Contributors Editor-in-Chief Armaun Rouhi
Executive Editors Joseph Baer Ashwath Raj
Design Editors Sami Chang Kedwin Chen Amy Tuey
Principal Artists Mareya Dick Brian Huo
Content Editors Ethan Chung Divya Ghoshal Jessica Ho
Copy Editors Ishwinder Battoo Yeonjae Hong Manisha Seelam April Xie
Directors of Finance Casey Chen Daniel Shevchuk Gleb Shevchuk
Writers Joseph Baer Romeo Ignacio Ethan Chung Sukruth Kadaba Gurleen Gill Kyle Kissinger Jessica Ho Ashwath Raj Yeonjae Hong Armaun Rouhi Brian Huo April Xie
Advisor 2
Kimberly Pytel
Letter from the editor Dear Readers, Welcome to your first issue of The Future Doctor. On a warm, July afternoon, four executives from the Future Doctors of America (FDA) club gathered around a small library table to discuss their club’s newest venture: publishing The Future Doctor Medical Journal, what would soon be the only high school medical publication in the Poway Unified School District. Going for hours on end, these four executives debated, collaborated, and dreamed of turning The Future Doctor from misplaced notebook scribbles to a tangible reality. In the coming months, a staff of seventeen was organized, articles were written, design layouts were created, and advertisements were gathered. All the while, we at The Future Doctor completed these tasks with one goal in mind: to inspire a new generation of future doctors in the youth of San Diego County to become doctors who combine passion with compassion, diligence with discipline, and scientific knowledge with an eye for application. In these thirty-six pages, you will explore the raw science behind the field of Neurology. Our writers have detailed common myths surrounding the brain, the basic anatomy of our brains, recent breakthroughs in neurological research, and the newest medical devices that counteract harrowing conditions in the brain and nervous system. However, although teeming with complex science, the medical field is not just chemicals and reactions; rather, the medical field is driven by steadfast altruism. Therefore, we have also prepared articles which express the positive impacts that are actively made by doctors through a treatment, procedure, or arguably the best medicine of all, a sense of compassion. We would like to recognize and appreciate the invaluable contributions of our tireless staff, talented writers, and wonderful advisor, Ms. Kimberly Pytel. We would also like to acknowledge Dr. Regina Faulkner of The Scripps Research Institute, Dr. Alexander Khalessi of the UCSD Medical Center, and our many sponsors for their support in allowing this dream to flourish into a spectacular reality. Finally, we thank you, our readers, for allowing us into a small part of your day. Now we invite you to sit back, relax, and enjoy the rest of this inaugural issue! Sincerely, Armaun Rouhi Founder and Editor-in-Chief art by MAREYA DICK Cover image courtesy of www.talmedical.com
If you would like to join our team as a writer, sponsor our publication, or advertise in a future issue, please contact us at delnorte.fda@gmail.com
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neurology Pgs. 6-7
The Brain’s Regular Functions
Dispelling Myths & Pseudoscience
Pgs. 8-11 Pgs.12-13 Breakthroughs in Research
The Doctor to Patient Impact
Pgs. 14-17
Neurological Phenomena
Pgs. 18-19
spring 2015 Q&A with Dr. Regina Faulkner
Pgs. 20-21
Technology in Medicine
Pgs. 22-23 Pgs. 24-29
Surgical Procedures +Q&A with Dr. Alexander Khalessi The Psychiatry Corner
The Plan Your Future Corner
Pgs. 30-32 Pg. 33
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Disproving the ten percent
by ETHAN CHUNG The human brain, having taken thousands of years and countless generations to become what it is today, is nothing short of a wonder of science and human evolution. It is also mysterious and for centuries has been surrounded by myths and questions. The recent action film Lucy, which details how one can supposedly surpass their “average ten percent brain capacity” to unlock supernatural abilities, brings a key question to attention: Do we humans really use just ten percent of our brains? Before jumping to conclusions, we must first dive into the brain itself and examine all of its sections and corresponding functions to unveil the answer. The best way of observing the human brain is to analyze the forebrain and its various parts. The forebrain is the largest portion of the brain in terms of surface area and it is the most evolutionarily advanced. Otherwise known as the cerebrum, the forebrain consists of two hemispheres: the right and left hemisphere [1]. The hemispheres of the forebrain hold their own unique roles; the left hemisphere is responsible for movement of the right side of the body as well as control of one’s logical and rational processing. In contrast, the right hemisphere allows movement of the left side of the body and houses the majority of a person’s creative thinking [1].
