BME Summer Immersion 2022

Despite the fact that the midpoint checkpoint has now arrived for my immersion program and I will soon be winding down for a trip home to Ithaca, the arrangements for my culminating research project have only accelerated this week, to my excitement. Most likely, my project will evaluate methods of quantifying and assessing lymphatic function to diagnose lymphedema. Obesity is a well-documented risk factor for lymphedema and has been associated with decreased macromolecule clearance, impaired trafficking of antigen presenting cells and abnormal lymph node architecture. Thus, dramatic changes in lymphatic fluid and immune cell transport can be utilized as a diagnostic tool for observing lymphedema resulting from obesity. A potential goal would then be to discern which test for lymphatic function provides the best specificity and sensitivity for observing significant differences in lymphedema versus control.  Dr. Mehrara introduced to me five methods for assessing lymphatic funct...

 This is Ruoxin, who shadows Dr. Crystal. This week, we saw one patient with pulmonary fibrosis. This is a chronic lung disease which is caused by damaged lung tissue. Except for some known lung damage histories or known pulmonary gene deficiency, it is hard to find out the problems causing it. It is important to do constant medical examination over years to maintain a functional state of lung. This patient comes with a long medical records because he has been seeing Dr. Crystal for over 15 years. With a good life style and necessary medicines, he seems to maintain good lung function. However, this disease is kind of irreversible. So when I got the chance to use stethoscope to hear his breathing, there were still clear cracklings, which were some short explosive sounds,  during each exhalation. Also, the patient had to be careful with strong movements in case of the short breathe. Therefore, it leads me to think if there is anyway that can help the lung tissue recover. Fo...

In this week's clinic, one of the patients whom Dr. Rohit Chandwani operated on 2 weeks ago came back for a follow-up visit. The patient had severe nausea, congestion, and heartburn after the surgery, but the condition has turned much better since last time. The patient could produce 4 to 5 stools per day, meaning a more normal bowel movement. Dr. Chandwani suggested the patient continue taking CREON (pancrelipase), an common enzymatic medication and supplement to help with the digestion of food after removal of pancreas. The drainage tube was taken out from the abdomen. Normally one liter of fluid is produced per day in the abdominal cavity. Since the patient had only about 100 mL drain, this means that the leakage is controlled. Stitches on the major incision were all removed and strips were put on. From the pathology report, the patient had T2 (stage 2) malignant pancreatic tumor of 2.5x2x2 cm in size. This is a T2 instead of T1 because 2 out of 33 lymph nodes presented metastas...

I'm Chengqi Xu, a graduate student at Elemento Lab at the EIPM,  Weill Cornell Medicine . This week I was still shadowing with Dr. Manish Shah, and the physician assistant Dr. Marina Beltrami in the GI oncology  Program at WCM and NewYork-Presbyterian. Dr. Shah has led several phase I,II and III clinical trials in patients with advanced gastric cancer. During this week's immersion, I recognize the importance of good clinical practice and its role in clinical trials. As we learned from safety training courses before we set off to the town, I remembered  one of the principle   in the Belmont report, is beneficence. This principle requires that researchers maximize benefits and minimize harms associated with research. In other words, clinical research or trials should be designed to maximize the benefits to an individual or to society while minimizing harm to the individual. But in research we do not know in advance all the harms that may occur. Let's say, a patien...

 This week  I had the opportunity to get involved in the process of preparation for clinical trials with my mentors Dr. Kaner and Dr. Guzman. As I was working in the clinic, I got to know the patient's complete medical history and understand why s/he is a good candidate.  In order to contribute to future clinical trial work, I was shown and trained on how to process patient peripheral blood in order to separate red blood cells and leucocytes. The sample preparation was a long process that took us half of the day and the other half we used to run the sample on the flow cytometry. Along with the patient sample, we got to prepare positive and negative control samples which was also laborious process. Patient sample flow example can be seen on the image below.  Moreover, in the hospital, a patient came with suspicion of the Kikuchi disease which is an extremely rare disease as the patient's biopsy showed necrotizing tissue in the lymph nodes.  It is really fascinati...

