BME Summer Immersion 2021

For my clinical immersion term, I was matched with Dr. Ariel Marciscano in the department of Radiation Oncology. Aside from his clinical responsibilities, Dr. Marciscano heads a research group at Weill Cornell Medicine and serves as Director of the Radiation Therapy Preclinical Core. His group is interested in elucidating the mechanisms by which radiation therapy engages the immune system when treating solid tumors, and how clinicians can take advantage of a deeper understanding of this process to design more effective cancer treatment paradigms for patients. During part of my time here, I will be helping with a project in Dr. Marciscano's lab that aims to investigate the effect of radiation therapy on Fc gamma receptor expression by various immune cells. Differences in expression and engagement of Fc receptors have implications on the effectiveness of cancer immunotherapies and combination therapies.  While Dr. Marciscano does not currently treat many patients in the clinic, he ha...

    Week 1 06/21/2021   This week I have been shadowing clinicians in the Interventional Radiology (IR) department. My clinical mentor, Dr. Bradley Pua, was on the leave this week, but he has assigned me to work with other clinicians in the department, including Dr. Malhotra, Dr. McClure, Dr. Scherer, and Dr. Browne. I was able to shadow them for both patient visits and outpatient procedures. The procedures I observed this week include balloon angioplasty, tumour ablation, embolization, and biopsy, which are all minimally invasive interventions which utilizes various imaging techniques, e.g. CT scan, MRI, to guide the insertion of small, intravenous catheters.   One of the medical conditions the IR department treats is deep vein thrombosis (DVT). DVT is essentially a blood clot, or thrombus, found in the deep veins in the body. Most DVTs are found in the lower limbs. Sometimes the blood clot and break loose and travel to the lungs, causing what is known as pulmonary ...

  During my first week of Immersion at Weill Cornell Medicine, my clinical mentor, Dr. Jason Spector, was out of town. As a result, I spent my time shadowing other clinicians, familiarizing myself with the layout of the hospital, and introducing myself to his lab.  I witnessed four major types of surgery: gastric bypass, breast reconstruction, hernia repair, and craniectomy. Gastric bypass surgeries reduce the working size of the stomach with the intention of helping the patient lose weight by reducing appetite. This is accomplished by creating a small pouch from the stomach and passing over the first section of the small intestine.  The first breast reconstruction surgery was for a patient who was undergoing radiotherapy for breast cancer. Temporary inflatable implants were surgically inserted as placeholders while she undergoes therapy. After her treatment is complete, she will return for polymeric-based implants. This case was interesting to witness since...

         Dr. Marshall Glesby peered through his glasses at the computer holding the health information of his patients as he prepared to see them at the clinic. Before the appointment, he described to me his first patient’s medical situation with HIV, the team of social workers and psychiatrists prepared to offer a helping hard as needed, and, in a slightly quieter tone of voice, remarked that patients would have benefited from additional outreach when the Covid-19 pandemic socially isolated them.     Soon enough it was 10:00 AM and the first patient walked into the room, duffel bag in hand, clunky slides thwacking on the white linoleum floor. His other hand gestured through the air as he described the recent loss of his antiretroviral medications after a late night date gone wrong. Without these medications to suppress the replication of HIV, his viral load would rise from an undetectable level leading to potential further disease ...

Hi, everyone! My name is Samantha Bratcher. My clinical immersion is with Dr. Adam Talenfeld and Dr. Kyungmouk Steve Lee in the Interventional Radiology (IR) department. Although it's not very related to my field at the university (biomechanics/mechanobiology), the clinical experience has still been very interesting. The IR department is super friendly and all the clinicians have been very available to letting me shadow them. It's only been one week, but I've already learned a lot! Every day has been watching something new, from angioplasty to biopsy to embolization. I find it so crazy that they're able to thread a wire through someone's veins to practically any area of the body. It's always a bit crazy to watch. I got a video of a balloon angioplasty using this method. The balloon is inflated inside a person's veins to expand them and increase blood flow. The second video shows the veins and their quality. The rate at which the contrast dye flows through is...