The forebrain’s hemispheres are then divided into four divisions known as lobes, each holding their own specific purposes and functions. The first section of the forebrain, the frontal lobe, can be found in the anterior of the cerebrum. The frontal lobe is a very important part of the forebrain as it is where our personalities reside; the frontal lobe runs everything from our critical thinking and problem solving to our complex emotions. The frontal lobe is also responsible for coordinating our motor movements, such as jumping or riding a bike. Past the frontal lobe and into the top middle of the forebrain lies the parietal lobe. The parietal lobe has three important functions which are divided into its two sides: the left side of the parietal lobe allows humans to talk, as it is where the majority of language processing (written and spoken) takes place [1]. While the right side of the parietal lobe deals with attention and sensory processes. The next section of the cerebrum is the temporal lobe. Located at the bottom center of the forebrain, it also has two main purposes. The first is to help with integrating auditory information with the other processed senses from the other lobes [1]. While the second is helping with storing our memories. Image courtesy of www.sites.cdnis.edu.hk
Occupying the back of the cerebrum, the occipital lobe is the last lobe to uncover. Being one of the smaller lobes, its sole purpose is to help with processing a person’s visual information (facial and shape recognition, colors, etc.) for the temporal and parietal lobe [1]. All in all, the forebrain is fairly important, as it is responsible for so many day to day tasks, like writing something as simple as a facebook post, to holding the components of one’s personality, memories, and emotions. Finally, we return to our initial question, Do we as humans use only ten percent of our brains? We can now state that this statement is incorrect, as the average human is capable of using much more than ten percent of their brains. At first it may seem disappointing that there are not any secret sections of the brain, filled with mystical powers and super human abilities, but one must appreciate and acknowledge how extraordinary the human brain already is. Our brains are truly the ultimate multi-taskers; they control our emotions, organize our deepest memories, house our distinctive personalities, and manage our senses all simultaneously. And to accomplish these tasks, it is evident that our brains utilize one hundred percent of the neurons in their domain. 7
Neuroplasticity Your Brain’s incredible power to change
by SUKRUTH KADABA You are walking through school on a regular day. There’s a test in Biology, and now your Spanish teacher is droning on and on about conjugating ser and estar. Finally, the bell rings. Suddenly, you feel a wave of inexplicable anxiety. Your breakfast seems to be fighting your way up to your mouth. Your brain feels like it was dumped in a trash compactor. The normal noise of break fades away, and a soundless void replaces it. Then the symptoms disappear. Worried that you might have af mental disorder, you call your parents. They take you to a doctor, who scans your brain and finds a malignant tumor growing on the left side. Then the doctor says that he plans to remove half of your brain. You protest but the doctor explains that this process will not result in any stunting of intellectual processes. How? Because of neuroplasticity. Neuroplasticity is the ability of the brain to rewire neurons to adapt to new circumstances [1]. Since you are missing half of your brain, some neurons from the other side of your brain will rewire to fulfill the duties of your other side. This is called functional plasticity. Neuroplasticity also has less dramatic effects. It is the basic process you use in school every day to learn. It helps you forge new mental connections and gain skills you use in everyday life. It is the reason that people (even adults, whose brains were previously believed to have been shaped by childhood) can change and reform, developing new habits and behaviors. This is structural plasticity. Neuroplasticity is one of the most studied topics in the realm of psychology. However, it does have its limits. It cannot, for example, compensate for the loss of the neurons that control the left-hemisphere-controlled arm or eye. Additionally, the brain sometimes adapts to new situations in ways that are not beneficial [1].