 I am xinzi he. My medical mentors are dr. Ajar guitar and kooman kamel. On Thursday, I got an special opportunity shadowing a neurosurgeon dr. Cisse. The surgery is vp shunt and was in Whitney operation room. Vp shunt stands for ventriculoperitoneal shunt and is used to treat hydrocephalus. Hydrocephalus is the swelling of the ventricle in brain caused by excess buildup of cerebrospinal fluid. By embedding vp shunt into patient’s brain, it could reduce the pressure exerted by the brain’s ventricle system.  The procedure of placing vp shunt requires a patience being put into a general anesthesia condition, thus no pain will be felt by the patient. After the anesthesia, a nurse needs to shave the area where a hole will be drilled for inserting a catheter through into the ventricle according to the ct image. The other end of catheter will go through the chest and abdomen, and finally be inserted into abdominal cavity. 

I am Adarsh Singh and I am working under Dr. Kyu Rhee for my Immersion. This week has been quite slow for me as many people from our lab were on holiday, so, I focused this week on analysing the data that I got last week and plan my next set of experiments. Last week we ran an untargeted mass spectrometry run in order to identify metabolite and lipid composition of my test human stool derived membrane vesicles. For the analysis I used Profinder software that is provided with the LC-MS machine. Although we found some interesting metabolites and lipids in our data, we also observed some kind of contamination in our blan samples. The hypothesis for that is it could be from the samples itself as some particles from samples might be getting stuck in the loading syringe. So, we are planning to use a new syringe and redo the whole thing.  Next week I will also be doing vesicle purification for the Bacteroides sample and further do protein quantification and size characterization. I am rea...

It's Week 3 of immersion working with Dr.  Tranbaugh  and other Doctors in the Cardiothoracic unit at  NYP Methodist . The experiences keep getting interesting with observing various surgical procedures, going on ward rounds, working on clinical research projects, and interacting with Doctors and Surgeons.     Earlier this week, I observed 2 major surgical procedures:   1. CABG, LAA Closure, and Mitral valve Annuloplasty   2. TAVR Procedure   1.  CABG, LAA Closure, and Mitral valve Annuloplasty :  The case presented was that of diseased coronary arteries and  atrial regurgitation  with other underlying comorbidities like Atrial Fibrillation, etc. With the patient having dual LADS, both LADs were bypassed to enable perfusion to various area of the heart. Following that, the left atrial appendage(LAA) was closed off with a clip to prevent blood pooling into the area, since patients with  AFib  are more at risk...

 Cole Latvis – Blog week 3 This week my time was split almost evenly between research preparation and cardiac catheterization lab shadowing. I am happy to have a clearer direction for summer research goals, and I am really enjoying the opportunity to network with so many medical and industry professionals. For the beginning of the week through Wednesday I focused on acquiring the skills necessary to work on my summer research project. My project will work on assessing strain in the aorta in response to ascending aorta graft placement. While custom tools in MATLAB have been used in the past to measure aortic strains, I will be investigating whether a common general cardiac MRI imaging software can be applied for this purpose. Namely, I will try to repurpose the left ventricle strain tool to be used on the aorta. If I get reliable data, then I will apply the new technique to analyze a dataset of patients with and without ascending aorta Dacron graft replacements. I can try to rec...

Student: Ayomide Oloyede  Mentor: Dr. Marshall Glesby       Okay! 3 weeks down! This week was particularly interesting. I got to see the brain in different facets. Brain slices and a neurosurgery to drain the brain of excess Cerebrospinal fluid (a condition caused by hydrocephalus). These were the highlight of my week. Being able to ask questions, read articles and learn about the brain was something that fascinated me. I might not be an expert but now I can tell you a thing or two about the brain thanks to Dr. Cisse (the neurosurgeon who allowed me observe in his OR) and Dr. Ben (the neuropathologist that described several parts of the brain to me while cutting specimen up for autopsy).      Most of my week was spent in meetings and reading about HIV for my summer project and potential presentations. I learnt a lot about the lymphocyte counts in relation to people living with HIV (PWH) compared to people not living with HIV. It's interesting to n...

