Saturday, August 11, 2012

Week 7

This week wasn't too exciting from the clinical aspect. I got to see patients with Dr. Rosenblatt at the clinic, but I worked on my research project for the most part of the week. I was able to grow my cells on the silk films, however when I tried using my flow chamber on the silk films, I did not get a proper vacuum seal on my silk films most likely due to a void space created by the elevation of the silk film off of the bottom of the dish. However, I have come up with an idea to create PDMS molds to allow for the silks to adjust to the height difference. However because time has run out for the summer immersion program, this would have to be something I need to explore further on past the summer immersion program during my tenure at the Rosenblatt lab, since I will be doing my PhD in his lab at Weill Cornell Medical College.

Week 6

This week I did not really get a chance to visit the clinic or shadow a surgery. However, I did work more extensively on my project. I used the silk fibroin extract solution I produced last week to cast and process 14mm diameter silk films. Then I seeded my HCLE cells on the silks to used for my flow chamber experiments. I decided to use this time, much higher shear stresses to notice any marked differences in cell behavior between cells grown on tissue culture plastic and cells grown on silk. Under about 800 dynes/cm^2 of shear stress, I was able to drastic results. A certain percentage of cells had detached sheared off of the tissue culture plastic under the strong shear forces. I took time lapse images at different time points of 24, 48, and 72 hours to notice if there were any differences.

Week 5

On Monday, I had the chance to shadow Dr. Rosenblatt during three cataract removal surgeries. I was surprised to find out that patients are actually awake during the operation which also surprisingly lasts no more than 20 minutes. Most of these patients have been suffering from greatly reduced vision due to the cataracts. Most patients can immediately notice a restoration of vision when the cataracts is removed and the lens is replaced, and that is because although the patient is sedated, the optic nerve is not. During the rest of the week I worked a little bit more on my research project. Last week I had not seen marked differences in cell behavior or adhesion under low shear stresses. As such, I decided to grow more cells to repeat my experiments next week with greater shear forces. I also extracted and processed my silk fibroin, from Bombyx Mori silk worm cocoons, that I will use to make my silk films for my experiments.

Week 4

This week I started off by collecting HCLE cells and seeding them in small 35mm dishes for my experiments. I seeded them at a rather low density because I would first like to see how the cells behave under laminar shear stress on a single cellular level. I decided that over the course of the week I would take time lapse images after 24 hours of growth, and then 48, and then 72 hours, to see differences in morphology, cell behavior, and adhesion. Dr. Rosenblatt is back in town and I got to see patients with him on Wednesday in the clinic. One of the patients had come in for a post op follow up after a cataracts surgery. It was great to see in person the different medical conditions that my research would help develop treatments for.

Week 3

This week Dr. Rosenblatt was out of town. However I did not waste any time in getting around to shadowing a corneal transplant surgery. It was very interesting and thrilling. I have never been in such a setting. It is easy to see that although the science behind medical practice and lab research are the same, there is a different set of people skills that doctors and physicians have. Interacting with patients requires a whole different set of social skills that is something we don't really get to see or have to practice often while doing research in a lab setting. With that said, working with patients has definitely gave me a different perspective on the way medical care is delivered. This week I also started to work on my research project. I am using a parallel plate flow chamber to culture corneal epithelial cells under laminar shear stress. I started by first culturing my HCLE cells to be used in the study. They should be confluent and ready to use on Monday.

Week 1-2

These two weeks were very exciting. The feeling of working in a clinical and hospital setting is definitely thrilling and far different than working in a research lab. I didn't get to do much around the hospital because it took me a bit of time to get familiar with getting around and touring the different facilities around the school. My adviser, Dr. Mark Rosenblatt showed me around his clinical office and introduced me to the residents and fellows working there. We also got to discuss the research project that I would be working on during the summer. I am very excited to work on this project, and gain some of the medical knowledge that would help me with my research.

