorporation of multiple surgical tools into one robotic probe. The Da Vinci forceps attachment could cauterize and cut tissue, which decrease the amount of tool switching the surgeon had to do. It was really fascinating seeing how sealing tissue via stapling and suturing was done using the robotic arms. The vacuum pressure and gas exchange system incorporated into the machine, like the cauterizing and stapling tool, were also configured with audible cues to alert the surgeon to errors. I found that the auditory feedback helps the surgeon determine how long to use tools and allows them to monitor the success of failure of an intervention. One of the issues for this machine is that it the camera probe often had to be pulled out and cleaned manually. Stray tissue, bleeds, and system pressure/temperature can all contribute to build-up on the camera lens. Therefore, I think some optimization could be used clear the lens in-vivo and prevent time being spent on monitoring the state of the lens. Later this week, on Friday, I will see another liver resection. Together, experiencing clinic and surgeries has allowed me to see the importance of pre-transplant organ preservation and understand the value of surgical time when performing a transplant surgery. Up to this point, Dr. Samstein, my thesis advisor, Dr. Schwartz, and I have been finalizing the aims for the research collaboration that will ensue this summer. As liver transplantation involves human subjects, we have been careful to examine logistic hurdles to ensure the safety, de-identification, and consent of all involved parties before starting any research. My project will focus on examining the technique of normothermic machine perfusion used to preserve donor livers before transplant. More specifically, I will try to expand readouts for organs before transplant to better understand organ viability and predict graft success in patients. 

Week 3: Wendy Zimmerman

 On Monday and Thursday this week I shadowed sham and shoulder impingement surgeries on young and aged mice. This procedure is used to create a tendinopathy model in the rotator cuff. The RNA sequencing data that I have been examining is from this same experiment, but with smaller cohorts. Four mice per group were used in those earlier experiments and for the procedures I shadowed there were 15 mice per group. It was very interesting getting to see the process of placing the clip in the subacromial space to cause the impingement, and it was very nice getting to talk more with Dr. Eliasberg and the postdoc with whom I am working. On Tuesday, I learned the RNA isolation procedure used by the lab. I will be helping with the processing of the tissue samples over the course of the summer for the shoulder impingement and ACL models. My lab back in Ithaca has done some RNA isolation, so learning this technique will be helpful for my future work. On Friday I will finally get to shadow my first human surgery with Dr. Eliasberg. Next week, I will be shadowing procedures on mice using ultrasound to look at tendon properties. I am excited for this as some of my previous research used focus ultrasound for therapeutic delivery, so I am interested in seeing other ways it can be used in research. Additionally, I also finally received Dr. Rodeo's schedule and will be shadowing him in the clinic and in surgery. In July, I have also schedule a couple of days where I will get to shadow Dr. Eliasberg in the clinic. I am very much looking forward to getting to do more on the clinical side of this program.

Week 3: Ben

For my third week in NYC, I did a lot of wet lab research and clinical shadowing. To start off my week, I got to practice the islet extraction protocol that the Alonso lab performs routinely. I was given post mortem mice to practice the procedure, in which I cut open the abdomen of the mice, carefully remove the ribcage and remove the heart so I have easy access to the gallbladder. I then clamped the small intestine where it meets the bile duct, then through the gallbladder, I inject collagenase to disassociate the pancreas. I then excise the pancreas and further digest it, and centrifuge it to isolate the islets (Image 1). The following day, I picked out the intact islets that survived overnight incubation and further disassociated them onto a 24-well plate (Image 2). After, typically the lab performs different assays to assess its insulin and glucose responsiveness or treats them with an inhibitor, but the mice I performed the procedure on were practice mice with genomic defects in its insulin secreting gene INS. Thus, it was not worth the time and resources to perform further analysis, and I discarded them. However, this was valuable practice that I will keep doing throughout the summer so that I can master it. This will be an essential skill to take back with me to Ithaca.

Image 1: Islets after isolation from mice.

Image 2: Islets after disassociation and plating.

I also engaged in talks with a potential collaborator that can contribute a lot to the success of my project. I talked to Dr. Shahin Rafii, whose expertise is in organ-specific endothelial cells and their function. They recently published a paper in Cell about using an engineered adaptable endothelial cell line that vascularized and promoted the function of islets. Their work and ongoing efforts align with what I am trying to do, and working with them will definitely mutually benefit both of us. Dr. Rafii has invited me to present my research at their lab meeting, and I will get a more comprehensive view on how exactly we can help each other out, and what areas we can collaborate in.

Finally, I got the opportunity to shadow surgeries. Through my friends in my cohort, I was connected to Dr. Lisa Newman, who is a oncology surgeon specializing in breast cancer. During my time shadowing her clinic, I saw five surgeries. Two of them where mastectomies, which are full breast removal, and three of them were lumpectomies, which are partial breast removal. For the mastectomies, one procedure was a single breast removal, while the other was a double breast removal. For both procedures, the nipple was not preserved. For the lumpectomies, different strategies were used. One strategy used was a pellet-guided tumor extract, in which a radioactive pellet was injected near the site of the tumor pre-op. During the procedure, a probe that detects radioactive activity was used to detect the position of the pellet, and it was them excised. This strategy is used when the tumor is deep into the breast tissue and cannot be definitively felt by hand. Another strategy used was a guide free approach. In this case, the patient was able to feel the lump in her breast, and the tumor was located on the posterior of the areola and felt very defined. In this case, they simple added a metal clip which was inserted as part of a routine mammogram. Due to the easy access and physical identification of the tumor, no further guided strategy was needed. Finally, a wire-guided approach was used, where a metal wire is inserted into the site of the tumor pre-op using a mammogram as a visual guide. Similarly to the pellet-guided strategy, this was used for difficult to feel and access tumors, but it is typically offered as an alternative strategy if the patient is uncomfortable with radioactive material being inserted into their body. Also, the strategy depends on the radiologist on the case and which strategies they prefer. However, this strategy can be invasive, as needle will be sticking out of the breast. It was very cool to see clinical practice and the thought processes that go into the decision making on how to remove a breast tumor from a patient.

