BME Summer Immersion 2023

 This was a very exciting week for me, as Dr. Chandwani was on service, meaning every day he participated in rounds at the kidney and liver transplant center. I was able to tag along and observe the meetings and patient visits. It was awe-inspiring to watch the group of doctors rattle off facts about each patient almost faster than I could even process; each of them nodded along to a stream of acronyms and medical terms that were only vaguely familiar if not completely unknown to me, and absorbed an unbelievable amount of information regarding test results, scans, medications, and medical history before discussing and coming to a consensus on what sort of treatments and changes should be applied that day. If at all possible, I gained even more respect for this profession -- it was clear that they had all been through an incredible amount of training and preparation in order to achieve this level of expertise. Being able to interact with a wide variety of doctors, from transplant su...

This week, I shadowed Dr. Hartl in the OR and clinic.  On Monday, I observed two TLIFs with a laminectomy and discectomy. On Tuesday, I spent the day in meetings and observing Dr. Hartl in the clinic. I reached out to a neurosurgical resident that agreed to help us with our stem cell project. Wednesday morning I continued to shadow Dr. Hartl in the clinic. On Wednesday I also shadowed Dr. Spector and Dr. Cohen in the OR.  I observed a mastectomy with a total breast reconstruction and part of a total knee reconstruction. During the breast reconstruction, I saw the breast implants and expanders. Dr. Spector explained how the expanders were necessary to get proper teardrop formation of the breast. He also explained how mutations in the P53 gene are responsible for individuals having a higher likelihood of breast cancer.  Dr. Hartl and Dr. Spector were away on Thursday and Friday. 

Monday (June 26th, 2023) I attended Dr. Carli's clinic on the 7th floor of the Weill Cornell East River Professional Building. I left early to go to the HSS Center for Advanced Materials and Engineering in Orthopaedics (CAMEO) Skeletal Biology and Orthopedics Course Day. The topics covered included Bone Development, Repair, Nonunions, Fracture Management, Bone Histology, Biomechanics, and more. The speakers were research and clinical orthopedic leaders. They included Dr. Joseph Lane, Dr. Edward DiCarlo, Dr. Marjolein Van Der Meulen, Dr. Kyung-Hyun Park-Min, Dr. Ryan Breighner, and Dr. Greenblatt. In between lectures, we were given tours of HSS facilities such as the Xtreme CT imaging room and the HSS hospital. I loved catching up with my Cornell Ithaca friends and labmates who journeyed to HSS for the day. Tuesday (June 27th, 2023) The Prosthetic Joint Infection (PJI) research groups have their weekly meetings at 8am at HSS Research Institute on the 6th floor. The group is led by D...

 Week 4: 06/26/23-06/30/23 This week, I spent more time in the neuro ICU with Dr. Alex Merkler. I was able to see the progress some patients had made from seeing them last week which I found encouraging. It was interesting to see the variety of cases in the neuro ICU, the majority of which were stroke and hemorrhage. I had the opportunity to learn more about particular medical conditions, including how subarachnoid hemorrhage leads to a much higher risk of cerebral vasospasm, especially within about two weeks of the hemorrhage. I also learned about idiopathic intracranial hypertension which can lead to a loss of vision due to pressure on the optic nerve. Dr. Zan was out of town this week, but I hope to join her again in the neuroradiology reading room next week. For research, I continued work on analyzing a stroke data set with a goal of performing perfusion-diffusion mismatch. I have been going through each case to check which patients have both a perfusion weighted image (PWI) an...

      This week I had the opportunity to shadow Dr.Kaner who is also in the hematology/oncology department and specializes in leukemia. I was able to attend rounds, see a patient who was just about to begin his CAR T therapy and learn about how he developed his passion for acute leukemias which are quite aggressive but tend to respond quickly to therapies.      Additionally, I spent some time in the lab preparing the cell line for my project and was able to attend Dr.Prince's class on imaging which I found so interesting. We spent the time discussing and analyzing a wide range of cases. He taught us how to approach each image and break down the problem so that even someone like me, who had never really spent much time learning to read CT scans, MRI's, x rays or pet scans would be able to have a conversation about them and ask questions regarding the patient's diagnosis, treatment, etc. It was an extremely helpful class that will come in handy in the clinic ...