 I can't believe it has already been a week since I arrived in New York City. This past week, I shadowed Dr. Dan Riew from Neurology and Brain and Spine department. Dr. Riew specializes in cervical spine surgeries, including spinal fusion, disk replacement, and laminoplasty. I watched a couple of surgeries on Monday and Wednesday. It was really fun and interesting to see the surgeries! With laminoplasty, Dr. Riew enlarged the spinal canal by drilling apart the lamina and connecting the two ends with bone plate and screws. Laminoplasty treats spinal stenosis by enlarging the spinal cord canal so that the pressure on the spinal cord can be relieved.  My research project this summer is to develop a design proposal that details the function and technical specifications of a paper-thin and ultra small pressure transducer that can be put inside the disk replacement implants. Ideally, the pressure transducer will be connected to a drain that extends outside of the body for a couple o...

     I can’t believe it’s only been a week since I first came here. I have done so much during the week that getting the ID card seems like a month ago. I met with my clinical mentor Dr. Chiang from Radiology in the neuro reading room on Tuesday and got the opportunity to observe radiologists analyzing scans. In the neuro reading room, radiologists primarily work with CT, MRI and sometimes PET scans of the brain and the spine. The first thing that I noticed was that every doctor has at least three screens in front of them. The usual settings are one for displaying scans, one for recording findings and the other for viewing files and communication. The monitors in the reading room are medical grade, which display more colors and maintain a stable luminance so that images are displayed with greater accuracy and consistency. I learned that nowadays all images are digitized and displayed on such monitors and films are already outdated in the U.S. After images are acquired, th...

Over the course of this week, I did some labwork in Dr. Ethel Cesarman's lab in the Pathology Department. She has been collaborating with my PI, Dr. David Erickson, on developing a device called TINY ( Tiny Isothermal Nucleic acid quantification sYstem ) for the point-of-care detection of Kaposi sarcoma-associated herpesvirus (KSHV) that can also be utilized in resource-limited settings where KS is more prevalent, access to sources of electrical power, especially in the field, is challenging, and power outages occur often. It performs nucleic acid quantification through a loop-mediated isothermal amplification (LAMP) reaction. During this past week, I learned how to process skin biopsies acquired from KS patients in sub-Saharan Africa and perform DNA extraction. I also quantified the concentration of the final nucleotide sample extracted from each biopsy. In total for this week, I processed 29 skin biopsies, extracted their DNA, and quantified the concentration of the nucleotide s...

I am working with Dr. Mirella Salvatore from the infectious disease division. My research project will revolve around associations of COVID 19 patient clinical characteristics with their hostresponses throughout their hospitalization and recovery.   On the patient care side I have been following Dr. Ole Vielemeyer in ID consultation. A large part of the round is to discuss the choice of antibiotics, itsdosage and duration from lab results and examination reports. Some of the cases this week have been quite complicated and chronic; therefore, joint effort were required to provide adequate treatments. One patient had to battle both Crohn's disease and histoplasmosis, where the immunosuppressant and antibiotics used must be carefully considered to treat the histoplasma and maintain some immune system function, while not severing the GI tract. A part of medical care I learned that I haven't considered much of is the inpatient - outpatient transition: how is the treatments adjusted ...

                 This is the first week of the clinical immersion experience, and my clinical mentor is Dr. Timothy Wilkin in the infectious diseases division. The topic of his work relates to Human papillomavirus (HPV), One of the things HPV can lead to is cervical cancer. My project will be focused on developing an app or efficient storage solution for images related to cervical cancer. It was fascinating to hear about the background and rationale behind this study through discussions with my mentor. Since cervical cancer is the leading cause of cancer death in women among low resource countries, the goal is to develop a screening process that is smoother and easier to implement in low-resource settings. Currently, the process requires screening for cytology, performing a biopsy (if abnormal lesions are found), then proceeding to treatment. The study aims to make this process more accessible as well as improve sensitivity and specifici...