This week was very productive, and I not only made strives in getting resources that will directly help me drive my thesis back in Ithaca, but I also got valuable insight on clinical practice and the decision matrix that goes on there. Moving on to next week, I wish to learn more protocols related to islet biology, further establish potential collaborations, and continue to observe clinical practice in other surgery areas.

Week 3: Peter

 This week didn't have a ton going on with Juneteenth and all that. My cells were slow to grow last week so we are postponing my Flow Cytometry experiment. In the meantime, I've started up a histology project. There are a number of TMA's from lymphoma patients that have been stained for EBER, EBNA2, LMP1. Using HALO, I'll be determining the number of cells positive for these markers for each biopsy. The software has been pretty quick to learn and I hope to meet with a pathologist next week to confirm my results. I should be shadowing my first surgery next week so I'm pretty excited for that.

Week 2-Meichi

This week, I had the opportunity to observe several breast cancer surgeries under the guidance of Dr. Newman. Witnessing these procedures firsthand was an eye-opening experience that deepened my understanding of the complexities involved in the surgical management of breast cancer. Dr. Newman thoughtfully walked us through each procedure, explaining the decision-making process and addressing our questions in detail.

One of the most fascinating aspects was the use of tumor localization techniques, such as breast seed localization and needle localization. These methods involve placing a small marker or seed near the tumor, enabling the surgeon to precisely target and remove malignant tissue while preserving as much healthy tissue as possible.

I also observed a variety of advanced surgical tools that assist in real-time intraoperative decision-making. These tools not only help guide precise excisions but also provide critical feedback, enhancing surgical accuracy and safety.

Overall, this is a profound learning experience for me and I hope to contribute to advancements that further enhance the precision and effectiveness of cancer treatments.

Week 2: Arina

 This week, we started diving into more lab work and learning new techniques. I got a chance to do a couple of surgeries and try a viral injection. Although I have performed those before in a different lab during my undergrad, the equipment we used was completely different, so it’s a bit of an adjustment. I also got to do some tissue work — specifically, slice some paraffin-embedded brains on a cryostat. Here, I experienced similar emotions: I’ve only used a cryostat a couple of times before, and the rest of my undergraduate I only worked with a vibratome. It’s curious to approach those familiar-but-not-quite techniques with better awareness. I am beginning to notice just how much improvement can take place even with something you think you’re somewhat comfortable with, and how many little hacks you can learn from other people. For example, someone mentioned using biopsy punches for marking the location of a future cranial window. This wasn’t something I thought of before, but it worked pretty well!

We also got to attend the lab meeting where one of the students in the lab practiced their A-exam. I haven’t seen an A-exam before, so it was informative to see what is typically being prepared, what the format is, and what the ratios of background and experimental content are. 

Week 2 : Adil

This week was heavy in the clinic and OR. We started out with attending the weekly multidisciplinary tumor board on Monday. Doctors discussed treatment plans for several patients. Doctors from surgical oncology, medical oncology and radiation oncology discussed treatment plans for several cases, depending on the grade of tumor, previous tumor and treatment history etc. It was very interesting to see oncologists specializing in different fields discuss and customize treatment plans for each patient individually.

Tuesday, I was fortunate to shadow Dr. Newman in clinic. Dr. Newman saw 7 patients. Most of them were either follow-up consultations who had surgeries in the last few weeks or newly diagnosed breast cancer patients who came in to discuss their treatment plans with Dr. Newman. It was amazing how Dr. Newman patiently discussed treatment options and plans with each patient and answered all of their questions. On Wednesday and Thursday, I shadowed Dr. Newman in the OR. She performed several surgeries ranging from bilateral mastectomies, radioactive seed localized lumpectomies to sentinel lymph node biopsies (to test for invasiveness of the cancer). One of these surgeries was particularly interesting, a wire guided lumpectomy instead of a radioactive seed to track the location of the tumor and calcifications. On Friday, Dr. Newman conducted a didactic session wherein she discussed Ductal Carcinoma In Situ (DCIS) and the COMET (Comparing an Operation to Monitoring, With or Without Endocrine Therapy) clinical trial for DCIS. In the lab, we had to redo a few steps for the TCR library preparation as the QC report from last week's TCR library was not great. We have submitted the new sample to the genomics core facility and will go ahead with the sequencing if the QC results come back positive!

Week 2: Kirtana

 This week I started shadowing Dr. Martin Prince and working with Dr. Eunji Choi as my research mentor. It was a wonderful, fast-paced week with a lot of learning. With Dr. Prince, I had a chance to evaluate MRIs of polycystic kidney disease. I learnt the anatomy of the abdominal cavity and more about the AI model used to automatically annotate each organ. I also learnt about how the model could be improved and started contributing to a research project to improve the performance metrics of the model. As a BME student with some background in AI, I found this very interesting and informative. I am excited to continue contributing towards the project and learning more about patient cases from Dr. Prince. 

I had a meeting with Dr. Eunji Choi on Monday to discuss my research project on lung cancer. We will be looking at the susceptibility to lung cancer in LMICs based on data from Demographic Health Surveys. We will then compare it to existing risk prediction models and the incidence of lung cancer in India. The hope is to publish some of our results as a report. I am very excited to get started on this project and hope to have more updates on this next week.