Week 4 - First time shadowing plastic reconstructive surgeries and clinic  Name: Sally Lee Mentor: Dr. Thomas J. Fahey I had the incredible opportunity to shadow Dr. Spector and other surgeons during several plastic reconstructive surgeries in the operating room. Among the various procedures, one that particularly caught my attention was the split-thickness skin graft. It involved delicately extracting a thin layer of skin from a donor site, in this case, the patient's left thigh, using a specialized tool called a dermatome. The harvested skin was then manually punctured to create small perforations, allowing for vascularization when placed over the defect on the patient's head. What truly amazed me was the precision and efficiency with which the dermatome removed such a thin layer of skin. Equally impressive was witnessing how this thin graft could develop into a stable, thick layer of skin over time. However, handling the skin that was peeled off from the donor site using the...

 This week, I have been working on a few different areas in the lab. As mentioned last week, I was beginning to learn more about designing CRISPR Cas-9 experiments. Once I had a better understanding, I was able to design guide RNAs and donor oligos for V5 tagging of H1 isoforms in lymphoma cells. Since we already have cells with V5-tagged H1E at the N-terminal, I generated three other V5 knock-in designs: H1E V5 at the C-terminal, H1C V5 at the N-terminal and H1C V5 at the C-terminal. Although, I may not be here for the end product, the eventual goal is to compare the performance of these tags for pulling down the H1 isoforms during immunoprecipitation. To complete this task, I utilized the Alt-R HDR Design Tool on the IDT website to generate potential designs. Then, I compared the designs based on the on and off-target scores to determine which one would be best. Higher on-target scores indicate better efficiency for editing the target site, while high off-target scores indicate l...

 Week 4: 06/26/23 - 06/30/23 The fourth week of my Summer Immersion term consisted of continuing clinical research, shadowing MRI case reviews, and observing cardiac catheterization procedures. For clinical research, I continued to perform volumetric analysis of cardiac MRI scans. Once I reach the desired number of characterizations of right ventricles in patients, we will be able to evaluate whether certain parameters in measuring right ventricle dysfunction correlate with prognosis of patients that suffered from coronary artery disease.   In the MRI case reviews, I witnessed the radiologist’s expertise in performing analyses and providing radiology reports to help direct patient care. A notable case that emerged during the week was a scan of a patient who was relatively young. From prior history of the patient, the cardiology fellow inferred that the patient may have a congenital disease that affects the blood flow direction. To investigate further, the fellow conducted ...

  This week was pretty decent in the city! On Monday, HSS-Cornell CAMEO hosted a trainee specific bone biology teaching retreat. It was a great day of learning/relearning some bone basics and how it can be implemented in the clinic. I think the most interesting thing I learned was how doctors know when to use a plate or a rod on a bone break. Plates are used when the break must reform completely perfect for proper use, as any movement will cause a callous to form. This callous can lead to serious arthritis later in life! The course was a good refresher on basic biology but I learned quite a bit on how the biology informs treatment practices, which was very cool. Very grateful to the organizers and presenters for putting the course together! The rest of the week has been focused on RNA sequencing gene analysis. I have been trying to modify code from a lab mate in order to get a better picture of how the genes are differentially expressed in our treatment groups in comparison to our ...

This week, I shadowed Dr. Gauthier for the first time in her outpatient clinic as she saw her MS patients. MS results from the body's immune system attacking myelin sheaths surrounding the nerve fibers. Because there is no cure, patients visit the physician annually or bi-annually to track treatment plans and monitor disease symptoms. Most of the patients we saw have been seeing Dr. Gauthier for close or more than 10 years. During the visit, Dr. Gauthier pulls up a side-by-side view of their most recent MRI vs from a year ago to review any lesions in the brain or spinal cord. Physical examinations such as walking speed, hand-eye coordination, bladder function, and limb reflexes are also conducted to evaluate the dosage of drugs prescribed for the patients. While most of the patients had little to no symptoms, some patients will digress to progressive MS, which causes symptoms to gradually get worse, usually resulting in an inability to walk. The tumor-injected mice from last week w...

Dr. Marx was back in the office this week so I few days shadowing again.  I shadowed both in the clinic and the operating room this week. This week, I continue to be amazed by how much the clinic work relies on treating the whole person rather than just their injured joint.  This week a patient came in with psoriatic arthritis, an immune disease that causes a build-up of fluid in joints, among other complications. This condition is chronic, unlike the majority of conditions seen by Dr. Marx. He spent the majority of the clinic visit talking about medications, other symptoms, and the patient's mental state. Psoriatic arthritis is a condition that Dr. Marx cannot fix, at best, he can suggest treatments to reduce immediate joint swelling. Despite this, there was still a large focus on general patient well being.  Another patient came in with a torn ACL. The determined treatment was surgery. Dr. Marx went through the general procedure, risks, and recovery details of the proce...

