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.