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For example, as a result of their brain rewiring to fit new circumstances, some deaf people report hearing an irritating ringing in their ears that goes on without stopping. However, as a whole, neuroplasticity has largely helpful effects that are critical to both normal and special functions of your brain, whether its basic motor functions or the most complex instances of critical thinking [1]. The science of neuroplasticity has given us a lot of insight into human beings. New discoveries have revolutionized our understanding of the human mind. For example, we now know that chronic stress is bad for brain growth and can even make it hard to gain and retain information. We also know that aerobic exercise strengthens the mind as well as the body. Still, we have much to learn about this simply amazing field of science. Scientists theorize that applying guided neuroplasticity could help treat or cure diseases such as cerebral palsy or Alzheimer’s. Even though this field of science is relatively new, it offers many promising possibilities for the future of mental health care and informs us about our own intricate mental processes. Image courtesy of www.livescience.com
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SLEEP & RECEPTIVITY by JOSEPH BAER Have you ever crammed an essay and spent an extra hour in front of the computer, only to find that afterwards you can’t fall asleep? Some may call it bad luck but a neurologist would call it light-evoked suppression of melatonin biosynthesis. While that may sound like quite a mouth full, it is actually fairly easy to understand. Let’s take a look at what makes you sleep. Most neurologists accredit tiredness and sleep to a hormone called melatonin. Melatonin is like a chemical clock; when melatonin is produced, your body is queued to sleep in order to help create the sensation of tiredness. Melatonin is only produced at night because we sleep at night, and during the daytime the production of melatonin is suppressed [1]. In addition, the low amount of
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melatonin that you may still have from the previous night is absorbed. Melatonin suppression comes from light, but because there is no light at night, light suppression typically comes from blue light (wavelengths of 460 to 480 nanometers). This blue light regulation system has worked for humans for many years. Sadly, with technology, sleep regulation has gone haywire. Much of the light from a monitor or phone screen is blue light and therefore suppresses melatonin production. The whole construct of artificial technology, from our MacBooks to our iPhones, creates a lack of melatonin production that subsequently causes irregular sleep schedules and general grogginess. However, blue light suppression works both
The science behind one of our most appreciated activities ways. During the mornings, when you spend prolonged periods indoors, you do not get as much blue light as you probably should, causing grogginess. This phenomenon is why spending time outside can make you feel less groggy. A battery of studies has consistently found health problems associated with a lack of melatonin production. Also, heightened amounts of stress and anxiety have been linked to nightshift workers, many of which work in blue lightheavy environments [1]. Blue light suppression and melatonin are in no way a catch-all for sleep. The production and suppression of melatonin merely help create a rhythm in our body that helps us know when to hit the hay. So the
next time you have a big test or just want to get to bed early, try turning of the electronics five minutes to an hour before bedtime to insure ample sleep. With this information, you can now put what you have read to the task and improve your sleeping habits, and ultimately, your knowledge of the rather simple science behind sleep. Image courtesy of www.mediflow.com
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In Spite of All Odds Johns Hopkins’ neurosurgeons tackle a rare strand of glioblastoma
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by JESSICA HO
tors that their work takes great efforts and great faith. Dr. Brem has Everything that could go wrong his own take on it: “What it boils was beginning to go wrong. down to is hope. The only way It was the fall of 1990, and 39-year- we can justify patients coming old father of two Richard Pollhammer was all this way and trusting us is to on his way back home. Rather than his offer more than compassion. You intended exit on the freeway, Pollhammer give them hope by making your abruptly entered a fugue state of seizures technical skills the best...you give in the middle of the road instead. Expethem hope that comes from really riencing a seizure in the heart of heavy caring about them. I know this traffic, it wasn’t long until an ambulance model works. I’ve seen it work.” arrived and transferred the man to a neigh- As