Some Exprience

Hello All,

I know my posts have been far and in between but that's a good thing because it reflects how busy I have been! As for this post, I don't even know where to begin...Wayyyyy too many things to talk about. UCSF is most probably the greatest resource for medical exposure that I've ever had; I cannot tell you about how many seminars, conferences, and presentations that I have seen or done. Not to mention that I am spending enormous amounts of time with world renowned faculty in the field or neurosurgery and neurosurgical research. The best part is that I'm not just a student who is just observing everything, I have a level of active involvement in everything I do, which is what makes this experience so profound and enriching.

In terms of my lab work, I have gained exponentially on an intellectual, social, and professional level. I have carved out a niche in the lab based on my primary interests in research. Carving out an area of interest has really helped me focus on improving my understanding and participation in the projects of this lab. I focus on the brain tumor research projects specifically in chemotherapeutic drug delivery via CED. Focusing has allowed me to learn a tremendous amount about brain tumor biology, etiology, and pathophysiology. One thing I've learned in research is that there is a tremendous amount of knowledge out there and it's simply not possible to learn it all, and a successful physician-scientist specializes on an area of research in which he/she can focus their expertise to produce results. So far, this approach has allowed our lab to produce over 20 publication per year, which is RIDICULOUS! The pace of our progress also allows us to get our newer techniques translated at a faster pace. Thus, if we find a superior Topo I or II (or combination) inhibitor that works well to destroy brain tumors, you can bet that clinical trials will begin within that year or early next year. Our Parkinsonian research has made the most progress, as we have seen real regeneration of dopaminergic neurons, which is revolutionary; maybe, after exploring brain tumors I'll venture into that field as well.

Recently, I attended a very cool Neurosurgical grand rounds at Parnassus. It was cool to see how attendings would review cases with residents in order to instill a certain mindset or train of logic within these future neurosurgeons. I can already see that being a neurosurgeon requires a lot of critical thinking in how to approach a specific neurological problem, as there are many approaches and a surgeon must choose the best on for their respective patient. The best procedure depends on the context of which the patient's pathology presents itself, which is why I suppose Transphenoidal Pituitary Adenomas require a high level of skill and analysis. I wish I could go into more specifics, but I understood very little of what was going on. The field of neurosurgery, especially on the clinical level, requires a lot of specialized and in-depth knowledge of brain anatomy and pathophysiology. However, this high level of knowledge and stimulation is why I love the field so much!! It's something I can see myself doing everyday for the next 30-50 years of my life. Hopefully, with a few more conferences I'll be able to understand cases in more detail.

I suppose the most intellectually stimulating part of my internship/job is reviewing papers and attending the weekly journal club. My P.I. makes me read a few papers every week so i can progressively increase my understanding of the research being done at the lab. After I read papers that our lab has published, he would sit with me for an hour or more to review my understanding and fill in any gaps that I have; the value of this process is something I cannot even describe. Having someone of great knowledge sit with you and help you develop your understanding and comprehension of science is indescribable. My analytical thinking and comprehension of what is occurring around me has increased exponentially. I can recognize concepts, and understand the significance of data and results. Also, I participate in journal club which further increases my understanding and involvement within the lab.

In journal club, each week a post-doc must read and paper and complete a presentation on that paper. This forces the person making the presentation to be familiar with everything within that paper and understand it so they can explain it to the rest of the lab. This process is invaluable because it forces you to master the knowledge presented within that paper. You're understanding must be so great that you should be able to answer questions related to that paper from post-docs or P.I.s. This paper review process has allowed me to make papers and lab research a part my persona, which I can use to further my development as an academic neurosurgeon.

In the upcoming weeks, I'll be shadowing one of the only UCSF neurointerventional radiologists so I'll keep you posted on that. Also, I'll be able to observe our monkey infusions which is very interesting because it's the closest model to a human that we have. We use monkeys mainly to develop the next generation of CED technology that can be transferred to the clinic in the near future.

Salaaam!!

Update

Hellooo,

I haven't posted in a while because my time has been saturated with some amazing research projects. As a quick overview, I've been performing neurosurgeries on rats for the brain tumor projects. We've been testing liposomal Topo Isomerase I and II inhibitors which target gene expression of both topoisomerases. So far we've done the cytotoxicity tests for these drugs to see how damaging they are to cancer calls and normal tissue, and have come up with the proper dosages to use in our tumor implantation rats. This week, I'm delivering these drugs (I and II) via CED into rats for drug half-life testing in which we harvest the tissue at different time points to see what the drug half-life is within the target tissues. It should be pretty long due to the fact that liposomes are inert until endocytosis occurs within the cells. In previous papers, we've detected liposomes to be present at 0, 30min, 24 hours, and 72 hours. Also, I've been two a few amazing research conferences at Mission Bay, which I intend to talk about briefly in this post.