For the past few weeks, I have been shadowing Dr. Chiang and learning how to identify pathologies in the brain using MRI and CT scans. During this time, I have seen several cases of Small Vessel Disease (SVD) in the brain, which will be helpful when I begin my summer project to use Quantitative Susceptibility Mapping (QSM) a s a means of better differentiating between SVD and Multiple Sclerosis (MS). While I had previously been able to shadow a clinician and learn more about patients with SVD, I still had yet to gain a similar experience for patients with MS. That all changed this week, as I also began shadowing Dr. Susan Gauthier in the Weill Cornell Medical Center's Multiple Sclerosis Center.  While shadowing Dr. Gauthier, I was able to meet a plethora of patients, all of whom had MS. The severity of the disease is highly dependent on the individual, and it seemed that no two patients experienced MS in exactly the same way. I particularly enjoyed watching when Dr. Gauthier would ...

 This week came yet again with meeting more people and expanding the scope of the work I will perform during immersion. Our cohort meeting on Tuesday was an interesting opportunity to speak with Dr. Gupta, Dr. Min, and Dr. Prince in a more casual environment. I have really enjoyed the opportunity to so far to discuss medicine, science, and life in New York with these incredible scientists and understand what makes them tick.  I again spent more time with my research project this week. I met with a postdoc in the biomechanics research group at HSS, Jonathan Glenday, to discuss the framework within which we can develop the FE model for my project. There is an existing musculoskeletal model that allows researchers in the lab to analyze reaction forces along key muscles and at the glenohumeral interface, which is our starting point for this more detailed model. While our goal is to analyze at a more precise level how glenoid implant placement impacts joint healing and failure rate...

It was a long weekend which meant a short work week! We didn't have clinic on Monday so we started the week fresh on Tuesday afternoon with a surgery. The patient had cancer in their buccal fat pad and it was originally thought that they would need to perform a flap reconstruction from the forearm to cover the incision. Due to the location of the tumor, the oral surgeon was able to fully remove the tumor without the need for the flap reconstruction and also saved the patient's molar that was nearby. This case was particularly interesting to me because as soon as the tumor was removed from the patient's mouth, the oral surgeon took the specimen to pathology right then and there to check the margins. The patient stayed under anesthesia on the OR table for about 30 minutes before the oral surgeon came back with the great news about clean margins on the tumor. From there, the patient only needed simple sutures to close the incision. There was only one short surgery on Wednesday...

 Matalin Pirtz Dr. Lora Ellenson, MSKCC 6/24/22 Three weeks in, and I am finally getting settled in to NYC and my clinical experience. After reading a lot about gynecologic pathology, I am getting more comfortable identifying lesions and different pathologies when I attend meetings such as sign-out and conference. I am really enjoying all of the things I am learning here! On Monday, I had the opportunity to shadow Dr. Kyi in Medical Oncology at MSK. Dr. Kyi had a busy day in the clinic, and I was very lucky to be able to see a few patients with her. I sat in with a consultation with a patient who was experiencing a reoccurrence after being part of a chemotherapy clinical trial. A big part of Dr. Kyi's practice is facilitating patient involvement in clinical trials at MSK, so I'm sure she has a lot of experience with these unfortunate reoccurrences. While this was difficult to hear, the patient was still being very positive and Dr. Kyi was amazing at keeping her optimistic.  Un...

  This week I learned about the different methods of performing surgery to implant ventricular assist devices (VADs). Implantation of VADs requires access to the heart, and the methods to do so are median sternotomy, bilateral thoracotomy, and (rarely) mini-sternotomy/L thoracotomy. Understanding these procedures requires having in mind the final configuration of the left ventricular assist device (LVAD) in the body (Fig. 1). Figure 1 shows a patient hooked to an LVAD and its supporting components. The LVAD in the figure is the pump (cap-like structure attached at the apex of the heart) which re-routes the blood from the left ventricle to the ascending aorta (essentially, the device takes over the function of the native heart’s ventricular contraction).   Figure 1: The HeartMate 3 left ventricular assist device (LVAD) from Abbott laboratories. Note that except for the LVAD (marked a 1 in the image) all other components are extracorporeal. Image source: https://www.cardiovascul...

This week, I continued my time split between a virtual research rotation with Dr. Elemento, and time in the clinic visiting patients and learning about hematology/oncology with Dr. Kasi.  Interestingly, the patient load was quite low - many of the patients whose encounters I had the opportunity to observe were following up from previous visits (since this was my third week in the clinic, and follow-ups and treatments are usually on a two-week schedule). It was really interesting to see how new information from tests done recently helped shape different patients' treatment plans. One patient for example, recently had PET scans done that showed a liver metastasis was stable and small enough (less than 30% of the total liver) to perform a partial hepatectomy. This meant that this particular patient's chemotherapy schedule was cut off so that the next few weeks can be spent fully clearing the medication from their system in anticipation of surgery. Outside of patient visits, I'...

