Milan!

I realize that this post is a bit outdated, as I visited Milan in the middle of June, but I've been busy with med school applications (among other things) since my return. At this point, I'm not even sure where to begin - my trip to Milan for the Annual Meeting of the European Neurological Society was incredibly educational, and rather fascinating!

To start, I found the four-hour train ride from Geneva to Milan to be absolutely beautiful! The train circled Lac Leman and then passed through the Alps. With scenic views of farms, vineyards, snow-capped mountain peaks, and waterfalls, I had a hard time believing that the commuters in my train cabin could become so accustomed that they were able to sleep during the trip.

Upon arriving in Milan, I found that public transportation is the most convoluted conglommeration of trams, trains, trolley cars, metro lines, buses, and taxis that I have ever seen. During my stay, I must admit that I was only able to successfully use the train, the metro, and taxis without direct supervision from Milanese natives.

During the conference, I attended lectures and workshops nearly all day for all five days (with the exception of half a day off on Monday - I'll explain that later, and half a day off on Wednesday for traveling back to Geneva). Many of the other attendees seemed to be impressed that I sat through so many lectures, but honestly, I think the difference is that everything was relatively new (and usually interesting) to me. I had enough familiarity with much of the background information supporting the neurological disorders and treatments discussed, so I could certainly follow along. However, as I lacked the formal training that the other physicians had, I soaked up new information like a sponge.

After the first day of teaching courses and lectures, I toured Milan's San Raffaele Hospital through a visit organized by the European Young Neurologists in Training. (I'm not European, I'm not a neurologist, but I am young and in training, so I suppose that was enough for me to be invited.) The hospital rooms were very much the same as any that I've seen, but the buildings (just like the University Hospital in Geneva) seemed to have more green space both outside and in courtyards inside than most of the medical facilities I've visited in the States. During the visit and dinner afterward, many of the other neurologists talked to me about the challenges of health care (in all countries) and finding funding for hospitals and research. It was fascinating to hear so many different perspectives! Another really interesting aspect of the tour was a statue that our guide (a Neurology resident from the hospital) pointed out. The statue was a large angel perched on top of a dome on the hospital, and our guide explained that since the facility has religious roots, she is there to "take care" of the patients. He went on to say that within the domed part of the hospital is a spiral staircase designed to look like a double-stranded DNA helix that rises up to meet the angel. This representation of the cooperation between science and religion was cool to see, but possibly contradicted by some of the information I learned on the tour. For example, one of the Italian neurologists was telling the group that it's difficult at his hospital to gain all of the information that he would like to have for a clinical study. He explained that autopsies are generally not conducted on deceased patients for religious reasons. While they are admittedly morbid, autopsies often provide crucial insight into organ structure and function (or dysfunction), and so it is easy to see how such restrictions might limit scientific progress.

At the conference itself, some of the presentations that I found to be the most interesting were those that coupled patient videos with guidelines for diagnosis. There was a teaching course like this on various movement disorders and another on epilepsy. The epilepsy presentation was especially cool because specific physical characteristics of the seizures were shown (through EEG) to correspond to different regions of the brain. Another lecture that I enjoyed was one discussing pharmacogenetics, or the use of genetic testing to find the medicine that will be most effective and have the least side-effects for each individual patient. This is awesome because there are often several different medications to choose from, but various mutations and different protein levels make some work better for different people. To me, being able to determine the best treatment before a patient has had to struggle with several unsuccessful ones sounds like a great idea.

I took Monday afternoon off to go on a walking tour of the city. I was able to visit Milan's Duomo, the Victor Emmanuel II shopping gallery, the Scala Theatre, and the Castello Sforzeco.

Milan's Duomo (the photo at the beginning of this post) is the world's third largest church, and one of the city's most iconic sites (apart from the shopping galleries, of course). It's made out of a stunning marble, but it's so interesting to explore because (according to our tour guide - otherwise, I have very little architectural knowledge) it's experienced quite a few restorations over a span of several centuries. As a result, some sections were built in the Gothic style with others in Baroque style, and restorations have been conducted by both French and Italian workers who didn't always get along. The result is still fabulous, but an architectural anomaly nonetheless.