of now, Pollhammer is boring hospital. Of course nobody expects considered completely cured of that the next time he opens his eyes, he his cancer; no trace of the ailment would be waking up in a hospital to the left behind [1]. Ironically, it seems distant phrases of “no real cure”, “malignant that his skull infection saved brain tumor”, and “average life expechim. Dr. Brem explained that the tancy of one year”. Lives can be instantly bacteria seemed to have triggered transformed in a moment, and the world a powerful immune response, of medicine is no stranger to these occur“mopping up the cancer cells” in rences. As former administrator of Johns the process. Hopkins’ Department of Neurosurgery, Things weren’t only Pollhammer knew better than anyone else looking up for Pollhammer; the that nothing would be the same. realization of brain immunity At the time, up-and-coming neuaided his doctor greatly in neurorosurgeon Dr. Henry Brem was breaking surgical research. Now director of through in the fields of neurosurgery and the Department of Neurosurgery oncology. Utilizing his years attending and at Johns Hopkins, Dr. Henry Brem on a research team at Harvard, Brem had has received much recognition for teamed up with other scientists in order to his ever-persistent efforts. These produce Gliadel wafers. Wafer therapy had include the Hopkins Professors proven to be the most promising treatAward for Excellence in Teaching ment at the time, but was still in its early (1996), the Grass Award by the Sostages of development. Pollhammer was ciety of Neurological Surgeons for taken in as one of Dr. Brem’s patients. meritorious research (2000), the Despite being admitted to one of Founders Award of the Controlled the most promising neurosurgeons of the Release Society (2001). Brem delivtime, the situation turned for the worst ered the commencement address when Pollhammer learned that he had a for the Johns Hopkins University grade IV glioblastoma; one may call it the School of Medicine in 2011, and is “emperor” of all neurological maladies. still internationally sought after as Although the situation really could not a guest lecturer today. have worsened at that point, hope di So what can be done in minished even further with the report of spite of all odds? Besides medPollhammer having been ineligible forwa- ical research, what is the secret fer treatment. Dr. Brem removed as much to miracles? Whether if it’s in the of the tumor he could during surgery, and operating room or in the ups and put him on intense chemotherapy. Howdowns of everyday life, what can ever, Pollhammer developed a rare skull be done when everything seems infection before treatment even began. to turn to disparity? “I was taught,” Another surgery and a few weeks of antibi- Brem says, “that you don’t take otics later, a miracle happened as Pollham- hope away from people. You give mer finally began radiation treatment; his patients the statistics. You don’t condition was improving [1]. make pronouncements, but you There is a consensus among docdon’t stop there.” Image coutesy of www.plazamedicalcenter.com
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Decoding DEmentia by ASHWATH RAJ Five million people suffering, millions of people gone, and billions of dollars wasted without recourse. This is Alzheimer’s (ALZ), a terrifying dementia that robs victims of their memories and cognition. Dementia is a general term for loss of mental function severe enough to interfere with daily life, and Alzheimer’s disease is the most common form of dementia. The disease mainly targets the elderly. One in three seniors die from Alzheimer’s or related complications. To make matter worse, Alzheimer’s has no cure, method of prevention, or even a way to slow its progression, so the death toll grows ceaselessly. Currently, five hundred thousand people die each year from Alzheimer’s, up from seventy percent in 2000, and experts estimate that by 2050, the number of people living with Alzheimer’s disease will more than triple to sixteen million [1]. With that, health care and out-of-pocket Alzheimer’s costs will rise from two hundred billion to 1.2 trillion dollars. In other words, the lethal progression of Alzheimer’s will never stop [1].
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In its early stages, Alzheimer’s causes slight forgetfulness, disorientation, and difficulty with “higher” functions. The basis of the disorder is neurological- Alzheimer’s causes extreme brain shrinkage through neuron death and tissue loss. These symptoms are caused because of damages to the prefrontal cortex (the center for higher function) and the hippocampus (integral for learning and memory). These lack nerve cells and functional synapses, with dense accumulations of beta amyloid plaques and tau tangles- types of proteins that cluster around dying neurons. Beta amyloid does its damage by blocking cell signaling at synapses and activating autoimmune responses towards damaged cells. Tau tangles cause the beneficial tau protein transport tracks to collapse, so nutrients and essential supplies can no longer reach the target cells [1]. Identification of Alzheimer’s can be done with