Monday, August 6, 2012

Kevin - Week 7's done. The program is officially over. I must say it's a little bittersweet. On one hand, I'm back home now, and man did I miss my apartment. Going back to a place all by myself with a queen sized bed and kitchen that only I use has been absolutely fantastic. It was also kind of funny to step outside of the bus and realize that, yup, that's the smell of fresh air outside. I had started to forget. But on the other hand, I really enjoyed NYC. I was in the clinic chilling with people during downtime, and a few of them asked about me missing a clinic outing that had happened over the weekend. It was funny; I didn't think I would be noticed, since I had only been around for a few weeks, but I feel like that place was starting to feel very comfy. Some of the patients got used to me being there too, and there are some people I will definitely miss. I'm also sad that I missed out on seeing a tumor resection that last week, just due to the way my schedule ran at the end. But I did finish sketching out networks for Dr. Shah, and he was very happy about it. I have to say that I was proud of them too; they turned out much more impressive looking than I expected. We met with the pathologists again, and this time a biostatistician joined the meeting as well, and we discussed what amount of patients and samples would be necessary for the different experimental and control groups. That time around, I wasn't sweating bullets in the meeting. It felt much more normal, especially since the people in the meeting expected me that time. I also got props from one of the doctor for my network sketch; that definitely didn't hurt either. That week I also observed an arterial valve replacement, and that was crazy. I do wish I had more involvement from the surgeons though. Oh well; it was still cool. I feel like a lot of neat things happened at the end, now that I'm sitting here looking back. Even the bus ride back home was eventful, albeit in a scary way. The bus driver accidentally gashed his head open loading bags into the bus, but luckily the ER was right around the corner. Perks of being in/around Weill Cornell. And the driver ended up being just fine, and we went on our merry ways. Now I'm back in Ithaca again, and it's time to get back to das business.

Thursday, August 2, 2012

Spencer Park Wk7

This week was mostly spent working on the research project. After finally collecting all the necessary data for our study on the effect of ventilatory modes on the recovery of patients with respiratory failures. The data from patients before the summer of 2007 (when Eclipsys was converted to the newer version) was collected after getting special access to the old software, which of course took very long. Data from patients admitted between 2002 and 2006 had already been retrieved by the respiratory therapist at the burn ICU so I could use it for my study. Now I have close to 450 patients on my list and I am in the process of analyzing for the difference between APRV and what we call 'conventional ventilation'. Before 2004, APRV was not used at the burn ICU and was very rare in the U.S. Hence, anyone with severe respiratory problems were put on increased PEEP, usually 15 or higher. However, starting in 2004, APRV replaced conventional ventilators using PEEPs > 15. Gradually, the use of APRV increased in the burn ICU and by 2007, APRV was more widely used, even on patients without severe respiratory difficulties. Therefore, I am analyzing my data to see if the substitution of conventional ventilation with PEEP > 15 with APRV has had any significant effect on patient recovery. So far, the analyses of the data points between 2011 and 2006 shows that APRV is at least just as good as conventional ventilators and makes a strong case that it should be used as widely.

Outside of my research project, I observed Dr. Bessey perform skin allograft on the female patient who had necrotizing fasciitis. Though the surgery went smoothly, he expects there to be a higher chance of one of the grafts not taking since there is so much void space below the skin grafts. However, she and her family were all very happy that she made such great progress after the first two weeks of her stay, when the infection was spreading too fast and things didn't look very optimistic.

After speaking with Dr. Bessey before leaving NYC, it seems I will be making a few trips down to the city during the fall semester to continue the study on the ventilators.

Wednesday, August 1, 2012

Week 7 -- Bunyarit (Time very flies)

All the good things have come to a halt when it was finally my last week in New York City. Apart from my continuing research project’s activity, I was expecting to get first-hand experience in observing cardiothoracic surgery in the city. However, they did save the best for last. Once I arrived in the operation room, an administrator took me to another room to observe neurosurgery instead of cardiothoracic surgery.  What I was seeing is Dr. Schwartz was removing tumor from pituitary gland. Not as usual, this brain surgery was crafted through the transnasal channel.  Thanks to a medical student who kindly explained the details of each step for me, I could follow this high technology-enabled operation. To briefly illustrate, Dr. Schwartz’s assistant anesthesized and installed an endoscope onto the lying patient. Yes, it was conducted transnasally. This breathtaking experience was proceeding on a monitor and I was paying all my attention very closely to it – an inside of the patient’s body.  After the surgery, the patient might be expected to rest in the hospital around one week and may be suggested to take a bunch of hormones in case that the normal tissue of pituitary gland was greatly removed. This unexpected and special surgery was far different from what I had observed over my first two weeks of observation, mainly, because while neurosurgery is an open surgery, prostatectomy is a robot-assisted surgery.  In addition to clinical experience, the other good things I have collected from trip also include my life experience and adventures in the real world lab, the vibrant city of New York. I admit that I was being sad to leave the city. Time very flied and I wish that time could have had more seconds.  I had many opportunities in shadowing many doctors at work in the emergency room and PICU including one seeing Dr. Sperling’s, by whose hard-working (he works hard from 12.00 am to 8.00 pm but never once a complaint) and other qualities I am very impressed. By the time Dr. Sperling meets his patients, he always smiles and soothes them. As for PICU, I shadowed Dr. Howell to meet many patients. She is a very good teacher. She explained me in detail of each patient and taught me how to interpret important information from MRI picture, CT scan, and X-ray film.  Working in Dr. Tewari’s lab, I have learned a lot about clinical experience, especially prostate cancer. He is an excellent mentor because not only did he teach me prostate cancer, but he also told me and his teams about his experience and the way of thinking. There is an impressive quote that Dr. Tewari gave me “tough times never last forever, but tough people do”. Also, at Dr. Tewari’s lab, I have met very good friends who helped me from the first week until the last week of summer immersion.  After all, I would like to say thank you to BME and NIH to make this program happen. I thank Dr. Frayer and Dr. Wang to arrange everything.  Finally, I gratefully thank Dr. Tewari for taking care of me and kindly gave me such invaluable experience and knowledge I could have never gotten elsewhere. The story about this summer immersion was already ended, and I know that there is so much clinical experience going on in the operating room, emergency room, and ICU that require vast time to learn, practice, imitate and improve. I still keep the sweet memory in the happiness zone of my heart. I hope to see everyone again in my next visit to the great City of New York.