Week 2: Anais

  On my second week of immersion, I was able to witness several more surgeries ad got to sit in on very interesting meetings. On Monday, I shadowed Dr.Fenster on to hysteroscopy surgeries conducted to remove and take biopsies of polyps.  One patient had a surprise cyst, which was also removed during the surgery.  Pei Wen and I also presented on our previous literature review from last week.  This meeting proved quite informative and Dr. Wolf suggested meeting again next week to further discuss the protocols and methods briefly mentioned during the meeting.  On Tuesday, I thus started off on creating my slides for the meeting.  On Wednesday, Pei Wen and I sat in on a few of Dr.Fenster’s meetings. The first meeting of the day was a meeting to discuss in detail steps toward applying for an IRB.  This meeting is particularly relevant for a project idea Dr. Fenster and Dr.Wolf are hoping to collaborate on.  The next meeting of the day was a fibroid center conference meeting, where several doctors and practitioners discussed particularly interesting fibroid cases.  Dr.Schiffman, was particularly helpful in describing and explaining each MRI presented and stoping to further elaborate on what they were talking about.  I found this session really cool and loved learning more about how patients are diagnosed and how doctors collaborate to decide how to best move forward with each case.  On Thursday, I continued to work on the presentation and joined in on a few meetings.  We had another meeting regarding Dr. Fenster and Dr. Wolf’s collaboration, this time they discussed prototyping and initial animal trials.  I ended the week by observing two more surgeries on Friday.  Specifically, they were laparoscopic hysterectomies.

Week 2: Amelia

This week, research got very busy very quickly. Monday, Tuesday, Thursday, and Friday were spent doing cranial windows and GCaMP injections in mice for a study in the Liston lab. These mice will be imaged in three weeks with a 2 photon microscope. I enjoyed the problem-solving of merging techniques from each of our labs. I got to see different methods of doing cranial windows and learn how to do the injections solo. I also attended my first lab meeting on Wednesday, which was a practice talk for a thesis proposal, which was well timed as it gave me some great context about the lab's previous and current work. I also got to try brain slicing on a Cryostat, which I had previously only done on a Vibratome. 

Week 2 : Zuzanna

This week I went into clinic with my clinician and shadowed as he saw patients. He sees patients in urological oncology, so I saw many cancer patients. It was interesting to see the different types of patients he sees, from people who are in chemo and immunotherapy, as well as people who are getting prepped for surgery. It was interesting to learn the different combinations of therapies used to treat patients, and even with these less invasive treatments, surgical intervention is often included. I learned removal of the entire bladder is still standard even if it has a tumor removed as it still has relapse risk. In my Ithaca campus lab I am making immunotherapeutic hydrogels so it can be interesting to see how to combine those with current standards. In lab, I currently have been analyzing cancer organoid images, so that can be a useful skill for some imaging I want to do in my Ithaca campus lab as well.

While my clinician mainly has male patients due to the predominance of males affected with the cancer he treats, there was a female patient that had previously had a cancer treated by my clinician, but came back with what was a uterine benign tumor, where it was optional for her to remove it, and was sent to an OB/GYN as they further specialize in uterine tumors. It is interesting to see the clinical flow of further consults and treatments, but also see the emotional affect it has on patients, as the clinician must remain professional and think of the treatment option, while also consoling a distressed patient. I may see some surgeries in the next few weeks.

Week 2: MJ

I started this week by attending lab meeting for the Donlin lab at HSS, where various lab members gave small research updates on their work. The research spanned from nuclei isolation troubleshooting to using machine learning algorithms to predict protein structure. I also attended a research in progress talk at HSS for a visiting scientist in the Rodeo lab, who presented on his work trying to characterize the biomarkers for predicting outcomes after meniscus tear and subsequent surgical repair. I similarly attended the rheumatology department's journal club at HSS, where two papers were presented on the association of treating kawasaki disease with various doses of asprin and coronary heart aneurisms, as well as the efficacy of using AI for identifying Raynaud's disease. This week, I also shadowed Dr. Fernandez in his clinic, where he treated many patients with various forms of myositis, such as dermatomyositis, which is an autoimmune disease that causes inflammation of the skin and skeletal muscle and presents with various symptoms. Dr. Fernandez is working with Donlin lab and other institutions to build a myositis registry from patient samples, so I also saw what those patients look like and shadowed a member of the Donlin lab as the blood sample was processed to isolate peripheral blood mononuclear cells.  

Week 2: Eleana

This week was an exciting week full of looking at pathological samples and learning new information. Allison and I started the week off with presenting our research to the Dr. Demaria and Dr. VanPouille-Box labs. It was a very long presentation, but we were able to share the research we do back in Ithaca with them and get their input on our work that we do, and the project proposal we have for them to work on this Summer. From the initial meetings, they approved our project and they thought that it will be exciting to work on. We spent the next few days working on protocol development, and figuring out what materials that we would need to start the project off. During the beginning of the week we also viewed a mice craniotomy where, mice were being implanted with glioblastoma and will then undergo radiation treatment. Thursday and Friday we then shadowed Dr. Demaria in the Breast Anatomical Pathology lab and got to sit in as they viewed cases and their slides to determine a diagnosis of the patient. We had a tour of the grossing lab and saw a lumpectomy being grossed by one of the residents. We were showed around the lab and saw the microtomy, and special stains room. Friday, we were in pathology again and viewed cases and later attended a grossing conference where residents had to identify what kind of tumor they had. Finally, on both days we attended conferences where the slides and cases are reevaluated in a group to get a consensus.  

Week 2: Allison

 On Monday, I was able to see craniotomies and stereotactic injections of glioblastoma cells into mouse brains to establish models that will be used for radiation and immunotherapy in the coming weeks. On Tuesday, Eleana and I presented our research and an immersion project proposal at a joint meeting for the labs of Dr. Demaria and Dr. Vanpouille-Box, and we have been working with members of the labs to create experimental plans and get materials together. I have spent the past two days in the anatomical pathology department shadowing Dr. Demaria and a resident and fellow in breast anatomical pathology. In the mornings, I have seen how histology slides of breast, lymph node, and skin biopsies/lumpectomies are analyzed to diagnose cancer. I have also been able to attend multiple conferences, including consensus conferences to see how more complex cases are discussed between clinicians to agree on a final diagnosis, and a grossing conference to walk through uncommon incidences of kidney cancer and a brain cancer autopsy. I went on a tour of the histology and immunohistochemistry labs to understand how a tissue sample goes from a patient in the OR to a slide for diagnosis, and was able to shadow the process of preparing a lumpectomy for histological staining. Overall, I have been able to learn a significant amount about how cancer is diagnosed, and I have a much better understanding of what tumors actually look like in the body.