After 2 weeks of continuous shadowing and observing clinical procedures in the Radiation Oncology department, I wanted to make my third week about reading papers and reflecting on the science behind what I experienced.  Radiotherapy creates an effect in our body akin to anti-viral response mimicry. Whether our host defense mechanism is exposed to viral infections or sterile inflammation provoked by radiation therapy, our response to either is similar. More studies and clinical trials are being done here at Weill Cornell to improve cancer treatment. Dr. Marciscano sent me a few papers that would bolster my understanding of the synergy between radiation therapy and immunotherapy. With this, I plan on potentially refining an idea for my summer project.  In general, it was a great week! Professional connections, reflections, and readings summarize my week.

I enjoyed celebrating Juneteenth this weekend! Unfortunately, surgeries this week were relatively slow. Dr. Spector was scheduled to assist in closing up the wound following the removal of a buccal fat tumor, but the incision was small, so he was not needed. The next day we saw a brief surgery in which Dr. Spector removed a lipoma from the patient’s right knee. He brought us close to the patient so we could see how the fatty tumor differed from ordinary fat tissue. Overall, it seemed to be a very straightforward process with the tumor quickly removed in one piece. Afterward, in a singular round, I got to see the previous week’s patient with tongue carcinoma. He appeared to be doing much better, even though they had to operate on him a second time this past Monday. I think the most interesting element of my week was going to the clinic. Again, there were patients there for cosmetic reasons but also patients who were about to undergo an intensive surgery to remove part of their mandibl...

This week, I was able to enjoy the holiday, but quickly got back into the swing of things. On Tuesday, I was able to observe a buccal fat tumor removal in the OR. This procedure was relatively short, and the tumor itself was very small. Post- excision, we had about 15 minutes of downtime for lab specimen processing to ensure that no more tissue had to be removed to completely isolate the growth. The surgery itself was successful, required no additional fine-tuning and took no more than three hours, so I was able to peek into the Spector lab afterwards. There, I shadowed a student in the lab and learned about T-cell proliferation in vitro. The cells are isolated from clinical tissues Dr. Spector obtains from his surgeries. Once they are isolated from the sample, they must be worked up until enough cells are present and can be used for construct seeding. In order to increase this proliferation rate, some T-cells were activated. Beads that present anti-CD3/CD28 antibodies were used to act...

Week 3 – June 20 to 24th.  This week Dr. Altorki was out of town, but I was able to shadow two new doctors: Dr. Lee and Dr. Shostak in the OR and I also shadowed Dr. Port in clinic. I shadowed Dr. Shostak in a case where he did a bronchoscopy to determine how the tumor was positioned and which surgery was best. He put a video camera down the airway, which was extremely interesting to watch. Dr. Shostak used cautery and cyro techniques to prevent the tumor from bleeding and then freezing the tumor to remove part of it. This tumor was specifically blocking an air passageway. As Dr. Shostak continued to remove the tumor you could see the passageway it was blocking. The surgery was not a treatment surgery, but rather a diagnostic surgery to help the surgeon determine what surgery is best suited. In the end, Dr. Shostak decided that based on the positioning of the tumor, it would be best to do a sleeve lobectomy as opposed to the normal lobectomy. One main difference is that surgeon wil...

With another week of immersion done, I am finally beginning to feel a bit more confident with the medical terminology and how the various teams operate within gynecologic oncology! To understand pathology in more detail, I have been attending more sign-outs to understand how histology slides are interpreted, and I have been reading a pathology textbook to go back and learn at a much slower pace.  This week in particular, I was able to speak with Dr Momeni about projects relating to molecular pathology and how types of mutations will present differently in specific endometrial and ovarian cancers using the patient data provided by MSK. I am particularly excited to get started, because it is all new information that I would love to learn for not only my project here, but also future work for my PhD! This week, I have also had the opportunity to shadow Dr. Zamarin to understand patient interactions and patient planning firsthand. Seeing empathetic communication and transparency was re...

