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.

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.

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.

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.