Liver and Kidney Transplant Department Research

This week, I worked only in clinical sciences because Dr. Adkins in the Basic Science building was still out of town Tuesday- Thursday. Thus, Monday I spent an hour and a half in transplant, following Kathleen, Dr. Chavin's PA, talking to patients and looking at their conditions. Then, this morning, I attended the weekly "learning meeting" from 7-8. After the meeting, I shadowed Kathleen and the other PA on duty at that time. I took a lot of notes (which I will record and discuss below) and I visited with 2 patients, one of which didn't go well. He said he didn't mind if I was in the room, but then when we started talking, he questioned my age and eligibility. Needless to say, he did not appreciate my presence in the room, so I left. The second patient, on the other hand showed remarkable gratitude towards the hospital and was delighted that a high school student was in the room, learning about medicine. Once I finished visiting with the patients, I talked to Dr. John _____ (I don't know his last name) about my future plans and he explained MELD scoring to me (something discussed in the meeting that morning).

Notes:

• kidney vs. liver: liver must be accepted when transplant procedures occur. If not, person will die. Kidney doesn't have to be accepted like the liver.
• there is a priority process in transplants: doctors looks at mortality rate for certain conditions, survival rates, severity of illness (the higher the patient's score, the sicker)
• Bens Jones Protein Tests- looks at urine vs. dipstick
• Mgas correlates with multiple myeloma: patient has abnormal protein bc white blood cells, must monitor his/her protein levels... could potentially cause nerve pain
• hypercalcemia: high calcium level in the blood
• bone marrow generate blood cells
• plasmapheresis lowers calcium levels
• high PTH= high parathyroid levels... stimulates calcium levels
• blasts- more rapidly new producing cells
• sarcoidosis- inflammation of liver
• lytic lesion: usually comes from a multiple myeloma- colony of plasma cells... lyse the bone, increases the bone density for repair
• bone lesions occurs as a result of hypercalcemia
• mitotic figures are normally seen because of cancer... mitosis is occurring out of control
• can infer that kidney is being accepted when you can see mitosis occurring again
• ATN= acute tubular necrosis: death of tubular cells that allow urine.. kidney transplant might then be necessary
• blue material is a sign of scarring
• creatinine measures the kidney function
• phosphorous levels usually decrease after about a week post op kidney transplant
• MELD scores (Model of End Stage Liver Disease): TIPS jams a tube between portal and hepatic vein
• cirrhosis: blood can't flow through liver properly
• MELD score determines if person will die or not
• 3 part to MELD- 1. INR (International normalized ratio)- generates a number between 0-40 to estimate the probability of person dying 2. Bilirubin- blood levels 3. Creatinine
• more prone to kidney disease can sometimes directly relate to being more prone to liver disease 

Schedule Changes

Last week was probably my busiest week yet. I worked 6/7 days. Monday I met with Dr. Chavin to secure my new job with him in the transplant department at MUSC. We made a plan for me now to go into the Transplant Department with him on Mondays and Fridays, that way I could continue to go into the rat lab Tuesday through Thursday with Dr. Adkins. Tuesday- Thursday were pretty baseline. We discussed an article and I worked on the ROIs, which are finally saving :D! Friday was crazy hectic, but fascinating and Saturday I worked in the ER and helped with a catheter. Tomorrow, I will be back with Dr. Chavin for another intense morning.

Catching Up

Last week was incredibly hectic due to the near shooting at school and other chaos, so I did not blog due to the distractions. That's not to say I didn't continue my work and research at MUSC. Last week Dr. Adkins and I started the week by discussing the articles and I continued to work on my ROIs. This week I have started a whole new plate of work. Yesterday, I met with Dr. Chavin to see what work I could do next. He offered me a job to come into the Clinical Science building at MUSC on Friday mornings. Now, I will go to the meetings starting at 7:00 AM and stay in that department until 9:30. For the first hour, I will go to the learning meetings with him, then, for the remainder of the time, I will go into the OR with him or another doctor in the department and watch surgeries. I'm very excited to start this because I will get more patient exposure and surgical exposure. This week is full of work; I'm working 6/7 days, but it's worth it because I'm about to have even more crazy experiences. Saturday's plan is back to the ER, which always fascinating.