Solving the complexity of Alzheimer’s disease about eighty percent accuracy in its earliest stages, and as the disease progresses, diagnoses can be made with even greater accuracy. Physicians use a battery of assessments to identify if a patient has Alzheimer’s versus a disorder with related symptoms. They examine medical history, use physical and neurological exams, test mental status, and implement brain imaging techniques. While brain imaging specifically can help to identify shrinkage, it is not completely precise enough for total confirmation; one hundred percent confirmation of Alzheimer’s is only available at autopsy. So with the hope of uncovering Alzheimer’s before symptom onset, the Alzheimer’s Association began funding research into biological markers. When these biomarkers reach a certain threshold, researchers are able to confidently diagnose patients before significant mental abnormalities take place. For example, because ALZ patients have significantly greater amounts of beta amyloid and tau tangles than the general pop-
ulous, analyzing a carrier of the two proteins known as cerebrospinal fluid (CSF- cranial fluid that protects the brain and spinal cord), researchers can improve detection. Researchers are also investigating how ALZ causes changes in other parts of the body. These developments in Alzheimer’s research have allowed for huge strides in our understanding of something as complex and equally tragic as Alzheimer’s disease. With time and applied scientific knowledge, researchers and physicians across the globe will surely surmount this harrowing disease. Image courtesy of news.discovery.com
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Deep Brain Stimulation Conquering Parksinson’s disease one scan at a time by GURLEEN GILL
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Whether it’s at home, school, on the streets, or in the hospital, everyone has heard of Parkinson’s disease. But how many people actually know what it is? Parkinson’s disease is caused by a miscommunication in the nerve cells of the brain that secrete dopamine. Its symptoms include muscle stiffness, drastic changes in walking, increased slurring in verbal communication, and most of all, trembling [1]. Unfortunately, unlike many other diseases, Parkinson’s has no cure. However, neurosurgeons at the University of California, San Francisco have developed a new MRI device to assist surgeons in implanting electrodes into the brains of people who have various neurological disorders, including Parkinson’s disease. This surgery, referred to as deep brain stimulation, can help allay patient’s symptoms while making the process faster and easier for the patient [1]. Deep brain stimulation (DBS) blocks electrical signals from certain areas of the brain that exhibit symptoms of Parkinson’s disease. It uses a neurostimulator, or a battery-operated medical device, to deliver electrical stimulation to specific areas of the brain that control movement. This process blocks the nerve signals that exhibit Parkinson’s disease symptoms. To locate the precise area of the brain, neurosurgeons use MRI scanning before the procedure [1]. A standard MRI scan shows structures deep inside the brain, which surgeons use to accurately place electrodes. The procedure first begins by giving the patient an MRI scan obtained with a frame in place. After frame placement and calculation of the coordinates on the computer, the patient is taken to the operating room where an intravenous sedative is given. After giving local anesthetic to the scalp to make it completely numb, an incision is made on top of the head behind the hairline and a small opening, about the size of a nickel, is made in the skull [1]. At this point, all intravenous sedatives are turned off so that the patient becomes fully awake. The brain’s electrical signals are then played on an audio monitor so that the surgical team can hear the signals and assess their pattern. When the correct target site is confirmed with the microelectrode, the permanent DBS electrode is inserted and tested [1]. Intravenous sedation is resumed to make the patient sleepy, the electrode is anchored to the skull with a plastic cap, and the scalp is closed with sutures. The patient then receives a general anesthetic to be completely asleep for the completion of the surgery. As of October 10th, 2014, neurosurgeons have implanted 67 electrodes in 36 patients using this technique. Larson, Martin, and Starr hope their inventions will reform the realm of Parkinson’s disease and the world of medicine. So, the next time you hear of Parkinson’s disease, you will not only know what it is, but also how doctors alleviate its symptoms and work towards a cure. Image courtesy of www.urmc.rochester.edu.
