BME Summer Immersion 2024

This was another productive week focused on liquid biopsy research and clinical implementation. On Monday, the Circulating Tumor Cell (CTC) lab team met with members from the Institute of Computational Biology (ICB) to discuss an analysis plan for the whole exome sequencing (WES) dataset we are receiving from Natera. This data was generated from the primary tumors of patients who underwent circulating tumor DNA testing using the Signatera platform. We learned that the ICB already has a pipeline built that uses and cross-checks several methods for variant identification. Running the data through this pipeline should provide us with a comprehensive mutational profile of each patient's tumor, that we will then be able to evaluate, contextualized with clinical information. The initial goal of this analysis will be to characterize the performance of Signatera's liquid biopsy test across different mutational profiles. In the afternoon we had Dr. Cristofanilli's lab meeting where

Today, I had the opportunity to shadow a multi-ligamentous knee reconstruction, including the ACL, PCL, MCL, and LCL, performed by Dr. Anil Ranawat. The surgery involved, first, harvesting tendon from the hamstring to be used as a graft for the various ligaments, followed by arthroscopic-led clearing of the surgical ligamentous entheses, and finally femoral tunnel creation and graft attachment. This was my first opportunity to shadow a surgery and there were a number of things I found interesting: - The dynamics between the scrub tech, primary surgeons, and anesthesia. It was fascinating for example, watching the scrub tech prepare instruments and anticipate Dr. Ranawat's needs. It was also interesting that there was very little interaction between anesthesia and the rest of the team—each mostly-independently managed their own responsibilities. - The flexibility required of surgeons during a procedure. In this particular operation, the surgical team discovered that the ACL was actu

 Week 4 On Monday, we performed a flow cytometry for mice tail skin cells. The groups were wild type mice and mast cell knockout mice. Mice were sacrificed and we collected blood from their hearts for later measurement of inflammation cytokines. We collected pieces of mice tail skin for western blot, PCR, and flow cytometry. We also used bright field microscope and hemocytometer to count cells. We used antibodies to stain for mast cells, lymphocytes, macrophages, and fibroblasts in samples. On Tuesday, we prepared for another flow cytometry for mice spleen cells. The mixture of spleen cells were collected from wild type and PTEN knockout mice and cultured. The supernatant in media were collected for ELISA. We stained the cells for IL-4, CD3, CD4, and IFN-a. On Tuesday, I also shadowed harvesting pancreatic tumor from mice.  On Wednesday, we repeated a western blot for 50% and 100% HUVEC and LEC. We also collected HUVEC and LEC for RNA sequencing. I also did literature review for correl

 This week in the pathology lab, I sat in for some more sign-offs with Dr. Demaria and Carla, the resident, on Tuesday and Friday. I was able to bring my notebook with me this time, so I could take more detailed notes on the proceedings rather than writing up my recollections after the fact. I’m glad I did so as I feel like I got a lot of insight into what breast pathologists are looking for and got to ask lots of questions in these two days. Dr. Demaria was so patient and generously made an effort to include me by asking whether I recognized different features or my opinion on some stains. Some of the new types of tissues I got to see this week include: a lymph node with metastasis from the breast, nipple, blood vessels with invading tumor cells, intramammary lymph nodes, mucinous carcinoma of the breast, and a radial scar. The lymph nodes stood out to me because I could instantly tell it looked different from a regular lymph node (there were a lot fewer dark nuclei and granules and s

 6/24/2024 - 6/28/2024 Monday started off with clinics. There were a lot of patients that Dr. Spector had to see. He had back-to-back appointments. The reasoning behind the appointments ranged from cosmetic consultations to pre-surgery check-ups.  The last one, the pre-surgery check-up, was because Dr. Spector was the plastic surgeon selected to be responsible for the abdominal reconstruction of a transplant patient. It was fascinating to be in the room during the meeting, as I got to see how Dr. Spector interacts with a patient before he operates on them. He took the time to explain the intent and procedures behind the surgery while also addressing any questions the patient and their family had. A few days later, I got to witness some of the surgery, which was really cool. This was the first time I saw a patient both conscious and responsive during a clinical visit before I saw them being operated on. There were also other OR cases that I observed throughout the week. Not all of these