This week I continued working with Dr. Cristofanilli in his clinic. I was unable to work with the breast surgeon because of a change in schedule, so I look forward to working with her next week. Patients that I saw this week highlighted the interplay between oncology and other specialties. One patient presented with breast cancer all throughout their bones. The cancer was so extensive that their femur was on the verge of fracture. Before starting treatment, Dr. Cristofanilli had to consult with an orthopedic surgeon and refer the patient to them because they could not risk a fractured femur in the middle of cancer treatment. Additionally, I saw a patient who presented with osteomyelitis, resulting in an emergency situation. Though not cancer related, Dr. Cristofanilli had to explain the severity of the situation to the patient and work with the emergency department and infectious disease to get the patient seen quickly. Furthermore, this week I was especially struck by the extent to wh...

 06/26/23 - 06/30/23 This week I spent more time doing my research. I finished my surgical training doing craniotomy in mice and I started implanting windows to aid with our imaging. I also finished writing a protocol for the window implant for the mScope experiments where we will be visualising specific network during epileptic episodes. Additionally, this week, I did a great deal of literature research to supplement our protocols and research scope. Dr. Schwartz is known for his minimally invasive surgical procedures. He uses advanced methods to remove large brain tumors, such as pituitary tumors, meningiomas and adenomas, endoscopically. Part of my clinical research with him is to understand the effectiveness of his methods and how patients´ symptoms have evolved since the tumor removal. This week, I spoke with some of Dr. Schwartz´s patients to understand their symptoms one year after the tumor removal. During these calls, I learnt compassion, compassion from the patients and c...

 During this week I followed Dr. Hissong in GI Pathology while they reviewed and signed-out cases. I got to attend the GI pathology consensus meetings which were interesting as the pathologists reviewed cases which they were uncertain about or needed a second pair of eyes prior to confidently sending out a diagnosis. I got to learn more about what GI pathologists get to see on a daily basis and the significance of their work in patient care. Something particularly interesting to me was about appendicitis which can sometimes be caused by tumors rather than simply being inflammation. This was an important note because if appendicitis was related to abnormal growth the patient would need to go back to the hospital for more testing and monitoring, but since appendectomies are typically emergency routine procedures the patients are long gone prior to the pathology diagnosis and they are difficult to reach as they do not usually have prior association with the hospital.  On Friday, ...

 This week, I spent more time in the clinic with Dr. Chandwani. Across the many visits with patients I observed, I experienced a shockingly wide variety of emotions, from profound sympathy to joy and relief. A realization I had at our weekly immersion meeting with the program administrators is that I honestly expected these events to be very clinical and detached; in my mind, I pictured myself shadowing an expert surgeon who would get assigned a case, enter a room with a patient already prepared for operation, complete the necessary task with cold precision and immediately move on to the next task. This could not be further from the truth! Instead, Dr. Chandwani works with these patients from the very moment there is any suspicion that they might have a condition related to his expertise (e.g. they received a scan revealing something that might be pancreatic cancer) and stays with them long after all the procedures and treatments have concluded, observing them even after the recove...

This week, I continued to shadow Dr. Hartl in the OR and clinic.  On Tuesday and Wednesday, I spent the majority of the day in the clinic.  Multiple patients had a herniated disc and spondylolisthesis causing spinal stenosis. These patients are good candidates for our study on bone marrow aspirate. I was able to obtain 3 patient consents this week in which we will be harvesting patient discs and/or bone marrow. This week, I better understood why some patients were getting a microdiscectomy vs TLIF vs artificial disc replacement. I now clearly see where the problem areas are in MRI scans of the spine.  Thursday and Friday, I observed Dr. Hartl in surgery. He performed multiple lumbar discectomies and TLIFs. I also observed a cervical intervertebral disc artificial replacement that I hadn't seen before. It was interesting to see how suppliers communicated with Dr. Hartl on implanting the artificial disc during surgery. 