Oligodendroglia Disregarded brain cells are discovered to be key to ALS development
by APRIL XIE In 1921, neuroscientists Wilder Penfield and Pío del Río-Hortega discovered oligodendroglia (pronounced oli-gō-den-droglē-ă) and identified them as non-astrocyte glial cells [1]. Unlike astrocyte cells, which provide metabolic support to neurons in the brain, oligodendroglia cells were characterized to insulate axons and allow fast communication between neurons [1]. However, almost a century since their discovery, oligodendroglia have made a reappearance in the neurological world as researchers realize that oligodendroglia are actually essential to the survival of neurons, and damage to these cells could be a leading factor to the development of neurodegenerative diseases [1]. A recent Johns Hopkins study, led by neurology professor Jeffrey D. Rothstein, M.D., Ph.D., uncovered that oligodendroglia actually supply energy to neurons in the form of lactate, which is crucial to axon and neuron survival. Previously, astroglial brain cells were thought to provide the primary nutrition for neurons in the form of glucose. Lactate, which is less energy-rich in comparison with glucose, was considered minor in this process. However, through experiments conducted using mice, resear-
chers discovered that when lactate transport was cut off, axons and neurons started to die even though they were getting supple amounts of glucose [1]. Johns Hopkins researchers then went to work to determine whether abnormalities in the lactate shuttles were leading to amyotrophic lateral sclerosis (ALS). With ALS, motor neurons slowly degenerate, leading to respiratory failure and death. Astrocytes were long theorized to provide lactate to brain cells and were known to be affected by ALS, so the researchers tried to find a link between damaged astrocytes and loss of lactate. Much to their surprise, Rothstein’s team found that in animals, the abnormalities with the lactate shuttles were not occurring in astrocytes but rather in oligodendroglia. Rothstein realized that the connection between astrocytes and lactate was only present in cultured cells. Finally, the researchers tested mice with ALS and found that their brain cells lacked MCT1 even before the disease was developed. Similar results were found with ALS patients. Rothstein concluded that damage to oligodendroglia—specifically injury to the mechanism that produces
MCT1—is a major event in the development of ALS and could be a factor in the development of other neurodegenerative diseases as well [1]. These results have prompted Rothstein to conduct further research on the function of oligodendroglia, studying why they are damaged and where the relevant protein is localized. He has also been studying possible treatments for ALS. He stated: “One possibility, that we did not explore in the paper but we are now doing, is what if we make more of the protein involved in the pathway? Would this have a protective effect? This is the next phase of our research [1].” Without a doubt, the discovery of oligodendroglias’ critical role in neuron survival and ALS development has greatly increased the human understanding of neurological health. With scientists such as Rothstein pursuing the mysteries behind oligodendroglia, researchers are now one step closer to a cure for ALS—and potentially an end to neurodegenerative diseases. Image courtesy of www.wikipedia.com
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Purkinje Cells A closer look at one of the brain’s most vital components
by BRIAN HUO Of all the many organs that comprise the human body, none are so vigorously studied as the brain. In spite of this, it also remains one of the most difficult of structures to comprehend; it is composed of countless parts and divisions, and within these are unique tissues and classes of neurons. Among these classes of neurons are the Purkinje neurons, or Purkinje cells. Purkinje cells play a crucial role in the ability of the cerebellum to carry out its duties, and damage to them can cause a variety of symptoms. As a reminder, the cerebellum is the region of the brain associated with motor control and language. It is located below the larger cerebrum, and behind the brain stem. The cerebellum consists of the outer cerebellar cortex, and the inner cerebellar deep nuclei, which connect to the brain stem. The cerebellar cortex consists of three layers: the outer synaptic layer, or molecular layer; the intermediate discharge layer, or Purkinje layer; and the inner receptive layer, or granular layer. Purkinje cells themselves are GABAergic neurons, meaning their output is the inhibitory neurostrans 18
mitter gamma-aminobutyric acid, or GABA. They are also among the largest of neurons present in the human brain, and are easily identifiable by their large branching dendrites on one side of the cell body and single long axon growing from the other. The dendrites are organized in a flat layer, and each dendrite branch is lined with small protruding “spines”. Within the cerebellar cortex, Purkinje cells sit in a layer one cell thick, while their dendrites sit parallel to each other receive input from each other through their spines. Meanwhile, the axons transmit information to the cerebellar deep nuclei, and are in fact the only source of output from the cerebellar cortex. This makes Purkinje cells critical to the ability of the cerebellum to coordinate movement. Certain human neurodegenerative or neurodevelopmental illnesses are the result of cerebellar abnormalities, and many specifically involve problems with the Purkinje cells. For example, one study demonstrated that a hereditary disease leading to degeneration of Purkinje cells can cause the onset of Parkinson’s disease and Lewy Body dementia in mice. This study Image coutesy of www.psychologytoday.com
entrapped organelles in Purkinje cells, leading to the degeneration of the Purkinje cells after about one year of age [1]. In another case, researchers found that a hereditary lack of certain calcium-binding proteins in Purkinje cells of mice caused “permanent deficits in motor coordination and sensory processing” [1]. Studies like these demonstrate the importance of Purkinje cells in the normal function of vertebrate brains. While much of the human brain is beyond current understanding, the constant progress of neuroscience promises to expand humanity’s knowledge of its most valuable asset. Research of the cerebellum and its constituents—especially of Purkinje cells—has the potential to achieve a greater understanding of neurological diseases, as well as mental illnesses such as autism spectrum disorders and obsessive-compulsive disorder.In other words, neuroscience is a field which is essential to the medical community’s ability to comprehend, diagnose, and treat some of the most crippling diseases, as well as many of most poorly understood and commonly overlooked mental illnesses.
