Week 1: “I want to wake up, in a city that never sleeps.”

Week 1: “I want to wake up, in a city that never sleeps.”

Over the course of the first week of the Summer Clinical Immersion Program, I lay down the foundations of my research endeavors for the next seven weeks at the Hospital for Special Surgery (HSS) under the mentorship of Dr. Emily M. Stein. During our initial meeting, Dr. Stein provided me with the background information and the scientific rationale behind two of the clinical research projects that she is working on along with other collaborators at HSS and The New York-Presbyterian Hospital (NYP). On Monday, I attended a Metabolic Bone Disease Case Conference where the attending physicians discussed two clinical cases. It was very insightful to see how the doctors utilized a collaborative process to review the cases which mean that each one provided some insights, an educated guess about the conditions or treatment of the patient, based on their area of work. On Monday, I was also able to get an HSS ID badge and finalized the paperwork to observe surgeries.

On Tuesday, I attended the Biomechanics Lab Meeting where a visiting undergraduate student discussed his research with Tekscan sensors which are a type of pressure mapping sensors capable of reading forces with a high degree of accuracy. Eventually, they would like to incorporate those into the femoral condyle to explore the biomechanics of the knee when subjected to different loading modes. Later in the day, I shadow Dr. Stein in the clinic. Before seeing each patient, she discussed the medical condition of the person and the reason for their visit. Most of Dr. Stein’s patients are women on their mid-fifties struggling with the adverse effects of menopause resulting in decreased levels of estrogen production ultimately compromising their bones overall density and microarchitecture. On Wednesday, I met with Dr. Robert Schneider where I was trained on how to identify osteoporotic vertebral fractures based on the degree of height reduction of the vertebra (Fig. 1). From a radiography study, they can be classified as either wedge, biconcave, or crush fractures depending if the high reduction is seen in the anterior, middle, or posterior portion of the vertebral body (Fig. 2). Identifying compressed vertebral fractures is a challenging task in the field of radiology due to multiple abnormalities in vertebral shape mimicking a fracture and the presence of imaging defects in the patients’ radiographic examinations.


Fig. 1.—A wedge compressed fracture is seen in the second lumbar vertebra from the two radiographic projections of the spinal cord. The arrows indicate a height reduction on the anterior portion of the vertebra (http://www.klinikaikozpont.u-szeged.hu/radiology/radio/trauma2/a2trau1c.htm).



Fig. 2.—The semiqualitative method is often used for the diagnosis and grading of vertebral fractures based on the height reduction of the individual vertebra and the location (Lenchik et al., 2004).

On Thursday and Friday, I worked towards obtaining access to three main tools that I would be utilizing for my research at HSS: EPIC, eCap, and PACS. I also helped Dr. Stein to submit and Institutional Board Review (IRB) for a knee arthroplasty study. Lastly, I am looking forward to my time here in New York City, and I am certainly thrilled to work as a clinical researcher and potentially contribute to the advancement of the field of medicine!

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