In the OR this week, we observed an ear reconstruction following a squamous cell carcinoma removal by ENT Dr. Kutler. Carcinoma was removed from two areas of the ear, leaving skin that needed to be filled. It was determined by Dr. Spector that Integra was not needed, as the carcinoma removal left enough vascularized tissue exposed that the full thickness skin graft (FTSG) can immediately be applied. The skin graft was harvested from the clavicle region, and the size was determined by tracing the shape of the opening left on the ear with deformable plastic piece that was then flattened to get the 2D shape. The FTSG was then attached to the ear. I also shadowed Dr. Spector in clinic this week as well. This week there were a lot of people coming in for consults, post-op follow ups, and new patients. One patient had a post-op appointment from a squamous cell carcinoma removal from the mandible region. They had just come in from radiation treatment, and they mentioned that the radiation was

In this week's clinic/OR, I followed Dr. Spector as he saw patients in his office. I observed many Botox and filler injections. It was moving to hear how one patient was adamant that they would donate their tissues for scientific research. They strongly believed no progress could be made without tissue donation, particularly with their unique genetic mutation. In the OR, I observed Dr. Spector and Dr. Kutler's team perform a resection of squamous cell carcinoma from a patient's ear and subsequent reconstruction of the site. For the first time, I was able to follow Dr. Spector and PA Ann to see a transplant patient who would be getting reconstructive surgery in the abdominal region. I was able to hear how Dr. Spector informed the patient on his role in their reconstruction, why the reconstruction was needed, and to reassure the patient's concerns. Subsequently, I was able to observe this patient the same week receiving a mesh to reconstruct the abdominal wall region.  In

I shadowed Dr. Yiwey Shieh in the clinic this week. I learned that he's also the PI for the grant which funds the project Eunji and I are working on. We met to discuss that project and I presented an outline for AI implementation of a Dense Neural Network to work in conjunction with her Large Language Model which extracts smoking data from EHR's. Our goal is to create a reliable prediction model for lung cancer metastasizing to the brain.

Week 4 June 24-28 I started the week by shadowing an oncoplastic reduction surgery. A surgical oncologist removed a tumor from the right breast. Since the patient opted for a breast reduction within the surgery, this allows for the surgeon to obtain better margins. The surgery was continued by a plastics team who removed breast tissue from each breast. I was surprised to see the different tissue types that were exposed; adipose tissue has a very distinct yellow color. I learned that the team typically props the patient to a sitting/standing position to see the symmetry and shape of the breasts after the reduction. This week I also shadowed clinicians in the Cath labs. I observed a transcatheter aortic valve replacement (TAVR) and a tricuspid valve replacement. From the control room, I could only see a monitor that displayed the live x-ray imaging. It was interesting to see the artificial valve expanding and being placed. The team could not go through with a mitral valve replacement bec

 This week, I was able to shadow a variety of procedures and made some progress on my research project. On Tuesday, I watched an oncoplastic surgery in which a tumor is removed before performing a second plastic surgery, not directly related to the original procedure. In this case, the patient has several tumors in the breast removed before having a breast reduction. In speaking with the surgical oncologist, this method can often be preferable because a larger piece of tissue is removed, which reduces the recurrence of cancer and the amount of secondary chemo or radiation treatment. Additionally, a breast reduction can improve the quality of life for the patient without undergoing another surgery. Removing the tumors was relatively fast since they had been labeled, and once the tumor was removed, the plastic surgeon team began on the breast reduction. Two plastic surgeons worked on each side, removing excess tissue and skin. They also used staples to hold the incisions closed temporari

Dr. Horn was not seeing patients this week so I bounced between the cardiac catheterization lab and the electrophysiology (EP) lab.  In the cath lab, I was able to see 2 percutaneous coronary interventions (PCIs). These are procedures where the doctor enters the coronary arteries with a catheter, uses a balloon to open them up, and then places a stent to keep the artery open. They also utilize intravascular ultrasound (IVUS) imaging to visualize the inside of the artery to determine what pressure to use when opening the artery with the balloon and eventually the stent. This also helps them confirm that the stent is properly in place and will not dislodge. In the EP lab, I saw three very interesting procedures this week. The first one was an atrial ablation case where the patient already had prior "gold standard" ablations but was still experiencing atrial flutter. Therefore, the doctor needed to map out the electrical conductivity of the atria to determine where the atrial fl