 This week I continued to work with the Biomechanics group on the research project for the summer. I helped perform data analysis on samples that were collected before I got here. I also started helping another engineer in the lab to perform a review on distal radial fracture models and how they can replicate them in the lab for a study they are starting. Additionally, I started becoming more familiar with the previous publications of my research project. On Wednesday and Thursday, I shadowed Dr Strickland in the clinic and the OR, respectively. In the clinic, we had a lot of downtime between patients and Dr Strickland used that time to discuss difficult cases with current residents and fellows. It was interesting to see differing opinions on the course of treatment the patient should get and trying to figure out how to fix someone's clinical problem while they had already undergone several surgeries. It opened my eyes to how doctors have to also consider the human aspect and the t...

Week 3: 06/19/23-06/23/23 This week, I joined Dr. Santosh Murthy in the neuro ICU at WCMC. I enjoyed seeing that even though the medical team consisted of different members from the week prior, such as a different attending physician, fellows, residents, and a physician assistant, everyone in the medical team was well-informed on the patients who had been treated by others. I believe this communication between team members is very important in order to provide the best care for the patients. Also, I found it interesting to see how patients were doing from when I first saw them. While some were doing much better, unfortunately there were others who were doing worse.  I was also able to join Dr. Elcin Zan again in the neuroradiology reading room. Dr. Zan provided constant teaching moments when reading the scans, such as teaching the anatomy of where each lobe of the brain is and how to identify them on an MRI scan. Also, she described how enhancement in the brain on MRI means that ve...

Tuesday (June 20th, 2023) The Prosthetic Joint Infection (PJI) research groups have weekly meetings at 8am at HSS Research Institute on the 6th floor. The group is led by Dr. Mathias Bostrom and Dr. Alberto Carli. The meeting discussed the following steps to completing various experimental projects. At 9am, I attended our weekly immersion meeting with Dr. Yi Wang at the Belfer Building. Carly and Kelly provided breakfast sandwiches and orange juice for the meeting. At 11am, I met with Dr. Fernando Quevedo Gonzalez, a scientist at HSS who researches bone-implant integration using computational models. We discussed his computational workflow utilizing FDA-cleared programs such as Mimics, as well as Design X and Abaqus. I returned to the lab after my meeting and ran a minimal inhibitory concentration (MIC) assay. We used a MIC assay to determine the lowest concentration of vancomycin necessary to inhibit bacteria growth (E. Coli).  Wednesday (June 21st, 2023) I shadowed Dr. Carli and ...

Week 3 Blog Name: Sally Lee Clinician mentor: Dr. Thomas J. Fahey This week was filled with both setbacks and thrilling possibilities. Unfortunately, due to the shortage of staff at the clinic and challenges in arranging shadowing opportunities in the OR, I missed out on observing clinic appointments and surgeries this week. However, hopefully, I will be able to resume shadowing next week.  To make the most of my time, I took the initiative to reach out to several other clinicians, including Dr. Jason Spector. Attending one of his seminars back in Ithaca on reconstructive surgery and witnessing the profound scale of the surgeries and the impact they had on patients' lives was an inspiring experience. During the seminar, Dr. Spector also shed light on certain limitations associated with some of the procedures, such as the challenge of preventing inflammation, which occasionally necessitates additional surgeries, and prolonged recovery periods. Hence, I am eagerly anticipating the op...

    As in the previous two weeks, I spent most of my time in the day hospital and the clinic with Dr.Gomez. It's been pretty nice getting to see the same patients every few days and seeing their progress every time they come back.   Additionally, I also was able to observe how an apheresis machine works. One patient who has been diagnosed with Lymphoma will undergo T cell therapy in the coming weeks and the first step to that was to collect his T cells. This machine collects the patient's blood and then centrifuges it to separate it into its various components by their density. This isn't a surgical procedure but it does take a few hours to complete. The blood is taken through an IV from one arm, goes into the machine which separates the white blood cells into a separate compartment, and then returns the plasma, platelets,  and red blood cells back to the patients through the other arm. While the patient waits for the T cells to come back from the lab he wi...

 In tackling the problem of the unsuccessful western blot, I decided to re-verify the DNA sequence to ensure that the V5 tag was inserted correctly at the N-terminus of the H1E isoform. To do this I extracted genomic DNA from the cells, performed PCR, and sent the product for Sanger sequencing. By aligning the sequences and checking the chromatogram, it seems that the V5 tag is present in some of the alleles, but not others. I plan to try the western blot again with more cells, as well as use some different antibodies. In the meantime, I have been designing a CRISPR Cas-9 experiment to generate other cell lines with V5-tagged H1 isoforms. This has been a bit of a learning curve for me, since I have no previous experience with CRISPR. I have looked into a few papers that have optimized CRISPR protocols for their own purposes. I’ve also been testing out some of the online tools for designing guide RNA and donor DNA templates to gain a clearer idea of how to proceed with this projec...