Week 2: Ben

This week, I continued to shadow in the Alonso lab. I learned more about their projects in expanding beta cell mass to recover insulin secretion capacity and treat diabetes. I observed their FSIVGTT protocol in action for the first time, and also shadowed the staining and imaging of pancreatic tissue for a few of the ongoing projects. Also, I followed Dr. Alonso on Thursday to her outpatient clinic, where I observed her rounds in checking in with diabetic patients. From this, I learned a lot of things about diabetes care and the field. First, it was really interesting to see how widespread Dexcoms (continuous glucose monitors) are in the clinic. They were user friendly, simple to use, but very robust in their measurement of blood glucose, which provides lots of use for the clinician to make recommendations in their treatment regiments.  Second, it was interesting to see how normalized Ozempic and other GLP-1 agonists are in diabetes care. At this point, much of my knowledge of Ozempic came from the media and its usage by celebrities to lose weight, and it is from media where my perception of it is controversial. It was really insightful to see how useful it was in the clinic in diabetes management as it decreases hunger and caloric intake of diabetes patients to prevent high glucose spikes. As per my clinician's words, GLP-1 agonists have been a game changer in diabetes management, as it helps lower blood glucose while decreasing weight gain, which is a drawback of increasing insulin content in bolus injections. Finally, I learned about the intersection of lifestyle changes and pharmacological intervention in diabetes care, and how endocrinologists have to navigate this line. A lot of their recommendations depends on what the patient ultimately wants, but they need to be able to communicate medicine and science to them effectively if they believe pharmacological intervention is absolutely needed, which is often the case in patients with dangerously high levels of chronic blood glucose, ketones, hemoglobin A1C, and triglycerides which need to be brought down immediately in which lifestyle changes cannot do. Moving to next week, I will be presenting my research to the lab to introduce them to my research in organ-on-chip models, and I will be practicing the islet isolation protocol for the first time. Also, I plan to shadow in the bariatric division to observe surgeries. Finally, I have plans to talk to the Shahin Rafii group, whose work revolves around engineered adaptable endothelial cells and co-culturing them with tissues such as pancreatic islets and cancer cells to study how they adapt to them. Their research complements mine, and I aim to engage in a discussion to see how we can collaborate and help me drive my project back when I go back to Ithaca.

Week 2: Aidan

 Another very busy procedure week. Two very exciting cases. One involved awake brain surgery with two electrodes inserted to treat Parkinson’s disease, and listening to the brain circuits converted into sound was a fascinating experience. The other type of procedure (3 this week) involves inserting two flexible electrodes into the spinal cord, which can directly stimulate the spine. I have to learn more about the technology/how these work to treat Parkinson’s. Something interesting about the implantation surgeries is that there is always a company rep from the device manufacturer, who is trained in the specific device. In these electrode implants they use live x-ray to carefully thread the electrode up the spine, so there is a very minimal incision area along the spine. 

Week 2: Adam

This week was much lighter in the OR than last week, but I observed the placement of a patient-derived skin graft, as well as a mastectomy and tissue expander placement. Mini lessons in the OR this week included the history of the mastectomy and how to calculate the maximum safe dose of local anesthetic for patients. I also spent a lot of time in the outpatient clinic, where I was able to observe follow-up visits for patients that I had seen in the OR so that Dr. Spector and his team could monitor the healing process. We also saw a patient that was recovering from a traumatic injury to the ear, and it was informative to learn how the reconstructive process changes from reconstruction that is a planned part of surgery to reconstruction after a traumatic injury. I also learned a lot about scar tissue formation and scar revision. We are planning on doing some fluorescent imaging of patient-derived adipose tissue, so I started laying the groundwork for those experiments. 

Week 2: Nina

This week, I started off by seeing a liver transplant with Dr. Samstein. I saw the liver pre-transplant while it was being preserved under normothermic machine perfusion using the TransMedics Organ Care system. Dr. Samstein showed me all the different features of the machine, such as the oxygen pressurization system and efflux routing ports, that are designed to provide constant circulation to the organ. I learned that the transplant was coming from quite a few states away, so it was flown in the previous day and immediately put on the pumping system. The organ then sits overnight until the patient is prepped for surgery the next morning. Some of the advantages of this system are the ability to provide oxygen-rich red blood cells to the organ, prevent thermal injury, and decrease ischemia. Static cold storage can only preserve organs for around 4-6 hours, however organs pumped using normothermic machine perfusion can preserve for nearly double or triple this time. Yet, I learned perhaps one of the most overlooked advantages is the time for medical professionals to rest and prepare for the surgery. This increased preservation times enables donor organs to travel further distances and also allows surgeons to more thoroughly examine an organ before accepting or rejecting it. However, I was told that this time window is so crucial in allowing the surgical team to prepare and perform well-rested. I learned that transplants at night run the risks of understaffing and can put strain on physicians who are operating well into the night. Normothemric machine perfusion is a way to decrease errors and overall risks to the patient, as it give more time for the surgical team to plan.

I also got to see the OrganOx organ preservation system, which works off the same concept of normothermic machine perfusion to preserve organs. I learned that one of the main differences for this machine is the cost and sometimes even organ viability. Both OrganOx and TransMedics systems offer ways to pump organs, but their use varies patient to patient. When I saw the OrganOx machine it was not in use, but I was able to examine all the features and interface design. Dr. Samstein noted that a large difference between these systems is the way the organ is oriented while it is being perfused. The TransMedics system situates the organ about a foot or two higher than the OrganOx system, which can be easier to monitor the organ, as it is closer to eye level. I learned that sometimes the liver can injure itself while sitting these perfusion system simply due to its own weight. I though was very fascinating because this phenomena does not occur in physiological states due to the liver being cushioned by other organs in our bodies.

