Week Two (Jason Chang)

This week, I focused on installing MATLAB onto my work computer and getting clearance to observe OR procedures at WCMC and the Hospital for Special Surgery (HSS). As far as clinical exposure this week, Carla, one of the stroke research coordinators, brought me with her to the emergency room on Monday after she was paged about an incoming stroke patient. However, the patient turned out to be a construction worker who had fallen and sustained several blunt force injuries, which meant that the patient fell under the jurisdiction of trauma, not neurology. It was very interesting to see the high-pressure and fast-paced environment that the emergency medicine clinicians work in. Additionally, Dr. Prince gave a lecture on Monday on interpreting imaging results, specifically with magnetic resonance imaging (MRI), computed tomography (CT), and x-ray scans. During his lecture, Dr. Prince emphasized the importance of always having multiple views for every scan to confirm any abnormalities in the patient. His lecture included case studies with various pathological condition areas. Although he had to guide a lot of our answers, I learned a lot and am now able to differentiate between these commonly used scanning techniques.

On Tuesday, Dr. Mangat and I met to discuss more details regarding my research project on patients who have suffered from subarachnoid hemorrhage (SAH) (Figure 1).


Figure 1. Subarachnoid hemorrhage caused by bleeding into the space surrounding the brain [1]

SAH is a serious, life-threatening condition that occurs from spontaneous bleeding often caused by a ruptured aneurysm or traumatic brain injury (TBI). When blood accumulates in the subarachnoid space surrounding the brain tissue, the patient is at risk of seizures, stroke, coma, losing consciousness and/or alertness, and even death in extreme situations. The long-term impact on a patient’s quality of life after SAH depends largely on early diagnosis and treatment. Therefore, initial critical care management and monitoring is crucial to the patient making a recovery.

Our research study in collaboration with Dr. Forgács focuses on analyzing EEG segments from SAH patients. The first step of my research project will be to remove physiologic artifacts, such as eye movement (low frequency) or muscle activity (high frequency) signals, present in continuous EEG signals collected from patients in the study. This artifact removal process is typically done by having the clinician manually identify and delete artifacts, but this manual cleaning process can be very time-consuming and subjective. Additionally, variability in clinical expertise can affect the results, so an automated protocol in MATLAB would be more efficient. On Thursday, I met with Dr. Forgács to get all the EEG data and discuss how to approach this first step of my project. However, I soon realized that there was no all-encompassing solution since each region of the brain would contain different degrees and types of artifacts, so Dr. Forgács recommended that we start off by narrowing the scope of the analysis.

In the meanwhile, I spent time reading about the syndrome of SAH, as well as familiarizing myself with MATLAB codes written by Dr. Forgács' lab members for the various types of analyses of EEG tracings. 

Dr. Mangat and I will meet early next week to discuss my project in further detail. Next week, I plan to start going through patient EEG files and learn how to identify artifacts in each of the channels. I also hope to begin observing orthopaedic surgery procedures in WCMC and HSS, but I am still waiting on my clearance.  

References
[1] https://s-media-cache-ak0.pinimg.com/736x/96/27/a3/9627a3d11d53248564e3ea3b68fdfb76--subarachnoid-hemorrhage-stroke-recovery.jpg

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