This week, Monday was an off day, but I was doing data analysis related to a total shoulder replacement project that I’m helping with in the Biomechanics lab. On Tuesday and Wednesday, Amir- a biomechanics engineering researcher in the Biomechanics lab at HSS Center for Biomechanics teach me how to use Wrap software which I will be using to analyze and measure the size of the 3D shapes that I made using Mimics software based on CT scans. It was very interesting to learn how this software works and hope it will help me finish the project and get more than this project sometime in the future. On Thursday and Friday, I was in Clinic working with Dr. Gomall. The more I stayed with him in the clinic the more I’m learning and got excited about the work that I do in my lab, I think whatever we do in our lab might have a chance to change someone else’s life one day. I will look forward to going back to OR in the coming week.  

 06/19/23 - 06/23/23 This week I shadow Dr. Schwartz during his clinic hours, participated in the Tumor board meeting for the department of neurosurgery and I made progress on my lab research project.  During the clinic hours, it is always interesting to see the interaction between Dr. Schwartz and his patients. His attention to their needs and how he assures them of what he can do help them using his expertise. This week, we had many patients with complicated cases they had to be recommended to the tumor board for further analysis and the opinion of other experts in the department. Additionally, we had two cases of successful surgeries and it was rewarding to the happiness in our patient´s faces. During the tumor board meeting, I learnt a great of how Doctors consult on each and seek for other experts´opinions on difficult cases. It was enlightening to see everyone working together to help solve the cases. It was specially interesting to see the human aspects in all of the di...

This week I continued working with Dr. Cristofanilli in the clinic. We had many conversations regarding the treatment plans for specific tumors and current clinical trials different patients may be eligible for. I am beginning to see patients for the second and third time and it has been interesting to see their disease and treatment progression from week to week. Additionally, it has been rewarding to build connections with patients and I am beginning to understand individual cases better, as we are treating them each week and I remember their condition, symptoms, and plans from the prior week.  This was the first week that I truly observed the highs and lows that come with being a medical oncologist. On Tuesday, we were able to tell two patients they were cancer free and did not need any further treatment. The patients and families were very emotional, and it was rewarding to celebrate this news with them. On Thursday, we met an older patient coming in for an initial consult. She...

 Week 3: 06/19/23 – 06/23/23 I spent my third week of the Summer Immersion term focusing on my research project. I am performing volumetric analysis on the heart, specifically the right ventricle, using cardiac magnetic resonance (CMR) images to quantify volume, shape, and mass. Here, I gained a deeper understanding of the cardiac cycle which plays a pivotal role in quantifying cardiovascular features. The cardiac cycle is divided into two phases, systole (the contraction phase) and diastole (the relaxation phase). In cardiovascular physiology, important parameters that can be derived from these volumetric quantifications are end-systolic volume (ESV) and end-diastolic volume (EDV) which represent the volume of blood remaining in the right ventricle at the end of diastole and systole, respectively. The difference between the EDV and ESV is known as stroke volume (SV). Ejection fraction (EF) can be calculated using these values to calculate the percentage of blood ejected from t...

  This week was a slower week – between juneteenth and promptly getting a 48hr stomach bug, much of my week was compromised. In addition, my clinical mentor is travelling. The last two days have been focused on organizing my research activities for the rest of the summer. It has been a lot of emails to understand why my IRB hasn’t been approved yet and setting up shadowing opportunities for the next couple of weeks.  I worked this week on understanding the RNA sequencing analysis protocols that my lab has to switch around a couple of analyses that I need to redo to get a better picture of my previous experiment. I also worked a little on organizing a collaboration with a lab here that I mentioned last week in the blog, just following up on a couple of action items so we can move forward with that. Here's to next week being a fully healthy and productive week! Monday is a big HSS-Cornell Bone meeting, I am looking forward to learning from a variety of clinicians and professors ...