Below are photos of the Castello Sforzeco, the Scala Theatre, and the Victor Emmanuel II shopping gallery.

During my stay in Milan, I also had the opportunity to socialize with other neurologists and scientists through a welcome reception (held at the Castle) and a banquet (at the Museum of Design). It was great to meet so many different people and to talk about so many different things - where to travel, President Obama, neurology conferences, how to use Ebay, and all sorts of other topics. It was nice to speak in English, since my French pronunciation is not always the best. However, on this trip, I found out that my Italian certainly isn't any better. I think the epitome of my pronunciation difficulties became apparent when a Milanese neurologist asked me if I spoke even just one or two words of Italian. I enthusiastically replied, "Yes, I know how to say, 'Grazie!' Smiling, he told me that it was great that I know how to call "Taxi!"

On that note, I will finish this post to go work on reviewing my notes from Italian class (I started taking lessons just for fun last week). Ciao!

Bern, Pizza, and Nicotine

Last Saturday, some other interns (who work at the World Health Organization in Geneva) and I went to visit Bern, the capital of Switzerland. We took the train there and explored the Parliament buildings (see the photo on the right), some outdoor markets, the Münester cathedral, and the River Aare(the photo below). The cathedral was awesome because after a dizzying climb up a 254 step spiral staircase, there were amazing views overlooking the city!


We also saw the famous Bern fountains, like the one below. It's called the "Kindlifresserbrunnen," and it depicts an ogre eating young children.








From Bern, we took another train to visit a cheese factory in the Emmental region of Switzerland (see the photo below). (Emmental cheese is what we call "Swiss cheese" back in the States.) The cheese samples were tasty, and the surrounding scenery (with rolling hills, flowers, and farms) was absolutely beautiful.



As far as everything else has been going, I've been trying to work on my French around the house and at work, and I've been learning lots of new words and phrases that are used in conversation. It's also been cool to learn about pop culture by listening to music or watching movies with my housemates. Speaking of my housemates, they're a lot of fun! Below is a photo I took at last week's International Pizza party to celebrate the end of the school year. (Everyone made sure that I was sitting near the American flag.) Then for dinner tonight, one of my friends here made a "traditional dinner" from the south of France consisting of a lot of colorful vegetables and finished off with chocolate cake! It was great!

This week at work, I've been helping a bit with the Neglect study, running "my own" nicotine study with healthy volunteers (including myself), and trying to learn more about the computer program that I'll need to use to analyze the nicotine results. For our study, participants have had to wear nicotine and placebo patches before completing the fMRI scan, and so, by the end of the week, I'll have worn a nicotine patch for one of the days. (I just can't know until later what day that was.) On Friday, I'm off to Milan for the 19th Meeting of the European Neurological Society for five days. When I return, I'll be attending another conference in Geneva on Emotions, Stress, and Aging for two days, and after that, it's back to work at the lab.

Hopefully the next post will be full of fascinating science and some lovely photos of Milan!

My Brain!

Yes, that's me. This is one view of a structural image of my brain. I got scanned for about an hour (in terms of MRI studies, that's pretty long!) at work in order to test out our protocol before we tried it on stroke patients. I think being scanned provided me with a very good understanding of what we ask participants to do in a study. Scanning is certainly not terrible for me (at some points, the table vibrates, so it's kind of like a back massage), but for anyone who doesn't like loud noises or earplugs or enclosed spaces, I can image that it's not very pleasant.



For the past two weeks, I've been helping Arnaud to run a study of patients who have either had a stroke or shown signs of hemispatial neglect (or both). In this study, Arnaud runs a series of neuropsychological tests to determine each patient's cognitive level and the severity of neglect. Some of the tests include the Mini Mental State Examination (which I described earlier, and you can see a pretty accurate copy of here: http://www.bami.us/MiniMental.htm), visual search tasks, reading tasks, drawing tasks, and bisection tasks. In the case of a patient suffering from severe neglect, he or she might only read the words on one side of a paper, copy one half of a drawing (or one half of each element in a drawing), or only be able to find elements on one side of a visual search. After the tests, we've been scanning patients to obtain structural images (like mine, above), functional images of patients' brains while they complete a task involving memory, bisection, and search, and also diffusion tensor images (DTI). DTI are those that I'm least familiar with, but I find them really fascinating! Basically, they're used to find white matter connections within the brain by tracking the diffusion of water. The physics behind this type of scan is really cool! It involves rotating the magnetic field in many different directions in order to determine which protons (in this case, they're hydrogen atoms in the form of water molecules) have been displaced during the scan. DTI can be used to find the white matter connections and also to determine what direction water travels within the brain. You can check out a bit of background on DTI and white matter here: http://www.scientificamerican.com/article.cfm?id=white-matter-matters



