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Understanding the Brain: From the O.R. to the Lab

Question: How do you describe your scientific research?

 

Alfredo Quinones-Hinojosa: Well the best way that I can describe what I do as a scientist is the following. We have an opportunity, a wonderful opportunity. The opportunity is that my patients, our patients, allow us to go into the operating room every day. No one has more access to the human brain and the human central nervous system than we do as neurosurgeons. The reality is that many times to make a diagnosis you just need a small microscopic amounts of tissue. And many times the rest of the tissue just ends up in the biomedical waste, and we never do anything with it. And I decided that I want to go back to the basics.

And what I do is very simple. I use that tissue; that human tissue that otherwise would be absolutely discarded, I use it to take it back to the laboratory. I'm given that privilege by my patients. In the laboratory what we do is also complex, but simple in some ways. We're trying to understand whether or not within this tissue there are cells that have the ability to initiate brain cancer. We're trying to get to the root of the problem. So far what we have done with brain cancer is try to cure it.

The reality is that we don't even know how it starts. So what we try to do in our laboratory is try to understand how it may possibly start, and whether or not there is anything that we can do to prevent these little cells from migrating away and creating more havoc in the brain. And we do that by using models that are alive in animals and by using the small dishes where we can actually grow cells and see their behavior, see how they move, see how they grow, and see whether or not we can learn from that.

 

Question: How do you balance life in the operating room and the lab?

 

Alfredo Quinones-Hinojosa: The balance is not simple, it's actually quite complex. And the way it works is the following, in my experience, is you have to find a line of work that matches what you do in the laboratory and what you do in the operating room. In my case I am a brain surgeon and a spine surgeon, and I mainly specialize in brain tumors type of disease. Why? Because they actually fit exactly what I study in the laboratory.

So every time I am in the operating room, as an extension I am being part of my laboratory by collecting tissue, by collecting fluid, by interacting with my patients, by exploring and studying the disease which I study in the laboratory. So that's part of what I do. In general, it's not a simple recipe. It varies day to day, it varies week by week, it varies month by month. But the most important thing is that you have to find the time to do both, and if those two careers do not match, then it's virtually impossible to make it happen.

 

Question: What should the public understand about your research on the brain?

 

Alfredo Quinones-Hinojosa: What the public needs to know is undoubtedly that we are at a crisis. We spend a fair amount of money on many things in life, in our society, and unfortunately not enough on research. I have been extremely privileged that our work is being supported from several organizations, including the National Institute of Health, the Howard Hughes Medical Institution, the American Association of Neurological Surgeons, the American College of Surgeons, the Children's Cancer Foundation, the Robert Wood Johnson Foundation, the Maryland Stem Cell Research Foundation, and some other organizations that have been extremely wonderful in their support of our work. However, if you think about it, all those are small, little grants.

Although they're indispensable and they're extremely crucial for our work, they don't amount to very much at the end of the day. And to be able to do what we do, to be able to pay the salary of my post-docs, to be able to pay the space in which we do laboratory research, to be able to pay for all the resources and all the personnel that it takes to run such a laboratory is a fair amount of money. And the reality is that not a lot of people, and not a lot of investigators, are as lucky as I have been in my life to be able to obtain these grants. So there is a lot of investigators that are struggling to obtain more funding for their laboratories.

So what we need to do, and what the public needs to know, is that for us to be able to find a cure for brain cancer, we need to put those dollars, we need to put those resources to work. I know, based on what I do, and based on what other people have done-- and I stand on the shoulders of giants and I can do this because a lot of people ahead of me have done it for many years-- I know that the cure for brain cancer is not going to be won in the operating room. For me the operating room is a crucial part of my laboratory, so it's indispensable as well, but I know we're not going to find that cure in the operating room. That cure has to be found back there, in the laboratory, at the bench site every day, doing it over and over.

 

Recorded on: July 2, 2008

Dr. Q says that, as a neurosurgeon, he has incredible access to the brain through surgery, which proves invaluable in the laboratory where he can help get to the root causes of diseases. But, he also warns the public that we are at a crisis point when it comes to supporting scientific research in the United States.

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  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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