Mediclopaedia

Also my work is making me nervous. Not having the autonomy that I hoped for is frustrating. And since I am on a trial basis for the summer, not getting my pay renewed worries me.

Lymphatic Vessels in the CNS?

This Nature paper by a group at UVA looked at the presence of lymphatic vessels in the brain. Traditionally thought of as a immune privileged organ, the thought of immuno therapy in the brain was largely ignored. In the past decade or so, a lot of traction has been gained in the field of neuro-immunology with treatments such as immune checkpoint inhibitors showing some promise in the treatments of different brain tumor models. 

It was still a large mystery of how these immune cells were acting on these cancer cells, but this group seems to have the answer! Imaging layers of the meninges and looking at different cell populations, they were able to spot a region in the dural sinus which were lined with lymphatic vessels.

I especially enjoyed this article because of its origins in trying to ask why something was working instead of simply using a therapy that was working. I always love reading nature papers and other highly impactful papers because of the final paragraph...

Malfunction of the meningeal lymphatic vessels could be a root cause of a variety of neurological disorders in which altered immunity is a fundamental player

I thought I’d just share this with you guys. So the work I did for the past year mainly involved using nanoparticles to deliver genes in the brain. To test the efficaciousness of our therapy, we used a rat brain tumor model to deliver different types of genes. 

One way to correctly see if our treatment was working was by using a reporter gene (GFP in this case) to check how well the particles were transfecting the cells. I thought it would be fun to compare the conventional treatment (on the left) with our treatment (on the right, with blue showing the relative tumor) using 3D printing! I wasn’t able to get a hold of a two-tone printer, so I painted the two colors... 

This past year has been such a crazy non-stop journey. The combination of lab work, school and clinical research really kept me busy. But now I am once again in this transition stage and things seem very slow. 

I decided to spend this application cycle continuing the research project I was working on but at a new institution. This will give me a chance to expand my knowledge of the field while getting a fresh experience in a new lab. But I ended up moving a little too early and there seems to be this random gap of time where I am not allowed to do any experiments! So with this, my daily schedule has completely changed. Instead of being on the go constantly, I actually have time to do whatever I want! 

I’ve spent it mostly catching up on some literature readings and working on my application, but I can’t seem to shake off this restless feeling. It seems to be a combination of excitement of learning new things and the fear of not being good enough here. On top of this the applications open next week, and I decided to apply to a few MD/PhD programs in addition to MD programs. More and more I am realizing what a big part I hope research has in my future career. I hope that my research work can directly support my patient interactions and also that my clinical work will help guide me in asking the right questions. 

Now I feel like I am starting to write a statement for admissions committee members... Anyways, let’s all play a fun game! Can anyone guess where I am now? It would definitely be easier if you followed me throughout the years :). Here is a clue: my desk.

The New Surgeon General (Finally!)

I know I talked about Dr. Vivek Murthy a while ago now.. he was nominated to become Surgeon General last November. Unfortunately due to politics (and ignorance) he was rejected by the senate... but after a year of not having a Surgeon General, the senate finally accepted the nomination!

It's going to be very interesting to see where this is headed. This is the first time we are having such a young Surgeon General, and with his close ties and beliefs to Obamacare, his actions and decisions will be very unique compared to all others that preceded him.

I just finished my semester and am focusing on my January MCAT..  I haven't had a lot of time to go out to enjoy my passions in art, but when I saw this it made me so refreshed and happy. I can't wait to see this hospital in the future (crossing my fingers!)

Some amazing photography by Adam Voorhes.

When people ask me what my ultimate goal is, I tell them half jokingly (actually completely seriously) "To be the Surgeon General".

Anyways... right now we have people freaking out about Ebola, and we have a key player just completely missing; we have no Surgeon General. Remember my post from a few months ago? Dr. Vivek Murthy was nominated, but due to the politics of it all he was eventually not admitted into office. Although the Surgeon General is usually related more towards preventative health and social implications of medicine, a crisis like Ebola is something that can be helped out by someone in this position. 

NEJM has an amazing piece about the situation of the Surgeon General. Here is a little piece. What do you guys think? 

At this time of unprecedented need for respected leadership of the Public Health Service, President Obama should turn to a distinguished leader in American health care. Given their broad knowledge and stellar reputations, we believe that any one of the possible candidates we have named would garner bipartisan support. We urge the President to nominate and the Senate to confirm a strong leader and trusted voice as the nation's next Surgeon General.

Here is a NYT article titled "To Siri, With Love" where a mother talks about her Autistic son's experience with Siri. It's amazing to see this unique use that Siri provides. Who could've known? (Art work done by NYT artist Louie Chin)

Vertebral Implant

3-D printing has been gaining more and more traction in the medical field. It's versatility and precision allows for some amazing work to be done. 

Here is an example of a vertebral implant done in China. The idea is simple, but the execution was elegantly done. They used titanium that is already used safely for the main component of the vertebrae, and used a porous material that allows for fusion with the natural cell growth in the body.

This brings up an interesting point about the development and implementation of new technology... In foreign countries we are seeing the rise of these 3-D printed implants being used in the clinics, but because of the strict restrictions in the U.S. most 3-D printing technology is still being used for imaging and modeling purposes. Of course this allows for increase in safety and ensures optimal integration of the technology, but creates too much barriers (incl financial, accessibility) for patients...

I am worried about my future. 

I have always done things that I wanted to do. I chose things that I believed will make me a better person, things that fed my intellectual needs... But for the first time I feel like I have to make a decision according to what other people think.

I have been committed to do TFA for two years after finishing up my master's program. But this also means I will have to push off my medical school applications until the 2016 cycle; because applying with the intention of deferring a year will not reflect good on my application. Also, after talking with many deans, advisors, they think my future aspirations (MD-PhD) don't align well with my want for doing TFA. 

Anyways... there are a lot more variables to this story, but to cut it short... I feel like the things I value at this point in my life is not the best choice for my future goals, and I have to decide what I will be doing... and I DON'T WANT TO DECIDE!

Sorry about the whining, but I needed to vent somewhere... 

My days have been a big blur.. With school, hospital work and research, I haven't had a weekend to myself. 

I love reading PhD comics (is there such thing as a MD comic??) and most of it is all fun and games, but this one was extra interesting. 

I love the research I am doing and its fascinating, but I can't help think "what's the point" pretty often. One of the thing that worries me the most as I read more papers is the quality of research. I definitely think this is driven by the competitive nature of graduate school and the job search and the need to have publications out, but it definitely slows down research as a whole now that we have so much to filter out. 

I hope to continue my research as I start medical school in the future... but I will keep all this in mind as I do, and work with the same zeal I started with to produce quality work.

Galectin-1

There are a ton of approaches to cancer... but the most promising now a days seem to be an immune response approach. Galectin-1 is a membrane protein that is missing in many cancer lines and by introducing it, it was able to completely eradicate the cancer cells in rats.

Before anyone thinks.. they cured cancer! Here are some things you should consider about these research. Lots of studies designed this way seem to show very good results, but it is partially due to their ability to introduce these interventions invitro before introducing them into the animal models. If we could get every tumor/cancer cell to express these proteins, there are a number of treatments that would work just as great (pTK, p53..) The main problem with cancer research now a days is actually being able to target them efficiently, while reducing toxicity. 

However, it is great to see such an approach work since it immunotherapy is such a hot topic. With the specificity and strength our immune system can provide treatments like this have a great future outlook. Take a look at the study below; I would love to get my hands on some of this plasmid!