 Week 1 has been great and has flown by very quickly. I met with my clinical mentor Dr. Babacar Cisse who is in the neurosurgery department at Weill Cornell. Both Dr. Cisse as well as his assistant Sandra helped me set up in the office and gave me a workspace and computer that I can use for the next six weeks and I'm super grateful for all their help! On Monday I prepared a short presentation on my research and the nanoparticles that my lab at Cornell works on (C'dots). Throughout my presentation I discussed both perviously published work as well as my current project in Ithaca. Later in the week, I plated both human and mouse glioblastoma cell lines and incubated them with C'dots that I had brought with me from our lab in Ithaca. This is part of the preliminary work that Dr. Cisse is eager to explore as part of a potential collaboration between my lab (Wiesner Group) and his research group at Weill. With the help of the postdocs in the lab, I was able to get familiar with ...

  Clinical:     I was not able to see my doctor on Monday and Tuesday because he was out of town.  I did get to watch surgeries on Wednesday and Thursday though.  On Wednesday I saw Dr. Schwartz perform a supra-orbital craniotomy to remove a pituitary tumor.  Then on Thursday I saw two endonasal endoscopic surgeries to remove tumors.  These two surgeries were for similar types of tumors, thought the size and location of the tumor dictates which surgery is performed.  It was very interesting for me to see these surgeries now that I have performed animal surgeries of my own in a research lab.  I was able to see some things that are done similarly in humans and many techniques that are done differently.  I had many questions come up and ideas for possible improvements the I am hoping to discuss with Dr. Schwartz.  Moving forward I would like to see some different types of neurosurgeries (possibly for epilepsy), and I would like to see ...

This week I met with my clinical mentor, Dr. Rohit Chandwani, and my research mentor, Dr. Shuibing Chen. Dr. Chandwani is an Assistant Professor in the Department of Surgery at New York-Presbyterian and Weill Cornell Medicine and is a board-certified surgical oncologist. Dr. Chandwani specializes in pancreatic cancer and metastatic colorectal cancer and is also the Principal Investigator of a basic science laboratory studying the epigenetics of pancreatic and liver cancer. Dr. Chen is an Associate Professor of Chemical Biology in Surgery and of Chemical Biology in Biochemistry. Dr. Chen’s laboratory is focused on manipulating stem cell fate using chemical and biological approaches to develop functional tissues and organs that can be used for translational research. So far my time at Weill Cornell has been lab focused as I learn about the projects I will be working on for the rest of the summer. In Dr. Chen’s lab, I will be learning how to differentiate stem cells to insulin secreting...

Ready, Set, Go! Taken from Pinterest The immersion term started, and with it, a new stage in my career. This first week has been super busy! Getting accustomed to a new place is complicated - the trial and error in the elevator labyrinth, the thousand and none emails from your mentor, and the no-one-knows what-am-I-doing-project. While everything falls into place, there you are in the middle of the madness; it is just awesome.  Every day has been a new adventure, one that starts with the question: What is dermatology? For many, this is just the study of the skin, pretty underrated. For me, this is not only the largest organ in your body but the first line of defense against all kinds of threats. This amazing barrier includes visible and non-visible parts, like the scalp and the mouth. Did you know that dermatologists check your scalp for any condition? Did you know that you can have cancer on your scalp? Pretty interesting, right! While I thought I would work on the skin, I found o...

During my clinical immersion, I will be working with Dr. Jing-Mei Hsu in the Hematology and Oncology department at Weill Cornell. Dr. Hsu works with leukemia, lymphoma, and multiple myeloma patients undergoing autologous or allogeneic stem cell transplants. Dr. Hsu’s group also specializes in CAR-T therapies for patients with diffuse large B-cell lymphoma (DLBCL). This week I shadowed Dr. Jorge Monge, who was the attending on service for patients admitted for autologous stem cell transplants. Before rounds, the attending physician meets with the team of PAs assigned to each patient, and then we review their charts before going to check on each patient. I was able to observe a patient receive a clinical trial CAR-T therapy for DLBCL, and I also learned how patients on clinical trials are assessed and “graded” to determine at what time points they can receive additional treatments/infusions according to how severe their symptoms/ reactions to the treatment are. This particular patient ex...