6/24/24 - 6/28/24  Week 4: On Tuesday, during our immersion weekly meeting, I attended a talk that focused on AI for Medical Imaging by Prof. Mert R Sabuncu. It was insightful and covered a range of topics highlighting the transformative potential of artificial intelligence in the medical field. It began with an overview of the current state of AI in medical imaging, emphasizing its ability to enhance diagnostic accuracy and efficiency. Prof. Mert discussed three projects of his research lab. They were based on longitudinal analysis of MRI images, organ volume quantification and cancer risk assessment from images. The talk was great and easier to follow. Real-world case studies were presented, showcasing successful implementations of AI in detecting different diseases. This week, I had the privilege of engaging in CT and X-ray reading sessions with Dr. Alan Legasto, an excellent mentor. These sessions provided a comprehensive understanding of how CT and X-ray imaging are utilized in di

 Dr. Schwartz have been traveling this week so no surgeries or patient seeing is performed. In this case, I shift my focus more towards the lab work. As the name suggests, Dr. Schwartz's  Epilepsy Research Laboratory uses several models of neocortical epilepsy to study how seizures start and spread through the brain, neurovascular coupling mechanisms during epilepsy, and therapeutic approaches to treat, cure or prevent epilepsy. The current lab project I am working on aims to study the progression of seizure. The lab proposed a seizure spreading model, that besides simply spreading to peripheral cortical regions from the seizure focus, the seizure also spreads through the track of axon projections and thus to cortical regions with intensive connections to the seizure foci. In this model, the type of projection neuron is also important. When the projection from seizure focus is from excitatory neurons, the neural activity of downstream cortex will be thus further stimulated and trig

 This past week, I spent most of my time in the Liston lab performing various surgeries to help both my post doc, Shane, and the graduate student, Kenneth. I was able to learn a new surgical procedure - fiber optic implantation that used in mouse imaging and behavior! Fiber optic implantation allows for deep tissue stimulation and detection of cell-specific targets when paired with either transgenic mice and AAV injection. This was extremely exciting as I have been considering using fiber optic implantation in my research back in Ithaca for my thesis! Additionally, I helped Kenneth with prism implantation to deep tissue layers 5 and 6 in the prefrontal cortex, as he continues optimizing his protocol to image dendritic spines. It was great to combine my current knowledge from my project work upstate to my experience here. We were able to work together and troubleshoot aspects of the multi-photon imaging protocol that could allow for dendritic spine clarity.  This week was busy with many

 This week I found new clinicians to shadow. I'll be shadowing Dr. Kari Whitley and potentially a clinician in the nutrition department who works primarily with pregnant patients. Dr. Mount and I also are preparing a statistical analysis proposal with Dr. Tamimi about when exercise and nutrition are recommended for breast cancer patients. I am also working with Eunji to leverage AI to detect when lung cancer will metastasize to the brain.

This week I worked on converting the Spector lab Prusa printer into a 3D bioprinter. I also did maintenance on the Ender printer in the lab in order to use it to create parts for the bioprinter conversion. The bioprinter conversion requires making many new 3D printed plastic parts as well as purchasing machined parts, so I put together a parts list and I will need to customize the designs for the printed parts. I also researched the firmware upgrade and I am in the process of customizing the firmware for the bioprinter. On Thursday Julia and I shadowed in the clinic and observed the follow-up appointment for the patient that had a radial arm flap surgery for tongue reconstruction. The patient was healing very well and it was interesting to see the results of such a complex surgery. We also saw several follow ups that Dr. Spector had with patients he had done spine closure surgery on a few days previous. We also coordinated with a medical student to collect bone marrow aspirate concentr

 This week I continued to watch various cath lab procedures including a trans catheter aortic valve replacement. This was a relatively straight forward procedure for the interventionist I was shadowing as these procedures are relatively common. This procedure first involves the doctors intubating the patient and utilizing a trans esophageal ultrasound to acquire images of the heart and where the device will be implanted in the aortic valve position. They then insert guide catheters into the heart of the patient and then assess the blood flow and pressures of the involved chambers. This is normal time out spot for the procedure as they decide how they want to proceed and if their original plan will still be viable. The valve is then deployed and expanded using a balloon and the blood flow and pressures are taken again to make sure the valve sits right. I also got to witness a double mastectomy on top of my normal catheter lab shadowing. Our lab in Ithaca collaborates with a plastic surg