Tuesday, July 31, 2012


The final week of the immersion term was very busy. In the lab, we fabricated a new set of collagen scaffolds that contained adult lung endothelial cells, and we immobilized them on an excisional wound model. Our hypothesis is that endothelial cells play a more significant role in wound healing than previously understood. This project is in collaboration with Dr. Raffi's lab. We also excised our 14d discs and stained all of the samples, which I will image back in Ithaca. Finally, we cultured GFP HUVECs in the perfused collagen channels, but unfortunately the reservoir of media dried out on the third day of the study. We did perfuse the device with fluorescent beads and imaged flow through the channel, but it was far less satisfying than showing a fully endothelialized vascular network. I am confident that my labmates in LBMS will be able to achieve this milestone in the near future.

In the clinic, it was exciting to see the cardiothorasic surgery with Dr. Girardi. We watched an aortic valve replacement, with the implantation of a bovine valve. The patient was suffering from an enormous aneurysm caused by a bicuspid valve. The damaged artery was replaced with a polyester/collagen mesh. I was surprised to learn that this material would last the lifetime of the patient, while the Goretex tube from the femoral-popitial bypass was only expected to last a few years. I am surprised such different materials were used in each case, although the necessary mechanical stability of the peripheral bypass makes sense. This week I also saw  a nerve graft. In this case, our patient was famous! At least, he was in the newspaper earlier that week do to a fairly public injury involving a bread knife.

It was a wonderful summer in the city, but I'm happy to be going home!

Week 7 CGregg

My final week in NYC was mainly spent finalizing my project.  I fixed my last set of PEG-DA samples in formalin.  Unfortunately, the shared equipment with cell and developmental biology was unavailable until Friday; therefore, the final histology sectioning and staining will be finished by my labmates the first week that I am back in Ithaca.

Furthermore, I have a drafted version of a vascular network model but in order to continue this project I will have to have access to different modeling equipment which is only in Ithaca.  Hopefully I will have an opportunity once I am back in Ithaca to continue working on making vascular network models as a secondary project.

In addition to finishing up some details on my project, I was able to see a few different aspects of clinical medicine that I hadn't had the opportunity to see before.  The most exciting was the cesarian section that I observed.  The second was the simulation room in labor and delivery.  The simulation room is used as a training tool for the residents where they are required to pass a number of simulations.  The simulation that I saw was of a newborn baby born via cesarian section to a mother that had gestational diabetes.  The baby was bradychardic and slightly cytotoxic.

Monday, July 30, 2012

Joseph Miller - Week 7

This week wasn't too exciting.  I put everything else on hold to get more work done on the summer project, even though the summer project has become something much larger than just the summer.  I will be continuing the MRS research and currently am working on a way to make it part of my thesis research.  It may very well become my thesis research simply because it's so much more publishable and less risky.  We will see.

One great thing was a lecture by Michael Elad on sparse matrix methods and it was incredibly interesting.  I don't think anyone in the room understands all the mathematics involved because it is a very complicated theory but it's also extremely interesting and you can see the potential should one invest the time to understand the mathematics.  Also, I was a part of the Cornell-Technion conference, which is basically the medical school's attempt to be part of the new tech campus.  This is absolutely critical.  The new tech campus is not focused on heath tech but the opportunities here are huge and I plan on being a big part of that.  There were two days of lectures discussing research that bridges the two campuses.