The scanning has been interesting because the structural images come up on the computer screen while we're completing the 40 minute scan. None of the individuals doing the scanning have been trained to read structural scans like a radiologist, so none of us know exactly what we're looking for in terms of brain lesions, but in some patients, the lesions are incredibly obvious. There was a woman on Friday with a very large portion of her brain missing in the structural scan, and by meeting her, I would have never known it. She drove herself to the lab, walked fine, talked fine, showed no cognitive problems in the tests, and seemed to be just like everyone else with a fully intact brain. It's terrible to think of anyone suffering such a large brain injury, but at the same time, the brain's ability to recover amazes me.



One of the coolest aspects about work so far has been everyone's willingness to teach me something. I've been learning about the MRI technology itself whenever we're scanning and some of the operators have helped to explain some of the physics involved with the magnetic field, etc. I've been working on learning how to use MATLAB (apparently, the computer program for nearly every type of science) and a Statistical Mapping toolbox that's used to pre-process the "raw" fMRI images. This is really interesting for me because I'm pretty inexperienced with computers, but it's really been helping me to understand more about brain imaging technology. In one of the offices I work in, I've been talking with a postdoc about her work on imaging the brains of patients with Mild Cognitive Impairment (MCI) in order to try to determine structural differences between MCI patients who develop Alzheimer's Disease and MCI patients who don't develop it. This is done in an attempt to catch Alzheimer's Disease before it's too late. Another researcher was explained her work on sleep the other day and taught me how to recognize the different stages in the context of an EEG (or electroencephalogram). She finished a study recently in which participants were conditioned to associate a specific tone with specific information, went to sleep in an EEG lab, and then the tone was played when the participants entered REM sleep. The EEG showed that the brain did respond to the tone, even though the participants didn't necessarily wake up. This has some interesting implications about memory enhancement that could be done subconsciously during sleep.



So far, I have attended at least two seminars a week, and so I've heard lectures (in English and French) on a ton of different topics! Some of the more interesting studies have included imaging the brains of mothers with Post Traumatic Stress Disorder while they watch videos of themselves interacting with their children (as compared to mentally healthy mothers), using stem cells to treat Multiple Sclerosis, and comparing brain images of professional musicians to those of nonmusicians when listening to classical pieces ending in disharmonious chords. These talks have been great as well because I've been able to hear from researchers from all over on studies that haven't even been published yet.

That's all for now, but please post questions and comments if you like! I realize that this post might be more technical than the others, so if you want to know more about anything that I mentioned - let me know!

Exploring!

I must admit that this post is a conglomeration of several days worth of exploring, but it's probably a good thing that I'm not spending all my time posting on my blog! I took the photo on the left from a boat tour on Lac Leman in Geneva. It was cool to be out on the lake and being so close to the waves and sailboats made me really want to take up windsurfing! (I may just do that yet this summer.) After the boat tour, I strolled through several parks, saw basically all of Geneva out to enjoy the sun (it was Pentecost Monday, which is recognized as a day off by nearly every business here). I also found the famous Jardins Botaniques behind the United Nations.

While I'm thinking of the United Nations, I did an official tour of the Palais des Nations this past Saturday with a friend of a friend. You can check out the photo of me out in front with all the flags (on the right) or my favorite, the "Human Rights and Alliance of Civilizations" room (down below). The room is really cool because it's so new, but also because it has a very elegant setting contrasted with an absolutely wild modern-art ceiling. There are three-dimensional stalactites made out of multi-colored paint, and it's just the most fascinating combination! The UN tour was great, too, because we got to learn a little history of the organization and to listen in on a live International Labor Organization conference.