 This week I spent a lot of time in the cardiac catheterization laboratory where I observed various diagnostic and interventional catheterization procedures. The main procedures I observed were right and left heart catheterizations. Both procedures involve feeding a catheter up an artery or vein in the body into the heart to measure pressures in each chamber of either the left or right side. The catheter was fed through the vessel guided by X-ray, and the doctor determined the location of the catheter in the heart based on the pressure waveforms. The procedure was much faster than I expected and the patient remained awake for the entire length. I also was able to watch a coronary angiogram where contrast is injected into the patient's veins or arteries around the heart and blood flow patterns can be observed.  Detection of a blockage is crucial in order to determine if intervention is needed. One patient had a large blockage in the main right coronary artery, but the left coronary

This week was my first week in the OR. I was able to observe as Dr. Bostrom as he performed Total Knee replacements and Total Hip Replacements. During these procedures I was able to ask questions to the circulating nurse about the procedure I was observing and ask Dr. Bostrom directly once he finished specific procedures. I had an enjoyable time observing because seeing some of the direct implications of engineering research in a clinical setting. The following day I was in the clinic again seeing the pre-surgery and post-surgery patients and I could ask more questions about the anatomy and the physiology of the disease. Wednesday, Thursday and Friday I spent time in the lab. This time in lab was spent preparing slides that I received from Ithaca to be scanned. These scans will then be used to train a ML model to grade cartilage damage. This project would help me immensely in my following years as PhD student because it would allow for me to automate an important aspect of my research.

I spent a majority of this week reviewing clinical notes and research articles focused on liquid biopsy tests for metastatic breast cancer management. Monday evening, we met with Dr. Wang to provide an update on our experiences, thus far. Tuesday, I attended our weekly BME meeting where we learned about the important attributes of a mentor/mentee relationship. I spent the rest of Tuesday and all day Thursday in the clinic shadowing Dr. Massimo Cristofanilli and Dr. Caterina Gianni. A mix of new patient consultations and repeat visits provided insight into the different stages of oncology patient care.  New visits help me understand the interpretation of medical images and biopsy results, and which treatments are most likely to cause benefit with limited harm. In cancer treatment, managing the toxicity of treatment seems to be as challenging as treating the disease itself. Many of these patients are geriatric and have underlying conditions that need to be considered when building their

 This week got off to a bit of a slow start, as some car trouble kept me in Ithaca for a couple days after the cross-campus symposium. But after a new radiator I made it back to NYC Wednesday evening and got right to immersing! I went in to the Heart Failure clinic Thursday morning to meet with Dr. Horn and shadow. Unfortunately, Dr. Horn was busy with inpatient service, and the other physicians had many no-shows (heat wave perhaps?), so there weren't many patients to see. I did get to talk with her about research, and she gave me some literature to review on peripheral microvascular dysfunction, which I will be focusing on this summer. On Thursday afternoon I went to the cath lab with Anna for the first time to shadow some procedures. We saw a couple left/right heart catheterizations to take blood pressures, oxygenations, and coronary hemodynamics for diagnosis and preoperative clearance. One of the patients had an interesting issue with their radial artery, which the doctor said

This week I worked with Sophia and Xue of Dr. Spector's lab in isolating adipocytes from breast adipose tissue. It was quite shocking to discover that the tissue came to the lab in a bucket. It was also interesting to see that the adipose tissue was textbook-color yellow. From my understanding, human adipose tissue appears yellow because carotene (a yellow pigment from food) does not metabolize quickly in humans and settles in white adipose tissue, giving them the yellow appearance. This differs greatly from murine tissue, which I've seen my lab member Garrett isolate previously. The adipose tissue required intensive manual labor, i.e., mechanical dissociation of the tissue into smaller pieces using a scissor. After mincing for about 15-20 minutes, an enzymatic mixture of collagenase and hyaluronidase was added to the tissue, allowed to incubate for an hour, and then centrifuged. The resulting solution separated into the different parts. From top to bottom, we have the layer of

In the third week of summer immersion, the focus of my work is gradually shifting from watching surgeries in OR to observing more experiments in the lab. I went to the OR on Thursday to shadow Dr. Schwartz on the surgeries. It was a busy day as there were two surgeries happening in the morning. The first surgery I spend most of my time watching was the endoscopic pituitary tumor removal surgery. It was mainly Dr. Schwartz's residents who performed the surgery. The patients was put into sleep and an endoscope is placed in through the nasal cavity of the patient. The muscle/endothelial tissue was removed at the end of the nasal cavity to expose the bottom of the skull. Part of the cartilage between the left and the right side of the nasal cavity was removed to provide a larger area for optical/ surgical access. A craniotomy was then performed on the bone below the pituitary gland to expose the dura. The surgeon then cut open the dura to remove the tumor tissue. Removed tumor tissue w