I also shadowed Dr. Samstein's clinic this past Thursday. This involved seeing a variety of cases ranging from genetic conditions, cancer, organ donor screening, and liver transplant consultations. We also rounded through the surgical ward to follow up with patients post-op. I met residents, fellows, med students, nurses, PAs, dietitians, and pharmacists who all work together to help patients heal. I was surprised that the there were so many professionals from a variety of fields who all went to round together. Next week, I will see a robotic liver resection surgery and continue going into clinic with Dr. Samstein.

Week 2: Pei Wen

On Monday, I shadowed Dr. Fenster during hysteroscopic procedures for the removal of fibroids similar to last week. Following, we had a meeting where we presented our findings from literature review. We were particularly interested in procedural protocols and specific techniques, so we focus our next presentation on these aspects throughout the week. On Tuesday, I accompanied Dr. Fenster in primary care, where she follows up with patients post-surgery in addition to performing smaller scale procedures. I observed a more point-of-care approach to remove fibroids and polyps, which offered an interesting comparison to the experience in the OR. Moreover, observing patient consultations provided valuable insight into the broader scope of outpatient OBGYN care. Lastly, on Friday, I had the opportunity to observe Dr. Fenster perform two hysterectomies. The procedure was more time-intensive than fibroid removals, and since this was my first time witnessing this surgery, I was particularly fascinated by how the uterus was accessed through a single incision at the umbilicus. I was even asked to assist Dr. Fenster for a small portion of the procedure, so I also learned how to properly scrub in and participate in the surgical environment.

Week 2: Teagan

This week, I got the opportunity to start the clinical aspect of the immersion term. On Tuesday, I was able to meet Dr. Bostrom to discuss my research background and schedule days to shadow in the operating room (OR). In the afternoon, I was also able to go to the clinic with Dr. Bostrom and see how he interacts with patients. Dr. Bostrom is an orthopedic surgeon focused on hips and knees, so I got to observe both pre-operative consultations and post-operative check-ups for those cases. Some of the post-operative appointments focused on addressing pain and discomfort experienced by patients as a result of the procedures. It was interesting to see the steps the team took to understand how to best help their patients heal better and faster. One thing I noticed was that at each appointment, Dr. Bostrom sat down to be at eye level with each patient and made sure to address all their questions/concerns, ensuring they didn’t feel rushed.   

I also observed surgeries in the OR on Wednesday. I got the chance to see a total knee replacement, a total hip replacement, and knee revision surgery. For these surgeries, they create a sterile zone by pulling out panes of plastic to section off the part of the room used for the operation. When I observed, I stayed on the outside of the sterile zone and was free to move around to view the operation from different angles. Dr. Bostrom was able to do the total hip and knee replacements in about 30 minutes, which was much faster than I was expecting for such an invasive procedure! The revision surgeries took much longer, ~2 hrs.  

For the research portion of this experience, I downloaded the appropriate software and got trained on how to operate the 3D printer by Dr. Chen. I also continued working on my mouse facility training to get access to the Faxitron x-ray imaging machine.

Week 2: Wendy Zimmerman

 This week I spent some time working on a grant for a collaboration with Dr. Rodeo's lab. I really enjoyed working on figuring out how I could connect my project back in Ithaca to translational studies that can be done in Dr. Rodeo's lab, with his access to human samples. Additionally, I finally got to meet Dr. Rodeo during the lab meeting and hear ways I could potentially help on other projects within the lab. I also attended the Biomechanics meeting again this week, which was a talk given by Japheth Omonira in the Itai Cohen lab on creating a model for shear forces in cartilage. With the lab I also attended HSS's first Eid ul-Adha celebration and got to meet a variety of workers within HSS. In terms of research, I have begun examining the RNA Seq data to compare the differentially regulated genes across conditions after completing some background reading to understand how to examine the data. I have also contacted the schedule managers of Dr. Rodeo and Dr. Eliasberg and will be shadowing Dr. Eliasberg next week. Finally, I will also be shadowing some mouse shoulder impingement surgeries next week, which allow me to see the way a different lab induces tendinopathy.

Week 2: Peter

 This week has been pretty slow. The procedure I was to shadow this week got pushed back to the 24th as the patient had not stopped taking a certain medication. I have been doing a lot of background reading and have some cells to take care of now. The goal is to get a flow experiment started up next week so I'm super excited to learn that technique. I also shadowed some more mouse work. In the clinic, I saw some patients with varying levels of maladies. One had a pancreatic neuroendocrine tumor that while not malignant had shown a potential to grow. This patient will be getting surgery in July. Another patient had a tumor around their hepatic artery so it is currently inoperable. Hopefully chemo is able to turn it around.

Week 2: Brenda

This week has been very busy, but also very exciting! On Monday I got to shadow at the clinic and watch Dr. Carli and his PA (hi Lexi!) attend patients. It was interesting to see and learn about how to greet patients a certain way due to religious beliefs or a patients preference. Kind of like reading the room. I then got quizzed on anatomy by my clinician, and learned a lot on how to prep patients for knee/hip surgeries. It is very interesting because the implants are not a one-size-fits-all type of situation, so there is a variety of hip and knee implant sizes. I also got to meet some of Dr. Carli's regulars and hearing them all communicate in Italian (I speak Spanish so I understood some words). 

On Tuesday I attended weekly meetings and got to do some work in the lab. I had a typo on my last blog post, I am working on PJI but on implants used in humans (not on mice)! So I will be growing bacteria on implants and understanding how to remove the biofilm completely off of them, kind of replication what would occur to a patient. I have been re-learning a lot of my microbiology lab skills - I have not really touched on them since when I took microbiology in 2017, but still excited I remembered a lot!