Lab Lab Lab

Recently I have been working in the lab constantly. Last week, I worked on the ROI imaging, coloring in the motor cortex areas of the brain and their symmetrical spots. This week, for both Tuesday and Wednesday, I have been dissecting two hefty articles. The first one discuses a new discovery in biomaterials. A group of researchers found that they could use a scaffold and look at BDNF's reactions and how it can harm and/or benefit the brain. The researchers found that the BDNF can affect the axons greatly, perhaps making them more dense. Also, the scaffold the researchers created was very efficient because it can be preserved easily, lasting a long time for reuse. Tomorrow Dr. Adkins and I are going to discuss the article and I have three questions to ask her with regards to this article- 1. How does a cystic lesion cavity compare to the lesions we have been studying? What is it exactly? Is it just bigger and less precise? 2. How is the scaffold inserted? 3. Generally, what are the axons? How do they work? Do they help send out a lot of signals to the brain, specifically the motor regions? The next article I read discussed the ROI imaging I'm working on and the recovery sensorimotor function after an experimental stoke. This article discussed a perspective that really interested, but confused me. When the brain is exposed to a high impact injury, it tries to compensate and restore what it might have lost or what might have been damaged, sometimes referred to as neural plasticity. This group of researchers experimented a case of 70 days monitoring the rats after the strokes and observing their reactions via images. I had a really hard time understanding this article due to all the complicated and new words. Thus, I have quite a handful of questions for Dr. Adkins- 1. Would watching them for this many days be beneficial? 2. How does the neuronal tract tracing work? 3. What are they looking at in the images to find answers? Linear Regression? How does that work? 4. How does the guy who looks at the images I draw judge them and extract answers from them? 5. Could strokes cause increased abilities in other parts of the brain? Could there potentially be benefits to strokes because they force other areas of the brain to compensate, but become stronger?

Mini Strokes

This morning Dr. Adkins and I discussed another article concerning "Mini Strokes". The most interesting part about the discussion was excitotoxicity with regards to a drug flooding the body, killing an animal or person in a stroke. We also talked about different drugs that work to make a better rehab process and better stroke experience. After we discussed the article, I continued working on the brain drawings and coloring the impacted areas. I asked a lot of questions today, so hopefully I didn't annoy her like crazy :/. Any ways, it was a good start to the week.

Cortical Stimulation (CS) and Traumatic Brain Injury (TBI)

This morning I analyzed an article with Dr. Adkins about CSI and TBI. Throughout our 30 minute discussion, I learned that TBI and stroke rehabs are different. Stroke rehab requires different procedures than TBI because they are two different traumatic events. Also, we talked about the effects and differences between anodal, cathodal, bipolar, and no stimulations. We had to disregard bipolar because there weren't enough subject to put a treatment on. On the other hand I learned that the anodal was the negative current of electrodes and cathodal was the positive current of electrodes. We found that the graphs showed that if you put no stimulation, the results were better. Also, the cathodal and anodal had effects, but they were more severe than helpful in the end. Thus, I was able to expand my understanding about the brain's reactions to events and a little more about it's neural plasticity.

ER and Lab

Last week I went back into the lab for my routine Thursday, Wednesday, and Friday. I collected more data and learned how to use a new program called micron. In this program, I located specific areas of the brain to relate to where the lesion would appear. This past weekend I worked in the ER. I saw a variation of events: cat scans, a drunk woman, a dead 45 year old man due to ODing, a mental man, and a temperature taken rectally. It was a very interesting Saturday morning to say the least. Tomorrow, I will be discussing an article with Dr. Adkins in relation to a power point and plugging in more data to Excel.