I had the opportunity to be in the neurology ICU during their morning rounds where physicians and nurses brief the attending on each patient on the floor and discuss treatment plans moving forward. After that, they went to each of the patient's rooms to check on their progress and briefly speak with the patients. While some patients were progressing towards improvement and even getting discharged, some had worsening conditions beyond treatable.  In the neurology reading room, I shadowed radiologist Elcin Zan as she looked through patient images including PET and MRI. During MR-guided PET reconstruction, the reconstruction happens inside the scanner whereas MR-guided is a reformation of an existing image. A key difference I noticed between neurology reading versus cardiac reading is that much of the analysis of the brain comes from the expertise of the physician. Other than measuring the size of lesions or parts of the brain, any irregularities are pointed out manually by the radiol...

 Dr. Marx was out of town this week, so I focused my time in laboratory work. In the lab, I am looking at the changes in genetic pathways that are active in cartilage 24 hours after impacting. The data show that there are 11 pathways that are significantly altered following impact (p<0.05). These pathways are associated with inflammation, bone and cartilage maintenance, and mitochondrial function.  In the plot below, each circle represents a significantly altered genetic pathway. The size of the circle shows how many genes are in each pathway, the color indicates the p-value, and the position above or below the axis indicates how much that pathway was altered with impact.  I have started to compare this data to several other data sets with the goal of determining which genetic pathways are uniquely altered in impact as compared to other treatments. One of these data sets looks at the impact of IL-1B treatment. IL-1B is important in regulating the innate immune system a...

 This week, I gained both research and clinical experience. After watching a cardiac MRI taken of a patient, I shadowed cardiology fellows as they performed post-processes on the images to determine irregularities of the heart. In aorta imaging, they track T1/T2 values, hematocrit (volume percentage of red blood cells), myocardium (pre- and post-contrast), as well as extracellular volume (EVC). Additionally, they perform what's known as flow analysis by doing frame-by-frame adjustments to observe pulmonary vs aortic flow and compare stroke volume (SV) against a normal range. Afterward, the fellows will do a cross-examination/review with the attending to affirm their observations and clarify any indeterminate factors from the images.  On Thursday, I was able to observe an AVNRT (atrioventricular nodal reentrant tachycardia) procedure on a patient who suffered from a re-entry circuit. This particular non-invasive procedure used femoral catheterization to thread an ultrasound-det...

 This week I was able to meet with my mentor, Dr. Chandwani, for the first time! We discussed our mutual research interests as well as what I hoped to get out of this partnership, and were able to set up my attendance at many exciting experiences for this week and the rest of the summer, the first of which was observing appointments at his clinic. At Dr. Chandwani's clinic, I spent the day going with him to various appointments he had with pancreatic cancer patients. These ranged from visits with patients who had just undergone surgery, to patients who were being diagnosed for the first time, to patients who were finishing the recovery process and preparing to return to normal life. It was amazing and eye-opening to be on the other side of a medical appointment for the first time. I'm no stranger to sitting in a doctor's office as they read through my files, run tests, and provide me with information and diagnoses, so it was fascinating to be given the opportunity to see al...

Early this week I continued to shadow Dr. Hartl in the OR and clinic. Dr. Hartl was away from the hospital on Thursday and Friday for an out-of-country conference.  On Monday I observed Dr. Hartl perform a left L4/5 discectomy, a L5/S1 surgical laminectomy, discectomy, and transforaminal interbody fusion. Throughout the day I also compiled a data file with patient information for those who had received bone marrow injections. This file contained information regarding the disc level that received the BMAC injection and whether the patient had received a preop MRI, postop MRI, and if patient-recorded outcomes were recorded. This data will be used to evaluate the efficacy of the BMAC injections. Furthermore, the information extracted from this data will be helpful in my studies in which I am characterizing the bioactive components of BMAC. Next week, we will finally be harvesting tissue from a patient undergoing a TLIF. On Tuesday, I spent the day shadowing Dr. Hartl in the clinic. We...

Monday (June 12th, 2023) I attended Dr. Carli's clinic on the 7th floor of the Weill Cornell East River Professional Building. I got to see Dr. Carli consult over 20 patients from 8am-6pm. Dr. Carli always uses models of knee and hip replacements to explain the procedure step by step to his patients. He states the "universal truths" of knee replacements, 1) The replaced knee is NOT as a youthful one, 2) one in five patients are unhappy with their knee replacement, 3) the recovery process is painful. Prior to surgery, the patients should try minimally invasive treatments such as physical therapy and cortisone injections. Dr. Carli always examines his knee replacement-seeking patients, gauging the sensation in the bottom and top of the feet, determining baseline movement in non-impacted knee, and finally determining any leg length discrepancies. Dr. Carli performs 100-150 hip replacements a year.  Tuesday (June 13th, 2023) The Prosthetic Joint Infection (PJI) research group...