With my mentor, Dr. Hartl, gone this week, I had ample opportunity to spend time meeting and learning about physicians of various professions. I spent one day shadowing in gynecologic oncology. I primarily shadowed Dr. Holcomb, who is not only a fantastic surgeon, but also the Dean of Admissions. He was great. Though he taught me many specific details about the procedures we were performing, he also taught me about the layout of the OR, the general procedures for laparoscopic and robot-assisted surgeries, and proper conduct in the OR. I spent another day shadowing a couple surgeries in neurosurgery. There, I was able to shadow Dr. Schwartz, Dr. Ellozy, and Dr. Fu. Equally importantly, I was able learn my way around the hospital and college and complete necessary administrative duties. I now have the surgical schedules, building/ equipment access, and physician connections necessary to make my remaining weeks productive and exciting. 

The immersion term is shaping up to be a formative experience for my academic pursuits. My clinical mentor, Dr. Roger Hartl, is out this week, so I spent Wednesday and Thursday shadowing Dr. Jaspal Ricky Singh. Dr. Singh works in the Center for Compressive Spine Care and the David H. Koch Center. I had the opportunity to watch cervical/sacral epidurals, radio frequency nerve ablations, bone marrow harvests, and stem cell transplants. My PhD focuses on characterizing the cellular composition of bone marrow aspirate and its efficacy for treating intervertebral disc degeneration. It's established that intradiscal injections of aspirates with higher stem cell populations lead to favorable healing outcomes. Dr. Singh demonstrated a new device used to extract bone marrow aspirate with a richer stem cell population. This would allow for direct injection of the aspirate without gradient centrifugation or other purification methods, saving clinicians time during procedures. Ultimately, this...

Research - My project for this summer is going to focus on using a large national database that contains blood/plasma biomarker data, cognitive scores, and image data on ~6000 subjects that are either healthy, have mild cognitive impairment, or have Alzheimer's disease. Specifically, I will be looking for associations between neutrophil activation and reductions in cerebral blood flow, which is what my (Schaffer-Nishimura) lab in Ithaca is also investigating. I like this project because in the Schaffer-Nishimura Lab we only work with mice, and so it nice to now be able translate that work and to analyze some of the same measurements in human subjects. I am also learning how to use the statistical program 'R' for this project, which I think is a good skill to develop. Much of my week has been spent looking at this Alzheimer database and trying to find/extract the data that I need. I've already run into a few problems with this dataset in that there are not many patients ...

  Day 1:  I had the opportunity today to meet and greet my clinical mentor  Dr. Jian Shou and the trauma team, which were very welcoming and nice.  I also got a detailed description of the patients that the team was responsible for.  Day 2: I had the opportunity to see a sleeve gastrectomy surgery that induces weight loss by restricting their food intake and capacity. I learned that the surgery removed ~75% of the patient's stomach.  I had the opportunity to observe 3 hernia repair surgeries that help repair hernias that were either pushed back, tied off, or removed. I learned that once the hernia was placed back into the abdomen, the synthetic mesh is highly common to be used to strengthen the abdominal wall prior to receiving stitches.  Day 3:  I had the opportunity to observe a FLAP reconstruction also known as abdominal muscle reconstruction,  which showed how skin and fat from the abdomen can be used to make the breast shape. I learned ...

For my first week of immersion I attended the OR's of a few different physicians as my clinical mentor Dr. Jason Spector of plastic surgery and reconstruction was on vacation this week. I was able to see three different hernia repairs, and one double mastectomy and bilateral DIEP flap.  I think my favorite thing I saw was the double mastectomy and bilateral DIEP flap. From what I understand, this is a procedure in which both breasts were removed and fat from the stomach is used to reconstruct the breasts. The novelty of the DIEP flap is that it does not require the removal of muscle which allows patients to recover quicker. Additionally, blood vessels from the fat in the stomach are left in tact and "hooked up" to corresponding vessels in the breast. All in all, the procedure essentially amounted to a breast reconstruction and tummy tuck. It was a 10 hour surgery that required multiple doctors and departments, as this was not just a purely cosmetic procedure- the patient ...

 With week one of our immersion term coming to a close, I am excited by the potential of the coming weeks. I had very little idea/expectations as to how this first week would go. Initially, the research/shadowing experiences were ill-defined, but everyone I have met down here so far has made great efforts to make sure I make the most out of my time here. My mentor, Dr. Gauthier, is a clinician that specializes in multiple sclerosis (MS) and participates in various research projects that aim to enhance our understanding of the characteristic lesions observed in MS patient MRI scans. I was able to shadow here on Wednesday and observe how she handles routine check-ups with MS patients. Because MS is chronic and patients are typically coming on and off medications over the span of years to decades, these visits are crucial to assess disease progression or remission. Assessments are made on subjective patient experiences' of symptoms since the last visit, as well as assessments of senso...