On the same day, I also headed to the neighboring city of Lausanne, where we visited a cathedral from the 13th century, and the Olympic Museum. Lausanne is famous because it's THE Olympic city - where all of the decisions are made regarding where the games will be held. At the museum, we saw a torch containing the Olympic flame and a sand sculpture of Michael Phelps (among other things, of course).

In addition to some of the local adventures I've been able to do so far, one of the best aspects about Geneva, the house I'm living in, and the lab I'm working in has been the fact that I've been able to meet people with varied backgrounds. I've worked with or socialized with people from French Switzerland, German Switzerland, Italy, Spain, Slovakia, Canada, Germany, Holland, China, France, Colombia, and Belgium, to name a few places. To me, Geneva is just a mix of languages and cultures, and I'm sure other big cities are similar in diversity, but with a population that's 40% foreigners, I'm exposed to many different nationalities.

My supervisor and I are running brain scans all day tomorrow, so that will be all for now, but look for more updates within the next week or so about what I've been doing at work.

As always, please post comments or questions as you like!

My First Day at Work

My first day was this past Tuesday, and it was interesting, to say the least! In the morning, I met Dr. Patrik Vuilleumier, the supervisor of my lab, and my direct supervisor, Dr. Arnaud Saj. Arnaud is a neuropsychologist doing his PostDoc on issues of Unispatial Neglect, and we'll also be working together on the nicotine study. It turns out that Arnaud is even less comfortable speaking English than I am speaking French, so we mostly speak French at work. It takes me longer to understand everything because I wasn't necessarily prepared for scientific vocabulary, but it's definitely forcing me to learn and communicate in French on a very regular basis. I have a slight advantage given that I have a bit of background in English on some (but not all) of the topics that we're discussing. For example, Arnaud was explaining the short cognitive evaluation that precedes the fMRI study of brain-injured (usually from a stroke) neglect patients, and he showed me the form that he uses to score everything. He said that it was the MMSE, or the Mini Mental State Examination, and when I looked closely, I realized it was the same exact exam that I had seen Dr. Mark Mapstone administer at the University of Rochester many times - except the whole thing was in French! It was cool for me to see a tool like that one used elsewhere because it really demonstrates the universal nature of some aspects of scientific study.

Another universal aspect is the fact that English is becoming the "language of science," so regardless of who published them, all of the articles that I have been given to read have been in English. That has helped me to better understand what I'm learning in French conversations with Arnaud. Also, research presentations are usually (but not always) in English, like the one I went to on my first day. A presenter from the University of Barcelona described an fMRI study investigating the "Influences of Emotional Context on the Processing of Novelty Auditory Stimuli." The general conclusion of the study was that showing participants emotionally significant faces (angry, fearful, happy, etc.) versus neutral faces or objects also intensifies the processing of "novelty" sounds (like a phone ringing or glass breaking, as opposed to "neutral" sounds like a monotonous noise).

On my first day, I was also trained how to safely use the MRI machine. The session closed with a demonstration of how strong the magnetic field is, in which everyone in attendance was each given the opportunity to hold car keys up to the MRI magnets. It's a good thing that they were attached to a rope because otherwise, they would have gotten stuck to the magnets! We were shown some real photos of MRI mishaps (not from my lab!) like the one on the right. The magnets are strong enough to move a chair or even a stretcher, if they contain magnetic metal.

Throughout the day, I met a lot of people (neurologists, technicians, researchers, students, psychologists, etc.) and toured the Brain and Behavior Lab (BBL) at the University. I'm working at the University and the attached hospital, so I go back and forth rather often. I also toured the stroke unit of the hospital with Arnaud. It's been very surprising to me to see how much less security there is here than other places I've been in the States. I don't need to check in anywhere, and I can access almost any part of the building that I need to (except for the MRI lab) without a badge. When I worked at the University of Pittsburgh last summer, I needed to sign in to new buildings, and I needed a badge to access practically every building. This system is certainly more convenient for me, but I'm unsure about how secure it is. I guess I'll get back to that later.


That's all for my first day - I'll have to update this soon because I got my brain scanned yesterday (Thursday), and that was quite an experience!