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.