I'm quite lucky at this job because the people here are amazing. They are easy to get along with and facilitate intellectual development by providing answers to any questions that I have. They all carry a positive attitude and are willing to help anytime, especially my co-worker Yuying who was a nurse in china but moved with her Neurosurgeon husband Dali to work at UCSF on brain tumors. Yuying taught me pretty mcuh every lab technique I know, and she did with an amazing level of patience. I can't tell you how many things I've probably messed up in the learning process, however Yuying never reprimands me and gives me tips to improve my technique. Everyone's support really reflects their willingness and passion to develop the next generation of researchers and physicians who will continue their research in the future. I'm lucky to be here because these people are just so giving, and maintain that attitude in every part of their career. I plan to be like that as a physician, and to carry on this philosophy of teaching for the development of the future of research; which is what compels me to practice in academics.

Illumination

Heyyy,

I had lunch with a good friend of mine attending UCSF med, and talking to him really allowed me to obtain perspective in how I would like to approach a career in medicine. His wisdom from going through the application process was invaluable and allowed me to reflect on what I wanted to take from my current and past experiences. After exploring health policy and planning, underserved medicine, and research, I feel that I know where my passion lies. The process of exploration was an amazing growing experience as it really allowed me to learn more about myself; in addition, It has also given me an idea of what direction my career in medicine may take.

As of now, research has been the most invigorating experience that I have ever had. Because I have always been the creative/spatial learner, research seems to fit in extremely well with my persona. It's intellectually stimulating, extremely challenging, and really allows me to exercise my creative intelligence through the extensive problem solving and conceptual learning involved on a daily basis. Also, the challenge of making experiments work and solving complex problems that impede experimental progress, really makes produced results rewarding. I like translational research because it's easy to see the potential application of experiments in solving human diseases (hopefully benefitting my future patients!). I was able to see the translation while working in the lab because by treating human gliomas implanted rats with CED therapeutic, we can gauge how it may benefit patients suffering from GBM (or other malignant tumors), due to the similarity of mammalian physiology. If tested chemotherapeutics are fully translated, neurosurgeons around the world will have a new tool in their fight against brain cancer!

So...one might wonder why I don't pursue a Ph.D? Well, as interesting as research is, its main appeal to me is that it can be used clinically to benefit people suffering from fatal diseases. I would like to be the liaison between the lab bench and clinical treatment. I want to offer the newest, most cutting-edge treatments for my patients in order to give them hope through their difficult conditions. My year-long shadowing experience with Dr.--- has shown me the true advantage of being an academic physician involved in translational research. As a faculty neurosurgeon at UCSF, Dr.---- takes what basic and translational researchers produce from UCSF labs and apply it to his own patients by enrolling them into clinical trials. For example, many people with GBM have no change for survival within 1 year of diagnosis, only 20% survive up until two years, and there is no effective treatment thus far. Any development from translational labs carries the potential of a cure or at the very least superior management of the disease; the only people able to offer these new promises are physicians who involved in these studies, which is what makes academic/research medicine so intriguing to me. Also, translational/clinical research physician expand the field of medicine by generating data from clinical trials that could benefit patients at other medical centers, and incorporate new therapies into universally accepted medical practice. It's just mind-boggling how much of a contribution a physician can make to their own patients when he/she is involved in research and academics.

Also, academic medicine is extremely rewarding not only because of the research, but also because of the teaching aspect. It contributes to medicine by training the next generation of neurosurgeons who will further carry the field to new limits. From my limited teaching experiences in halaqas and training other lab assistants, it's extremely rewarding to see someone learn and apply knowledge due to your own efforts. When shadowing Dr.----, and discussing lab publications with Piotr (my P.I.) I can see how much they enjoy teaching their respective fields to students. It seems as though they also had amazing mentors, which inspired them to teach with kindness and compassion to create another generation of compassionate contributors to medicine. I would like to be part of this extremely spiritual process of teaching and mentorship in which you guide individuals into doing their best for humanity. I'm sure it's an amazing feeling to know that you helped create physicians who are improving the quality of life for hundreds of others.

First post

This is my first post of Fall Quarter, and I wanted to keep everyone updated on what I was doing. I've been ridiculously busy, and haven't had time to write in a while; fortunately for me, it means have tons to write about!! To get everyone up to speed, I began my research associate position at UCSF's Krystof Bankiewicz Laboratory for Convection Enhanced Delivery (CED) of Gene Therapy and Chemotherapeutics two weeks ago. The lab is a translational lab focused on bringing CED to clinical applications in the field of neurosurgery (and maybe even neurointerventional radiology). The technology is extremely promising as the results have been great in our animal models.