 This week was great! Dr. Pua had a research meeting on Monday morning with Mediview to test their augmented reality (AR) glasses. The glasses overlayed segmented CT images onto the patient on the table. I was able to try them on and play around a little bit. This innovation will be the future of surgery and other image guided procedures, so I'm excited to be a part of it. Then we had to meet with Dr. Yi to discuss how immersion is going so far. On Tuesday, we tried out the AR goggles in a port placement procedure for education purposes. Basically, we used Microsoft teams on the goggles during the procedure. In the control room, the attending, Dr. Pua, could watch the trainee (a resident) performing the procedure through their perspective and provide live feedback. This was the idea, but it did not work out as well as we hoped because the camera is a bit higher than the wearer's eyes. The field of view was quite a bit higher than we expected, so we'll have to adjust it some

Dr. Cong and I have coordinated with Dr. Ranawat for me to attend a surgery this coming Friday (6/28). Dr. Ranawat is an orthopedic surgeon, specializing in sports injuries of the joints—hip, knee, and shoulder. I look forward to the opportunity to see an orthopedic surgery in person, especially one where I can observe first-hand the kinds of cases my recent research on femoral fracture repairs could help improve. ---------------------------------- This week, I continued working with the Khormaee lab on their mesenchymal stem cell in alginate hydrogels project. There were unexpected problems with the most recent cell passage, so we were unfortunately unable to proceed to creating and imaging the hydrogels. We are currently expanding a new passage of cells until they are sufficiently confluent to create a new hydrogels on titanium. We will also be analyze prior widefield images taken of the stem cells this coming week, with the goal of obtaining cell density measurements in different re

This was an eventful week with the majority of time spent on the clinical side of things. At the beginning of this week, I connected with Dr. Dana Zappetti, a pulmonologist, who connected me with the Director of the Pulmonary ICU. I will start shadowing in the Pulmonary ICU next Monday! On Tuesday, we had an informative lecture on the nuances of both being a mentor as well as a mentee. Then, one of my classmates graciously let me tag along with him as he shadowed Dr. Schwartz, a neurosurgeon. The morning started with us shadowing an endoscopic removal of a pituitary adenoma. This was an easy surgery to watch as there was a screen showing the procedure via the camera on the endoscope. It began with a fellow clearing a path through the nose for Dr. Schwartz to eventually remove the tumor. I am not experienced with surgery, so I was shocked that this procedure was considered minimally invasive given the amount of tissue and bone that the surgeons were removing. Finally, we watched Dr. Sch

 This week, I continued my clinical shadowing with Dr. Rodeo. I was able to see lots of patients recovering from various knee surgeries, including ACL repairs, total joint replacements, and meniscus repairs. Through these visits I learned a lot about physical therapy regimens for knee recovery. Most surgical recoveries involve a high degree of quadriceps and core strengthening in order to regain full range of motion and strength in the limb. Learning what types of exercises, and at which timepoints those plans are recommended was very insightful, as my own work involves an injury and exercise model. In the clinic, I was exposed to various forms of injection therapies for knee cartilage and tendon degeneration, such as platelet-rich plasma, hyaluronic acid, and steroid injections. By listening to Dr. Rodeo counsel patients on their best options, I have learned a lot about when each type of therapeutic is most effective, and in what clinical contexts. More complex shoulder cases involvin

 One of the lab’s post-docs was on vacation this week so somebody had to present in her place during lab meeting. Dr. Demaria asked Diego, one of the medical students in the lab, and me to present on Tuesday morning, so I spent the majority of my Monday working on my presentation. Diego also went over his experimental timeline with me and the other medical student. This week, some of his organoids were ready to harvest so he worked on irradiating the different treatment groups and collected conditioned media for protein level testing and RNA sequencing of the samples. The other medical student, Marvin, also placed some samples in a hypoxic chamber. This is intended to model the state of tumor cells in the core of a tumor, which becomes hypoxic due to lack of vasculature to deliver oxygen. Tuesday morning, Diego presented some bulk RNA sequencing data collected by another lab member that he continued the analysis on. Part of the purpose of this study was to look at cell death after ra