Other than that, the summer immersion program did everything i hoped it would and I'm very happy about having moved down here.  My program is a little vague right now but over the summer it has started to come together.  It will be an interesting year.

JM Week 7

This was the last week at CWMC. I spent the majority of the week finishing up my research project and shadowing Dr. Lockshin during his office visits. However, I also got to see a double valve replacement surgery. It was very awesome to watch. I was able to stand up by the anesthesiologist so I had a great view. This was definitely one of the highlights of the summer. I am excited to return to Ithaca and resume my PhD research with all the new knowledge I gained this summer. It was a unique and fulfilling experience that I am glad I was able to participate in. 

Week 7 Jingwei Zhang

This week I spent my time among neonatal ICU, radiology reading room, MRI and CT scanning rooms. In neonatal ICU, I came across several interested cases. First case the patient was a termed baby. Small amount of water got into her lung during water birth. MRI images showed minor abnormalities in her brain, resulted from short term hypoxia. Initially I was not very worried. From my experience adult patients had great chances of full recovery from such small abnormalities. However, Dr. Frayer disagreed. First, baby brain was still growing and developing. It was very unpredictable what the effects would be. From his experience children with part of the brain resected can grow up normally since the brain can use different part to perform the functions of the resected part. On the other hand, damaged brain usually causes more abnormalities. Second, the baby was not following his eyes. Babies were very interested in pairs of big round things, like the eyes and glasses. Normal babies will show interests and follow your eyes as you starring at them. However, she was not responding well to Dr. Frayer. Later, I performed the same exam on her and she was following my eyes nicely. It was a good signs that she was getting better. She was discharged this week.
Another case was a pair of 24 week twins. They had difficulty in breathing because the lungs were not well developed. During pregnancy, most blood bypasses the lung since there is no need to breathe. Nitric oxide was used to dilate pulmonary artery. Elevated oxygen level and neutralize pH at 7.35 also improve gas exchange. At this point they were still not breathing well. There were also skin infections.
             Another common worry was infection. Infections can come from the environment or within the body as bacteria translocate. Urine culture is a common technique to monitor the situation. Specific antibiotic will be used to fight the infections since different bacteria react very differently to each type of antibiotic.
            On the side note, there were three babies discharged this week and another two next week thanks to Dr. Frayer and his medical team. Congratulations! Thank you very much for giving me such great summer immersion experience. Best wishes to you, your medical team, and all the babies in PICU.

Week 7 - Katie

This week I continued to work on analyzing the MR images previously gathered by my lab. They generally take MRIs before and after surgery, and 2 weeks, 1 month, 5 months and 8 months out. With 10 rats on average in an experiment, this can make for a lot of button pushing.

In analyzing all this data, I am starting to notice patterns in our experiments as well as the inconsistencies of the imaging technique. Small differences in the positioning of the rat in the MR machine can give dramatically different values as comparisons of the same healthy disc over multiple months attests. Quantitative analysis may not be the best way to judge these discs.

Dr. Hartl left on Tuesday for another conference in South America. Although he is a professor and involved with research, I am surprised by how much he and other doctors travel. My impression when I was younger was that doctors were almost always at home and on call if they were needed by their patients. Only after being in a hospital for 7 weeks have I realized how wide and varied the medical field truly is.

Also on Tuesday, I attended a cardio-thoracic surgery where the patient was put on a full bypass system so that the heart could be repaired without the interference of beating or flowing blood. I arrived just at the resident had finished cracking the patient’s sternum to gain access to the chest area. I was surprised by the lack of blood in the chest cavity and by the way the surgeon cooled the heart: he packed what looked like slushy ice around it as the bypass machine was turned on and the heart slowly stopped beating. There was a sense of controlled urgency as the core of the surgery began. The surgeon was repairing a ventricular septal defect. The longest part of the surgery was actually reintroducing the patient’s blood to the heart and getting the heart to reestablish a normal blood pressure. The heart started beating again but the blood pressure took about 45 minutes to be reestablished.

On Thursday I attended a cesarean section. The surgery was over quickly and the most surprising part was the pressure used by the surgeon to force the baby up and out. The baby started out purple but soon turned pink as she started to cry. It was an uplifting experience and it was a great way to end the summer.