      My first week with my clinical mentor Dr. Jiwon Kim of the Cardiology Department has flown by. Concerning research,  I am conducting strain analysis on the right ventricular free and septal walls in hopes of finding a relationship with incidence of different cardiomyopathies. I received my first dataset on Tuesday and have been able to process 100+ images. I have also been introduced to SPSS, where I will continue to perform analyses throughout Immersion. My clinical mentor has also taught me the basics of reading cardiac MRI images - how to analyze stroke volume, important factors to look for in short versus long axis images, etc. A new study is beginning next week that studies the effect of COVID-19 on heart function and I look forward to attending the MRI and Echo imaging sessions with patients. Additionally, I am excited to watch revascularization surgeries in the Cardiology department in the upcoming weeks.           As an inc...

For my clinical immersion term, I plan to work primarily in oncology to determine if this is the direction I’d like to focus my graduate research in. I’ll mainly be working with Dr. John Leonard in lymphoma at Weill Cornell Medicine. During this week, Dr. Leonard had numerous administrative things he had planned so he connected me with various clinicians and researchers. I spent a large portion of my time shadowing Dr. Christine Garcia doing inpatient rounds in the morning and learning from the decisions she makes with the residents and physician assistant’s for lymphoma service. I’m also shadowing Dr. John Allan in clinic this week and learning how patients with chronic lymphocytic leukemia (CLL) are treated. We had multiple patients that had undergone chemotherapy treatment but were dealing with other debilitating issues that were preventing them from going home. One patient in particular had a really bad case of jaundice and needed a stent added in his liver due to a really narrow p...

 It's been a busy first week of Immersion!  I haven't had a lot of exposure to medical imaging before, so I've spent a lot of time learning and observing different imaging modalities.   I spent the first few days of the week meeting with and shadowing various radiologists in the "bone" section of the department, including Dr. Kazam (my clinical mentor), Dr. Belfi, Dr. Asrani and Dr. Lu.  I got to observe the typical workflow in the Emergency Reading Room, and saw a wide variety of radiology cases.  Some of the highlights were torn menisci, bone lesions, lower leg amputation, and open fractures, among others.  During all of this, I spent a lot of time absorbing the various intricacies that radiologists have to manage in order to get the correct diagnosis. Today I am shadowing some of the imaging technicians at 1305 York in order to get a better idea of how different imaging sequences are actually obtained.  One of the most interesting things I saw ...

Clinical: My mentor, Dr. Michael Kaplitt, has been extremely busy over the last month, so it was difficult getting a response from him. Therefore, I have not yet been exposed to any clinical experience, but have established that I will begin to this coming Monday. I will be shadowing Dr. Kaplitt's focused ultrasound cases, as well as his deep brain stimulation surgeries, for which I am very excited to be able to watch. Research: Most all of my time since I have gotten here has been spent completing required animal trainings for the research project I will be doing in Dr. Kaplitt's lab. I will be using fiber photometry to record the neural activity do D2 (dopamine) receptor neurons of mice when exposed to a magnetic field. These mice have been altered to have magnetogenetic ion channels that when exposed to a magnetic field change cause changes to the functioning of the dopaminergic system. Mice are rendered motionless at the time of field change, mimicking a Parkinsonian state....

 Clinical experience:  Had a great first week shadowing some surgeons in the OR. My mentor (Dr. Spector) is out of office this week, so I hung out with Rigoberto and his mentor Dr. Shou. I got to see a few hernia repairs, which were very interesting. One hernia was quite small, and the surgical techniques were difficult to see from outside the sterile field. The other however was a massive hernia which was very interesting to observe. During the larger hernia, I was able to stand next to the anesthesiologist, which was both a great view and a great opportunity to chat about the machines and techniques used for anesthesia.  The most interesting surgery I saw this week was a bilateral mastectomy followed by DIEP (deep inferior epigastric perforators) flap reconstruction. It was a 10 hour surgery with a rotating team of surgeons and nurses that was incredible to watch.  I'm looking forward to Dr. Spector getting back so I can attend his rounds and surgeries. I went to l...