On Wednesday I shadowed Dr. Carli at the OR, it was my first time being in an operating room! I got to shadow both a hip and a knee replacement. I found it very interesting getting to learn the protocol before the operation begins. I was told that the operations sound like a construction site, and they do. Dr. Carli does a great job on keeping me in the loop during surgeries and will sometimes show me pieces of bone  being taken out of patients. 

Thursday and Friday are both lab days. Since I am working with bacteria, a few days is necessary to let them grow. I actually got to touch and get to feel the implants used in knee and hip replacement surgeries, they are a lot thicker and heavier than I thought! Overall, I learned so much on assisting patients pre-operation, post-operation, and during operation. Learning on how to fix implants on these patients, learn about anatomy from x-ray scans but also in real life at the operating table. 

My weeks here at immersion will look along these lines as its all on a fixed schedule with Dr. Carli.

 

Week 2: Anuj

 The robotic surgeries performed this week by Dr. Scherr included three prostatectomies and a ureter reconstruction. The robotic surgery involves several biomedical engineering tools integrated medicine. Here are a few features of the whole system that I noticed this week. There is an endoscope camera inserted into one of the ports within the body which helps surgeons visualize the internal tissues, and this is the way in which they maneuver the robotic arms (tweezers, forceps, blades, cauterizing forceps) through the tissues/organs. These cameras are equipped with air suction on the surface, to remove vapor on the camera lens that can arise from tissue cauterizing. Similarly, the surgeon’s chair with the VR view, actually has a 3D projection of the camera, therefore making it easier to perform the surgery and mimic the motions using the robot.

The non-robotic surgery included one pelvic tumor mass removal. This surgery was performed with two vascular surgeons present because of the complexities involved with mass tumor’s angiogenesis and integration with the surrounding tissue, which must be carefully dissected during the mass removal. The mass was approximately 4 cm in diameter, but was only attached to few vessels, which made the surgery easier. Besides surgery, I reviewed several existing papers and patents on wide-view cystoscopes and camera integrated catheters for my other project.

Week 2: Joe Denisco

 I shadowed my first surgery ever (on my 24th birthday!). Anuj brought Hamilton and I to Dr. Scherr's procedure: a robot-assisted total prostatectomy. It was amazing to see the complexities of surgery first-hand, especially with the advancement of robotic surgery. Four metal tubes were inserted into a man's inflated abdomen, (as to not damage any internal tissue), in which the robotic arms slotted into. Two doctors sat on the sideline operating on the patient through controllers and VR headsets, their deft movements accurately reflected. Dr. Scherr vocalized each step and relevant anatomy, providing an excellent learning experience. In research, I continued with my histologic stainings and standardizing our sectioning procedure to provide consistent and region-specific samples. I'm looking forward to more surgeries and continuing sectioning samples at different time points within the collagenase treatment model.

Week 2: Hamilton

This week provided rich clinical and research exposure. I shadowed two complex surgical procedures that deepened my understanding of anatomy, surgical innovation, and clinical relevance to biomedical engineering. 

I observed a minimally invasive spine surgery to treat lumbar spinal stenosis. When spinal discs and fat build up, it can cause spinal nerve impingements and ultimately lead to paralysis. The nerve impingements need to be relieved by removing the insulting tissues. Using CT imaging for precise localization, surgeons accessed the spine through a series of 2.8 mm metal tubes, removing the lamina with cauterization and suction techniques. The procedure preserved the dura (where the impinged spinal nerves are) and successfully relieved two impingements in just under three hours—with only a small scar after intervention. Attached is a protocol if you would like to learn more: 

https://surgeryreference.aofoundation.org/spine/degenerative/lumbar/spinal-stenosis/miss-transforaminal-lumbar-interbody-fusion#introduction

I also shadowed a robot-driven prostate removal surgery through Anuj's clinical mentor, Dr. Scherr, utilizing the da Vinci robot system. This robot system has 2 "driver's seats" that are placed near the side of the room, which allows a medical student to perform surgery while the clinician directs them. Four metal rods were used to pierce the patient's upper stomach, and carbon dioxide was used to inflate the stomach so that the surgeon can view the patient's internal organs. The bladder was partially resected to access the prostate, which was excised while preserving fluid pathways to maintain post-operative urinary function. 

Finally, I continued to plan my experiments for the summer, aligning surgical insights with translational research goals.

Week Two: Orren Shachaf

Compared to last week, this week was more research-oriented than clinic-focused. When meeting with patients this week, I saw a couple interesting cases, including one individual who tore his lower biceps tendon while riding a mechanical bull; his injury occurred about two weeks from this Friday, when he will undergo surgery—I learned that, for tendon tears, it is important to conduct surgery sooner rather than later, as the tendon will continue to retract over time, making finding it and its subsequent repair more difficult. Additionally, I observed multiple injections of hyaluronic acid gels into the knee joint, with one patient having ~26 mL of synovial fluid removed from her inflamed/swollen knee prior to the injection. Regarding research activities, I assigned fibrosis scores to H&E-stained mouse knees from a study investigating the effects of EGCG on fibrosis (triggered by single hind limb immobilization). Additionally, I worked on the development of an immunohistochemistry protocol for the staining of urokinase-type plasminogen activator receptor (uPAR), which is a cell-surface protein widely induced during senescence. For the writing of this protocol, I was able to utilize a protocol from my lab in Ithaca that I have successfully performed and am familiar with.

Week 1: Hamilton

This week, I began hands-on training with the microtome and successfully sectioned murine patellar tendon samples—an exciting step toward histological analysis. I met with members of the Rodeo Lab to begin coordinating the logistics for upcoming experiments, laying the groundwork for a productive collaboration. Additionally, I completed several required online training modules to enable me to conduct research as I transition into active lab work. Lastly, I finalized plans to observe orthopedic surgeries, which will provide valuable clinical context for our research.