This week started with the exciting MRI course by Dr Prince on Sunday where I was able to learn how MRI machines worked and got to scan myself and my peers on them. It was interesting to learn what radiologists look at in this scans and understand how treatment decisions can be made from these images. On Monday, I finally got the chance to shadow Dr Strickland working in the OR. It was exciting to see the variety of cases and to watch the role dynamics between every person in the OR. I saw a MCL allograft procedure and how they used donor tissue to recreate the ligament. Additionally, I was able to watch a MACI (Matrix Induced Autologous Chondrocyte Implantation) procedure where they used a patient's own cells to cover an osteochondral defect. Finally, I was able to see how they use the MAKO robot to perform a Unicompartmental Knee Replacement. I was amazed at the ability of the surgeons to utilize this technology and talked with the company agents to talk more about how the techno...

  On Monday, I was able to go to the operating room with Dr. Gomall. He has seven patients who are undergoing different surgeries. I was able to watch six out of the seven surgeries he performed. One of the very interesting surgeries that he performed was implanting Matrix-Induced Chondrocyte Implantation (MACI). The performed surgery was   Arthrotomy knee, autologous chondrocyte implantation; MACI implant stage 2 - right osteotomy tibial tubercle. This was amazing for me, as I’m interested in studying the macroscale structure of soft tissue biomechanics, especially cell-seeded hydrogels. The surgery went well, and I learned a lot as Dr. Gomall was explaining to me what he was doing, and he recommends his patients undergo MACI transplants. He told me if the patient has a healthy bone, and the damage is only on the cartilage then he recommends the use of either MACI or donor grafts. One of the other patients underwent Arthroscopy Knee revision anterior cruciate ligament reconst...

  This week was spent mostly meeting with collaborators and finalizing details of my research projects. Monday I finally got approved to work in the mouse facility, after 3 weeks of waiting! I am excited to get started next week working with mice on the digigait with members of the Rodeo/Bostrom labs. My IRB just needed one last tweak this week, so I yet again am hopeful that it will actually be approved soon! I also met with a couple people interested in collaborations with the projects I am currently working on back in Ithaca and here. I met Dr. Lane for the first time, got an insight into what he does and also where his research interests lie. He was very interested in the next step of what I am currently working on with my IRB (pending approval). His patients are the demographic I am most interested in, and the majority of them have consented to give their information to a bone data registry, so we talked about expanding the registry to include not just bone data, but cartilage...

 Week 2 (06/12/23 - 07/16/23 What a packed week full of learnings and outstanding insights!!! I started the week by shadowing three different surgeries conducted by Dr. Fu. My very first experience in the OR was beyond life changing, being able to see how neurosurgeons think inside and outside of the OR gave me outstanding insights and changed my perspective on how I conduct my surgeries in animal models for my research.  The first surgery I watched/shadowed was a Laminectomy and cyst removal at Lumbar 4-5. The patient had a 2.5 mm cyst that was removed successfully. There was no evident complications and it was a great teaching moment for me: first because it was my first time in the OR, second because I was able to learn how different a laminectomy is different from a human and from a mice, third because I was able to talk with the radiologist in the room and I learned about the cutting edge technology the hospital has been using to detect the vertebrae in the human bod...

This week, we received H1E and H1C knockout cell lines from a collaborator, which were created a few months prior using CRISPR-Cas9. Unfortunately, the majority of the cells were dead, so I have been working on trying to save and expand some of the cells that were still viable. Once these are at a proper viable percentage, I can extract the genomic DNA and sequence them with Sanger sequencing to confirm that they are truly H1E and H1C KO. Regarding the validation of the V5-tagged H1E cells, we received a new V5 antibody, so I stripped the western blot membrane and redid the antibody incubation and imaging. Although the β -actin antibody I used last week worked, there was some obvious non-specific binding, so I also tried a new actin antibody to try to reduce that. Sadly, this didn’t work at all and this time I could not see any bands. It is possible that the membrane was not stripped well enough to allow the new antibodies to bind. Next week, I plan to repeat the entire western blot ...