Sunday, July 29, 2012

Fredrik T Week 7

Wow, 7 weeks pass so quickly and I have absolutely loved to be in the city this summer. Even though my research project presented me with a lot of hurdles and I wish I would have been able to do more, I feel that the clinical immersion part of my experience has been totally invaluable. It has given me the sneak peak into medicine I always wanted.
Week 7 was also the week when everything would happen for my HUVEC project. Tuesday and Wednesday I ran two experiments attempting to capture HUVEC cells using a surface antigen antibody. Very excited to finally do some work! However, I wish I had more time to troubleshoot.

On my very last day I went to both Labor and Delivery and Cardiothoracic surgery! In L&D I saw a very small baby getting delivered through a cesarean. Even though the baby was 34 weeks and should have been a relatively uncomplicated preterm birth, something was preventing it from growing normally in the uterus and as a result he weighed less than two pounds when delivered.

In cardiothoracic surgery I observed Dr Girardi (appeared on the Letterman show this week!) perform a heart valve replacement and the repair of a large aortic aneurysm. These were by far the most intense and fascinating surgeries I have observed this summer! For the second surgery the patient was on complete bypass and in full circulatory arrest for parts of the operation. I got to see the surgeon replace an entire aortic arch with a branched artificial graft!

This weeks was also the time for our final group meeting and dinner. Delicious and very enjoyable!

Fredrik T Week 6 (reupload)

After all involved legal departments finally approved the clinical trial the first patient could come in for his injections this week. The clinical trial aims to develop a method for guided prostate biopsy using a Prostate Specific Membrane Antigen (PSMA) specific antibody (J591) conjugated to a radioactive Zr89 nucleus. The standard of care is to blindly take out between 10 and 15 biopsies of the prostate when there is reason to believe that the patient might have neoplastic lesions, e.g. after the patient has tested with an elevated PSA level. A guided biopsy would decrease the risk of a lesion being missed and also allow for fewer biopsied to be made. The patients are thus injected with the J591-Zr89 conjugate, followed by PET and MRI imaging. After the prostate is removed it is imaged in a micro PET and micro MRI to be able to correlate the PET signal directly to the presence of a neoplastic lesion.

I was also trained for flow cytometry at HSS in preparation for the TGF-beta transition experiments in the Bander Lab.

I also finally had my meeting with Dr Vahdat to discuss the use of our GEDI chip to capture progenitor cells from breast cancer patient blood samples. It was decided that initially primary HUVECs will be used for capture in lieu of blood samples. 

Fredrik T Week 5 (reupload)

After all involved legal departments finally approved the clinical trial the first patient could come in for his injections this week. The clinical trial aims to develop a method for guided prostate biopsy using a Prostate Specific Membrane Antigen (PSMA) specific antibody (J591) conjugated to a radioactive Zr89 nucleus. The standard of care is to blindly take out between 10 and 15 biopsies of the prostate when there is reason to believe that the patient might have neoplastic lesions, e.g. after the patient has tested with an elevated PSA level. A guided biopsy would decrease the risk of a lesion being missed and also allow for fewer biopsied to be made. The patients are thus injected with the J591-Zr89 conjugate, followed by PET and MRI imaging. After the prostate is removed it is imaged in a micro PET and micro MRI to be able to correlate the PET signal directly to the presence of a neoplastic lesion.

I was also trained for flow cytometry at HSS in preparation for the TGF-beta transition experiments in the Bander Lab.

I also finally had my meeting with Dr Vahdat to discuss the use of our GEDI chip to capture progenitor cells from breast cancer patient blood samples. It was decided that initially primary HUVECs will be used for capture in lieu of blood samples. 

Fredrik T Week 4

In the OR I saw a partial nephrectomy on a relatively young patient. Other than renal cell carcinoma the patient had several other comorbidities, including kidney stones and kidney failure. The surgeon picked out on the order 10 kidney stones the size of large olive pits. Both the surgeon and the nurses seemed surprised by their large size.

After meeting with Dr Bander again he expressed and interest in examining the effects of Epithelial to Mesenchymal transition on the PSMA expression of prostate cancer cells, initially in the cell lines that they are growing. The idea is to use TGF-beta to induce EMT and then quantify some key indicators of EMT and the PSMA expression on treated and untreated cells. 

Despite the fact that our first patient in the clinical trial should have arrived last week we are still being held up by the legal department. We will thus have to cancel and move on to the second patient. However, he isn’t scheduled for another three weeks, giving me very little time to do anything with my project. I am also trying to set up meetings with a number of different faculty members to discuss alternatives.