 6/17/2024 - 6/21/2024 On Monday, I was able to shadow Dr. Spector during clinicals. It was fascinating to see patients whose surgeries I had witnessed, up and interacting with us. It was also cool to see how the surgical wounds were healing. Tuesday began with the weekly morning meeting. This time, the meeting centered around establishing healthy mentor/mentee relationships. I'm sure the intention behind the meeting topic was to help us recognize and address any issues we may be experiencing with our clinical mentors.  After the meeting, I went to the lab to observe a breast tissue isolation. It was more labor-intensive than I had expected. The tissue needed to be broken down to a mush before enzymes could be used to dissolve it. The issue was that the breast tissue was extremely fatty and fibrous. As a result, it took around 15 minutes of cutting the tissue with scissors to break it down enough for dissolution. I spent the whole day on Thursday at the ER. As a result, I was able

This week I shadowed a burned hand scar contracture excision with placement of a full thickness skin graft (FTSG) by Dr. Adam Jacoby in plastics at DHK. This patient had healed from this injury on the hand years ago and is now having this surgery to regain full mobility of the hand. Four of the five fingers had a Z-plasty performed. This allowed the release of the scar on the fingers in the vertical direction and redirected the new scar lines perpendicular to the movement. This would allow for reduced tension on the wound. One of the fingers, the scar was much thicker than the others, an a FTSG taken from the medial groin region where the skin had a lot of laxity was transplanted over the missing skin on the finger. India and I also met with Dr. Roger Hartl's team in neurosurgery to discuss the tissue collection logistics for samples sent back to the Ithaca campus and other members in our lab. We then collected this tissue sample from a TLIF (Transforaminal lumbar interbody fusion)

  6/15/24 - 6/21/24 Week 3: On Tuesday, during our immersion weekly meeting, I attended a  talk that focused on how to choose a mentor and the qualities of a good mentee. The speaker delved into the significance of finding a mentor whose experience and values align with one's personal and professional goals. They highlighted key attributes to look for in a mentor, such as empathy, experience, and the ability to provide constructive feedback. Additionally, the speaker discussed the qualities that make a good mentee, including being open to learning, proactive in seeking guidance, and respectful of the mentor's time and advice.  Cardiac Catheterization [ ref ] This week I had a few cath lab and MRI reading sessions from Tuesday to Friday. During my recent cath lab experiences, I had the opportunity to observe several intricate procedures. One particularly fascinating procedure was a Percutaneous Coronary Intervention (PCI). In this case, the patient had two blockages in the coron

This week I shadowed physicians in the Cardiac Care Unit (CCU). I learned the difference between transitional and destination therapies. A balloon pump, for example, is a transitional therapy. It would be difficult for a patient with a balloon pump to perform activities as the patient is required to lie flat. A destination therapy, such as a Left Ventricular Assist Device (LVAD), is an implantable device that is used as a permanent treatment. I also learned what a code status is and the medical care a patient's team is to provide in the event of cardiac arrest, such as a Do Not Resuscitate (DNR) order. I followed clinicians as they went on rounds, discussed updates on patients and their care plan.  The rest of the week was spent continuing my research project. I have been getting better at analyzing cardiac MRI images. Our cohort had a meeting with Dr. Yi Wang to discuss our clinical progress, and attended our weekly Tuesday seminar on the role of mentors and mentees. 

Week 3 On Monday I shadowed a BCA assay to quantify total protein concentration in lymphatic endothelial cells (LEC) and human umbilical vein endothelial cells (HUVEC). Additionally, we used Western Blot analysis for specific protein detection and characterization. In the afternoon, we met with Dr. Wang to learn the importance of observing surgeries in OR.  On Tuesday morning, we attended a talk on mentorship. In the afternoon, I shadowed a surgery, gaining valuable insights into surgical procedures, including removal of tissue and suture. On Wednesday, I reviewed literature on Metformin and the AMPK-Akt pathway to help plan a new experiment to investigate lymphedema disease mechanism and treatment. On Thursday, I visited the ER due to severe thyroid swelling, as I was told that there was no available appointment until next year:) This experience allowed me to observe the ER operation from the patient's perspective, while i noticed significant waiting times. I also learned to read