Week 1: Arina

 Week 1 was mostly dedicated to logistics. Coordinating a meeting with Dr Liston and his team took a little while, but we met by the middle of the week and made plans for the work that we will be doing in the next 8 weeks. The planning so far includes doing more surgeries, which will be good practice in general as this is something I will return to once I am back in Ithaca, as well as some tissue work - and, hopefully, data analysis, since this is something I am very interested in learning more about. In the rest of the week, we also got to see the confocal microscope, as well as their lab spaces. I am still in the process of getting my trainings done in order to be added to the IACUC protocol, but will hopefully successfully wrap it up by next week. 

Week 1: Ben

For my immersion term, I will be under the mentorship of Dr. Laura Alonso, who is a research endocrinologist whose lab aims to understand the mechanisms behind β-cell (the insulin secreting cells of the body) expansion as a treatment for type II diabetes. On my first day, I met Dr. Alonso and the lab and got situated in getting familiar with the projects through reading their past publications. I got the opportunity to see their frequently sampled intravenous glucose tolerance test (FSIVGTT) system, which is system in which catheters are inserted into the left femoral artery and vein of mice. This provides more sensitive and real time measurement of blood glucose and plasma insulin compared to the traditional system of static intraperitoneal glucose tolerance test (IPGTT). Furthermore, FSIVGTT can give measurements of more difficult to capture outcomes of insulin resistance (Si), quantify first-phase insulin secretion (AIRg) and glucose effectiveness (Sg), and disposition index (DI). On my second day, I attended the first lab meeting, where I got to know what projects were happening currently in lab. On the third day, I got to observe islet (the exocrine cell clusters which contain β-cells) extraction from mice, in which mice are euthanized and their pancreases are injected with collagenase to break down the organ so that the intact islets can be isolated from the surrounding tissue for further characterization and tests. This specific procedure is something I want to learn for my thesis work back in my lab, so this is something I am aiming to master during my time here in WCM. Days 4 and 5 were slow, so I continued to read on the Alonso's lab past work. I also worked with Dr. Alonso to get me connected with bariatric surgeons, as bariatric bypass surgery is a surgical intervention that I read about from a class I took last semester, and it would be a really cool full-circle moment to witness it in-person. I also have plans to accompany Dr. Alonso in her out-patient clinic work, where she will directly interact with diabetic patients and consult them with diabetes management.

Week 1: Meichi

 

This week, I had the opportunity to meet with Dr. Newman, a surgical oncologist specializing in breast cancer management, to discuss my research plan for the upcoming immersion program. During our meeting, we talked about the exciting opportunities I will have, including the chance to observe surgery, shadow patient consultations, and attend cancer case discussions.

I also attended a didactic session with Dr. Newman, where we covered the history of breast cancer surgery and the advantages and disadvantages of different surgical approaches for various types of breast cancers. It was enlightening to learn how clinicians make decisions about which surgical methods to choose for individual patients based on their specific circumstances.

For the research portion of my immersion, I will be analyzing genomic datasets from patients with liver diseases, including liver fibrosis, cirrhosis, and other liver-related conditions. I am eager to explore how these datasets can help us understand the molecular mechanisms underlying liver diseases and how we can apply this knowledge to improve patient outcomes.

So far, the experience has been very exciting, and I look forward to the next week’s activities and the new insights and skills I will gain through this immersive experience.

Week 1-Zuzanna

This week I met with my immersion advisor, Dr. Bishoy Faltas. I will be joining him in the clinic on Tuesdays to shadow oncological consultations. I met with my lab mentors to discuss the project I will work on. I am going to join a project on optimizing the imaging of T-cells within cancer organoids, probably using micro-CT. This week I shadowed culturing and imaging of cancer organoids. The culture methods are to be optimized to get more consistent organoids before coculturing with and imaging T-cell interactions, thus currently we compared various methods of organoid culture and its effect on the shape/cell distribution using fluorescent microscopy. After it is optimized we can try the micro-CT imaging.

Week 1: MJ

This summer, I will be working in Dr. Laura Donlin's lab and shadowing in Dr. Fernandez's clinic, both of whom work at HSS. Dr. Donlin is an immunologist working on understanding autoimmune and musculoskeletal diseases through work with patient samples, while Dr. Fernandez is a Rheumatologist who specializes in treating Lupus and various forms of myositis, a disease that causes inflammation of muscle and has no cure. This week in Dr. Donlin's lab, I met members of the lab and attended their weekly lab meeting. I also shadowed members of the lab performing flow cytometry on whole blood cells and discussed project options for my summer here. This week shadowing Dr. Fernandez, I followed him in the clinic as he saw to a wide variety of patients, from Lupus to various forms of myositis. There were several patients who were involved in a clinical trial to treat inclusion body myositis, a form of myositis characterized by muscle wasting and inclusion bodies in the interstitial space between myofibers. I also saw Dr. Fernandez as he worked in the Rheumatology fellow clinic, assisting Rheumatology fellows as they learn how to treat patients. Finally, I went with Dr. Fernandez to the motion analysis lab at HSS, where he is considering starting a trial for his patients to wear mechanical exoskeletons that would assist with walking, which some myositis patients greatly struggle with. I even got to try one on (pictured below)!

Week 1: Anuj

 

The first week of my summer immersion has been busy but quite extraordinary in the hospital. My clinical mentor is Dr. Douglas S. Scherr, the Clinical Director of Urologic Oncology of Weill Cornell Medicine. This week, I shadowed Dr. Scherr on clinical visits, observed procedures such as cystoscopy (visualization of the inner urinary bladder using a small-flexible pipe with a tiny camera), and shadowed his team performing surgeries. These surgeries included nephrectomy (kidney removal), prostatectomy (prostate removal), and cystectomy with ureteroileal conduit creation (removing the urinary bladder and connecting the ureters directly to the small intestine!). The main highlight was that these surgeries were performed using robotic arms controlled remotely by Dr. Scherr!