Before this clinical immersion experience, I hadn’t witnessed areas of doctors' offices and hospitals beyond what a typical patient experiences. For my research in Ithaca, I am working on a medical device related to breast cancer. Most of us have heard the statistic that 1 in 8 women will be diagnosed with breast cancer at some point in their lives. So as you can imagine, most women and some men will rely on diagnostic imaging. I have watched videos of procedures, read literature, and even dabbled in the personal blogs of those affected by breast cancer, but this week I witnessed the actions involved and the gravity that they carry.   My clinical mentor, who is Jennifer Marti, was out of the office this week so I rotated with several clinicians and shadowed the following: -I began with a fellow, Jay, who was actually on the last day of his fellowship. He was in the diagnostic imaging room and he walked me through some screening and diagnostic mammograms. He explained the logistics ...

I've been excited for this for a few months now. Sometimes, you worry that your anticipation and expectations may not be met when you finally arrive. Even though it has only been my first week, I cannot express how my time with my mentor, a radiologist, and the overall experience already surpassed anything in my imagination. But first, I'll talk about how I got there. Many folks will take the bus down (and in the future that will likely be Cornell's Campus to Campus line -- it has all the snacks and amenities that will make any graduate student enjoy the 4.5 to 6 hour trip to Manhattan). Since I live near the area, I decided to see my family and they drove me in. I will just say we were warmly welcomed by the Father's Day city traffic, especially by the bridge tolls! With the driving out of the way, I got settled in and enjoyed the view of 1300 York, the main entrance to Weill Cornell Medical College. Every morning, you get to see clinicians and staff of all kinds flood...

This week has been great so far, I was able to observe radiofrequency ablation procedures, pacemaker adjustment surgeries, and hernia repair surgeries. I was particularly impressed by the system used in radio frequency ablation. The entire procedure is done through a small incision which allows the guide catheter to enter the heart venously. The physician was able to scan the 3D morphology and electroactivity of the heart, and identifying the precise locations with abnormal conductivity. The position of the ablation probe is controlled by an external electromagnetic field, allowing surgeons to operate remotely. I was inspired to consider building a simplified ablation system for the embryonic chick heart model that I am working on in my lab in Ithaca. This would allow me to ablate cardiac cushions at precise locations and thus study the effect of local hemodynamic change in cardiac cushion development. 

  Clinical Observation: I am observing Dr. Kevin Curran who is a physician at Memorial Sloan Kettering Cancer Center. Dr. Curran is a pediatric oncologist at MSK Kids and is a member of the Pediatric Stem Cell Transplantation and Cellular Therapies Service. Thus, he treats children with blood cancers, bone marrow disorders, and various immune system problems. Dr. Curran is also the Pediatric Director of the Cellular Therapeutic Center at Memorial Kettering. This means that Dr. Curran, along with many other clinicians and researchers, work to create cellular treatments for children with leukemia and lymphoma. I am very passionate about creating effective therapies for cancer patients that prevent, or minimize, any side-effects resulting from treatments. His work and knowledge concerning chimeric antigen receptor (CAR) T-cells is what drove me to ask for his mentorship during the immersion program. I was delighted when he allowed me to observe him this summer, even though he has a v...

This week has been really fascinating, I started this week by seeing an aortic aneurysm repair with a root replacement. It for sure has been the coolest thing I've ever seen. I'm very thankful for Dr. Lau and Dr. Payabyab for their generosity and hospitality. The flow of the clinical experiences has been to be there at 7:30 for ICU rounds, followed by looking at imagining results, followed by surgery. Dr. Lau and Dr. Payabyab, his senior attending, really blew me away with how skilled they are. In addition, I was able to see a hernia repair in the thoracic cavity. This was also really cool to see the expertise of the surgeons particularly their skills using laprascopic tools.  In terms of clinical research, I met with Dr. Geoff Pitt, a clinical collaborator of the Butcher Lab in Ithaca. He was very kind and introduced me to his post doc and staff as well as posed the opportunity to spend some time with his clinical rounds. There are some skills from our lab I could contribute t...