Due to the holiday, I could enjoy the long weekend exploring Time Square, stuffing my face with fresh Mangonada and 99-cent pizza. When evening came, I walked back to the upper east side down beautiful Park Avenue. Although the weekend was fun, I was ready to return to my immersion experience.  The highlight of Tuesday was spending time with my cohort conversing with those who make our immersion experience possible, Dr. Gillen, Dr. Wang, Dr. Gupta, Dr. Prince, and Dr. Min. Everyone encouraged us to continue our problem-solving path; Dr. Gupta said for us not to be afraid of being wrong but to always give our best answer. His advice reminded me that we have to speak up as leaders because innovation happens when people come together, open up, and share ideas. Fascinating was our conversation with Dr. Min. As the CEO of a healthcare organization, I asked him how one balances profit with affordability. His answer was unexpected but enlightening to the mission of health care. As I seek ...

This week I finally witnessed one of the definitive procedures of the lymphatic and microsurgery field I had been pining to view for so long: near-infrared angiographic imaging with indocyanine green (NIR-ICG). Before I could get to this exciting point though, I started with a more accessible stepping stone to this prize in the form of Evans blue angiography. Evans blue, as the name implies, is an azure-hued dye with a particular affinity for serum albumin, and so is often used in cell culture to label viable cells or vascular networks in vivo. In Dr. Mehrara's lab in the Zuckerman building, I watched as a research associate injected Evans blue subcutaneously into the hind paws of recently euthanized mice, taking care so as to not release the dye into the blood vasculature and instead allow the dye to be uptaken by the lymphatics. Over 15 minutes, the blue dye visibly began to permeate through the lymphatic vessels of the leg up to the popliteal and even inguinal lymph nodes, and c...

This week I have shadowed a PhD student from Dr. Rohit Chandwani's lab on mouse pancrease excision and a postdoc on mice pancreas ultrasound imaging. It was first difficult for me to recognize anything from the ultrasound images. However, after checking on a dozen of mice, I was able to recognize all the major abdominal organs (spleen, intestine, stomach, kidney, and of course the pancreas) and locate the tumor mass on the pancreas. Same as last week, I also shadowed Dr. Chandwani on his clinics. One of the patients he just operated on 2 weeks ago came back for the followup appointment. He mainly checked on the patient's food and liquid intake and answered any questions from the patient and the family. Normally, the patient needs sometime to recover from the surgery before chemotherapy (about 6 weeks) because the chemotherapy will put more stress on the body and have a lot of adverse effects. From the lymph node smaples taken from the patient, only one out of 17 lymph nodes pre...

      This is Ruoxin, who shadow Dr. Ronald Crystal in genetic medicine department. It is a very interesting experience that I get the chance to see patients involved in  a clinical trial. The patient was additive to cocaine. He volunteered to participate in this clinical trial for cocaine vaccine. The idea of this vaccine is that a analogue of cocaine is chemically conjugated to a immunogenic adenovirus protein. After injecting this vaccine, the corresponding antibodies will be produced to neutralize the new intaking cocaine. Therefore, people won't feel "high" after taking cocaine. It is very excited that this vaccine actually works in patients. According to patient's history records, the dosages of cocaine taken are decreasing overtime. The reason for still taking cocaine is due to a habitual instinct. Seeing the work from the bench can actually be applied to solve daily problems is encouraging!  

I'm Chengqi Xu, a graduate student at Elemento Lab at  Weill Cornell Medicine . This week I shadowed with Dr. Manish Shah, and the physician assistant Dr. Marina in the GI oncology  Program at WCM and NewYork-Presbyterian. GI program is dedicated to providing state-of-the-art and personalised care across the entire spectrum of cancers of the digestive system.  GI oncologists are actively involved in biomedical research to advance drug development for GI malignancies, leading worldwide clinical trials and collaborating with the field laboratories to bring new treatments to patients. I am deeply impressed that behind every number/data, there is an eager hope for survival of every patients and their families. With my clinical advisors, I saw more than 15 patients during the half day, some of whom are diagnosed with locally advanced/metastatic  esophageal cancer. There is a case where a 65~ year-old woman diagnosed with  Siewert type 1 adenocarcinoma  is c...