Tuesday, July 31, 2012

DelNero_wk7

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.

Fredrik T Week 2 (reupload)


This week I observed a very invasive prostatectomy. The patient was an elderly male with a history of prostate cancer. After having removed the prostate the surgeon discovered a large radiation induced fistula in the colon. The surgeon ended up having to remove the patient’s rectum and create a neo-bladder from a part of the patient’s colon. The process of creating the neo-bladder was very time consuming and labor intensive, it also requires an extended time for rehabilitation and healing. The surgeon stressed the need for good and reliable artificial bladders to use for situations like this, allowing the patient to recover faster and the procedure to be less invasive. He also stressed the importance of trying to maximize patient quality of life and pointing out that preserving the patients continence is a major factor in a case like this.

I also attended a tumor board meeting with several surgeon and oncologists presenting cases from the previous week.

Dr Osborne wants me to work on some cell culture for animal studies of prostate cancer. I will be helping one of his techs with setting up the culture.