In addition my research, I'm continuing my volunteer position at Bayanihan Clinic in Sacramento. Over the course of the summer I've accumulated a ton of experience as an intake, which has really helped me develop some effective interaction skills with patients. The most enriching part of clinic is watching medical students interact with patients because you can watch the learning methodology that is being taught at UC Davis medical school in action, and it has continued to fortify my decision to pursue medical school. Medical students are invaluable to watch as they are in an essential part of the training process in professional medicine; they represent a key transition phase from undergraduate education to medical practice. I'm glad I have a chance to observe this transition phase and get used to what is in a sense the medical student "culture". In the near future, I'll make a separate post elaborating on what I was able see and learn from the medical students that I've worked with.

I've joined the Bankiewicz lab for the year 2010 as a research associate. For the past two weeks, I was being trained for the various projects that I would have to take part in. My training incorporated skills and techniques for rat neurosurgery, tissue histology and extraction, cell culture and tumor-cell implantation. This lab is fascinating because each investigator has come from a different field of expertise. We have two histologists, a biochemist, three neurosurgeons, and a molecular biologist...and pretty soon a bioengineer (for our fluid-dynamics experiments). This multidisciplinary approach has allowed us to design extremely complex experiments, which normally could not be formulated by any one discipline alone. Experiments need perspectives from physics for the liposomal distribution component and from molecular-biology for liposome receptor interactions etc... The learning experience is unlike any other experience that I have ever had. The level of intellectual stimulation that this research facilitates is indescribable. My ability to think analytically and learn complex concepts has increased exponentially. I don't think I've been able to exercise my mind like this even in undergrad. Through this experience, I've realized that most learning in undergrad is memorization-based and isn't directly useable to produce outcomes or results. Memorization-based learning is only the first step in the process of learning, and isn't useful unless one takes the essential step of making it functional, so that it can be applied to something real (i.e. experiments). I've learned that research at it's very core is the act of turning the knowledge that you've learned from books or papers into knowledge that can be used and applied, which is also what makes it so essential for any future physician-scientist. As I went through the process, it surprised how little of what you memorize can be applied; the functional transition is completely intuitive and many times you're mind has to fill in the gaps by developing logic. When knowledge becomes functional its the most rewarding thing in the world because you now have a new tool that illuminates your intellect; it gives you the ability to address a particular issue with new angles and perspectives. In fact, only through functional knowledge can one even propose new hypothesis and predictions for further experimentation, which is the very foundation of new ideas and experiments. Within just two weeks, I can already tell that research will be inseparable part of my life and future career as a physician. As a physician, It's unthinkable for me to not participate in some form of translational or clinical research because I feel that it is the most effective way to advance the medical field and bring the most cutting-edge care to my patients.

The overall focus of the lab has been to develop and apply Convection-Enhanced Delivery (CED) as a treatment modality for degenerative neurological diseases (i.e. Parkinson's) and Brain Tumors. CED works by using a catheter to deliver various therapeutic chemicals directly to the target neural tissue through the bulk flow of molecules. It relies on a pressure gradient to drive the distribution of therapeutic molecules to the region of interest in the brain. It's better than simple neural injection because of the superior distribution achievable within a tissue-mass (due to the constant pressure gradient/stable rate of infusion). This technology is first applied to rats and if promising, then to monkeys, and then to humans, which is pretty much how all translational research works.

The lab specializes in treatments for two areas of diseases neurodegenerative disorders (Parkinson's etc..) and Brain Tumors (mostly gliomas). I chose brain tumors, as neuro-oncology is what interests me most as of now...however, I'm learning more about CED gene therapy and it's fascinating as well. The basic layout of what I do, or rather what I'm being trained to do, is to grow various human tumor cell lines in-vitro for implantation into immunocompromised rat models, specifically the striatum. We wait for the tumor cells to form a large tumoral mass that mimics the human pathological condition. The tumoral mass is then treated via CED infusion of liposome encapsulated chemotherapeutic drugs in order to test drug efficacy and potential for translation to clinical trials.

The lab is an the ideal training ground for a future neurosurgeon. The neurosurgeries and euthanasia operations on rats (and monkeys in the future!) allows me to gain an early understanding of the intuitive and functional aspects of the field. So of far I've conducted 5 or more CED infusion and tumor cell implantation surgeries on rats....and I must say that the experience is unreal. It's hard for me to believe the work that I'm doing is on the cutting-edge of neuroscience. I'm so lucky to be in this position because it has situated me in a place where I can prepare and plan for my future career. My involvement in the development of CED treatments and technologies will be the gold-standard of minimally-invasive treatment for neuro-oncological and regenerative medicine when I become a physician. I plan to make the most of this experience and stay with it from medical school and hopefully residency!