Similarly, Dr. Scherr is keen on working with technologies advancing the medical field. Back in 2010, he worked with my PhD advisor (Dr. Chris Xu) and Dr. Watt Webb (Dr. Xu’s PhD advisor) to patent the world’s first multi-photon endoscopy. For my summer project, Dr. Scherr shared some clinical challenges involving the current cystoscopy camera having a limited probe angle (0, 30, and 70 degrees), which requires constant rotation of the probes inside the bladder to visualize all sides clearly (Figure 1). The constant rotation and movement increase friction between the cystoscopy pipe and the urethral wall, which increases discomfort to patients. I will be working with Dr.Scherr to design a wide-FOV cystoscope to visualize the entire urinary bladder at once by minimizing movements of the scope. 

Figure 1. Tip-point angle of a cystoscope. This is the angle between the probe's direction and the center of the light field-of-view. 

Week 1: Allison

 
Early this week, I was able to shadow experiments in both the Demaria and Vanpouille-Box labs, which included preparing glioblastoma cells for injection into mouse brains and processing breast cancer tumors from mice treated with combinations of immunotherapy and radiation for single-cell RNA sequencing. Earlier today, I saw collection of lymph nodes from mice who had repeated rechallenging of glioblastoma after initial treatment and survival but never redeveloped tumors. The T cells were harvested for in vitro culture to study their activation and cytokine production. I have learned that immunotherapy can be applied with radiation therapy to provide greater efficacy than either treatment alone, and work is being done to translate these findings to clinical practice. Eleana and I will be presenting our research and a project proposal at a joint lab meeting next week, so we have also been working on putting that together. I will also be starting clinical shadowing next week to see how breast cancer is diagnosed in patients, which I am very excited for!

Week One: Orren Shachaf

This summer, I am working with Dr. Laura Moore in the Sports Medicine Department at Hospital for Special Surgery, where I will be shadowing her as she interacts with patients in clinic and performs surgeries and be conducting research with her arthrofibrosis-focused group. My introduction to interacting with patients and observing shoulder surgeries this week was quite exciting; despite being nervous about the surgical aspect of the program, I have actually found myself enjoying seeing both arthroscopic and open shoulder surgeries. In particular, this week I observed an arthroscopic rotator cuff repair, an anatomical shoulder repair (as opposed to a reverse shoulder repair, which switches the locations of the ball and socket), and a shoulder fracture repair which began arthroscopically and required a transition to open shoulder. Additionally, I have direction on the research project I will be working on this summer, which will focus on the role of cellular senescence on joint stiffness (particularly, resulting from fibrosis). This project relates very directly to the research I am hoping to pursue within the van der Meulen Lab at Cornell (my home lab), so I am both excited and optimistic about the prospect of this experience directly contributing toward my thesis (and potentially being extended as a collaboration).

Week 1: Adil

For the immersion program, I'll be working with Dr. Lisa Newman, who is a surgical oncologist at Weill Cornell Medicine. The week started out with attending the orientation session and getting to know more about the program deliverables. I also completed paperwork/training to get access to different hospital buildings. I look forward to attending patient consultations in the clinic and shadowing Dr. Newman in breast cancer surgery starting next week. 

Dr. Lisa Newman also leads the International Center for the Study of Breast Cancer Subtypes (ICSBCS). Hence, for my research project, I am working with Dr. Newman's research group to analyze genomic datasets of breast cancer patients. This includes analyzing datasets such as Whole Genome Sequencing and bulk or single-cell RNA Sequencing. As a part of my research project, I spent time accessing and organizing the datasets and their available metadata with help from other members in Dr. Newman's group. I was also fortunate to shadow the library preparation of a sample for single cell and TCR sequencing - my first close experience with bench work! 

Overall, it was a great start! Looking forward to gaining clinical experience and doing some amazing research over the next few weeks!

Week 1: Anais

On my first week of the Summer Immersion, I was able to get quickly settled.  On Monday, Carly Skudin and Dr. Kelly Gillen gave us an orientation on what we should expect this summer. Soon after, Pei Wen, Kirtana, and I met with Dr. Fenster to shadow her last case of the day.  I was able to observe a hysteroscopic procedure used to remove a patient’s fibroid.  It was quite interesting to be able to see what the fibroid actually looked like (it was less fleshy than I expected). I also got to see what the endometrial layer of the uterus looked like as well.  Later that day, Pei Wen and I had a meeting with Dr. Fenster and our PI, Dr. Wolf, to discuss some of our plans for the summer. 

As per our discussion, for the rest of the week I focused on reading up on the electrophysiology and neurophysiology of the uterus in order to better help understand the gaps and possibilities of electrically or mechanically  controlling uterus contraction.  On Friday, I was able to shadow Dr.Fenster at the Fibroid Center clinic where she does consultations.  It was enlightening to see how fibroids and other uterine related problems can impact patients day to day life and the frustration patients may feel.  It was great to see how relieved the patients seemed to feel after their consultations.  Additionally, I was able to see various MRI scans of patients with fibroids, which was quite informational as well.

Week 1: Nina

This week, I met everyone in the lab I will be completing my immersion project in. I got a tour of the Schwartz lab space and learned what occurs in each area of the lab. I started my literature review on normothermic machine perfusion of the liver, and examined current work for areas of improvement and expansion. I am completing basic saftey trainings for the lab and also finished the trainings for summer immersion. Next week, I will begin shadowing in the OR with Dr. Samstein and observe liver transplant surgeries. Later today, I will meet with Dr. Schwartz and Dr. Samstein to finalize details for this summer research project. We will focus on the data we can collect from tissue samples