 This week, I could only shadow one procedure following the plastic surgery team as they performed a double mastectomy. I arrived as the team was marking where the initial incisions would be to ensure symmetry. This took longer than other surgeries that I have seen because the surgeons had to consider not only the area needed but also the physical appearance of the surgical site after the procedure. Two surgeons worked together, one for each side of the patient. Both took their time cutting into the skin and removing the breast tissue and additional fat layers in the region. This took quite a long time because the surgeons had to carefully remove the tissue without damaging the surrounding tissue and cauterizing sections to reduce the bleeding. As expected the surgeons removed a relatively large amount of tissue, leaving a large area exposed which they initially closed with staples before making the final closure taking their time to reduce the visibility of the scar.  The rest of my t

 This week was one of orientation and starting with work for me. At the beginning of the week we had out lecture on the use of ChatGPT for medical use. These uses included assisting in writing reports, analyzing images and drafting email. This lecture was interesting because I had no idea that ChatGPT could be used as a resources in both clinical work and research. This week then followed with a meeting with Dr. Bostrom to speak about my clinical involvement this summer. The events of this meeting encouraged me with my involvement in the clinical and allowed for me to start the following day. On Thursday I was in the clinic with my mentor. The cases seen was a combination of pre-op consultations and post-op check ups. This was very interesting to see because seeing the different degrees of osteoarthritis and how the patients recover over time after the operation. Having time to ask my clinician questions between visits has been very helpful and allowed for me to understand how the clin

The pace this week picked up quickly with shadowing, surgeries, and imaging. I opened the week with prepping for what's to come with the Liston lab. This was followed by our reoccurring weekly meeting with the immersion teaching team. Dr. Shih presented his excitement about ChatGPT in medicine and how LLMs work. Afterwards I dove into confocal training with the WCMC Imaging Core. It was awesome to see how a new scope worked and the training session with Janet was comfortable, fast paced, and extremely informative! It's always cool to find new ways to utilize familiar software. Now that I am trained with the core, I will be able to move forward with the first half of my summer research along Shane Johnson, imaging and analyzing various RNAscope samples related to his TMS study.  The next day I had my first shadowing experience in the OR. It was exciting and overwhelming. Although hard to see (but amazingly and kindly accommodated for by Jess, the head nurse in the room), it was

 This week I spent most of my time shadowing Dr.Chen in interventional cardiology. I was able to watch several procedures throughout the week that helped bring to light the various ways you can treat valve diseases without doing full blown surgery. Dr.Chen is part of multiple clinical trials and as such allowed me to watch some very novel procedures. This included the first tricuspid trans catheter valve replacement. I was able to manipulate a version of the device in the dry bench to learn how it deploys and maneuvers in the patient. One procedure in particular was very interesting in that Weill Cornell is one of a handful of places in the world that is certified to perform it. This procedure involves slicing a valve leaflet utilizing two guide catheters all while the heart is still beating. This takes particular skill and planning and was very interesting to see. 

This week I shadowed Dr. Scott Rodeo in clinical visits where I got to observe post-operative care for orthopedic surgical patients. I got to witness the types/range of motion expected for patients recovering from reverse arthroplasty and ACL reconstruction surgery at various stages of the post-operative timeline. I also learned different techniques for clinically assessing the degree of tendon/ligament damage, such as the Thompson test (used to check for total Achilles rupture by squeezing the gastrocnemius-soleus complex in the calf and determining the degree of plantar flexion). Additionally, I learned a lot about both post-traumatic and age-related osteoarthritis, two subsets of the cartilage and bone disorder that demand unique treatment and management. Meeting with Dr. Rodeo's research team, I was able to engage with their work both in the post-traumatic osteoarthritis sphere, and with regards to tendinopathy. I am eager to start my summer research project on some of the sign

This week, I spent some time with Dr. Dan McDonald and Dr. Evelyn Horn during outpatient heart failure visits. With Dr. McDonald on Wednesday, I saw many patients with cardiac amyloidosis, a disease in which abnormally folded proteins are deposited in the myocardium. This results in stiffening of the muscle, and presents very similarly to traditional diastolic dysfunction. I learned a lot about the management of this condition, which is dependent on the exact cause of amyloid buildup. In most cases, it is not reversible, and progression can only be slowed. I am thinking this may be an interesting condition to investigate during my thesis work, focused particularly on coronary microvascular effects. There are a lot of parallels between this condition and Alzheimer's, where our lab has previously uncovered some very interesting vascular pathologies. With Dr. Horn on Thursday, I had some very interesting conversations regarding the relationship between diastolic heart failure and left