Synesthesia Seeing the world differently
by JOSEPH BAER I see time. Yes that’s right, I see time. It may seem like something out of a Back to the Future - The Sixth Sense crossover, but it is actually very real. I have Spatial Sequence Synesthesia or SSS for short. But what does Spatial Sequence Synesthesia mean? Let’s dissect the term. Spatial as in distance, Sequence as in time, and Synesthesia as in... wait, what does synesthesia mean? Before we figure out what SSS means, we need to find out what synesthesia really is. Synesthesia, a neurological condition that only affects a slim portion of the population, is caused by the connection of two parts of the brain. The effect is truly amazing; synesthesia causes people to see things in their mind that might not normally be associated with vision. Most synesthetes have Grapheme-Color Synesthesia, or the mental-visual association of color with letters of the alphabet. So when these individuals read a letter, they see a representing color. Other individuals have Chromesthesia, a strain of SSS, which causes them to associate musical notes with color. So what does Spatial Sequence Synesthesia mean? It means that I see time in the form of distance. I see time similar to a giant Candy Land Game board.
Now that we have dove into the basics, I would like to point out something interesting about synesthesia. For me, synesthesia was not an error that formed when my brain was developing, neither is that the case for most synesthete; rather, synesthesia is genetic. My mother has Spatial Sequence Synesthesia as well and the condition has a long history on my mother’s side of the family. Many people have actually tried to trace the roots of their synesthesia. Most are unable to do so because even though synesthesia was discovered in 1812, researchers had not started investigating it using modern research methods until the 1980s [1]. At that time, work was conducted by the famed Dr. Richard E. Cytowic of George Washington University. His research hinted a link between synesthesia and unbridled creativity, as the condition is found in renown writers, painters, and musicians. As previously mentioned, modern research on synesthesia did not take prominence until the 1980s. The first description of synesthesia was in 1812 by Gustav Fechner. He referred to the syndrome as “color hearing” [1]. In the 1880s Francis Galton conducted research on what he called “Visualized Numerals” [1]. As behaviorism began to rise in psychiatry, subjective experiences lost favor in the community until its revival in the 1980s. The rise of the internet allowed for further
research of synesthesia. David Eagleman, a neurological researcher at the Baylor University School of Medicine, created The Synesthesia Battery (www. synesthete.org). His website allows people to take a short test to see if they are a synesthete. Synesthetes can then participate in survey based research though the battery. Overall, synesthesia is a remarkable and rare genetic neurological condition that produces unique effects. By now you may be wondering whether or not you have synesthesia. If you are, I highly suggest you visit the Synesthesia Battery and take the test. While it’s not a surefire way to diagnose every kind of synesthesia, it covers most of the basic ones. Yet, if you do find yourself in the rare group of synesthetes, you can surely declare that you see the world differently. Image courtesy of www.daysyn.com
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Technology in MEDICINE
by ASHWATH RAJ The role that technology plays in everyday life is unavoidable. It branches into every field imaginable, inevitably changing it for the better. So when mankind combines the limitless potential of technology with the life saving selflessness of medicine, there is nothing that we cannot achieve. Such medical advances have already set the precedent for what efficient and effective medicine should be. That ideal will continue to grow, completely eliminating unnecessary suffering around the world. Take, for example, medical service bots. They are capable of autonomy and assistance; they can completely monitor and manage patients even in a busy hospital and assist doctors with patients’ assessments in emergencies. These machines are also extremely cost effective- “They are able to do the work of three humans for the cost of less than one” [1]. So while those machines maintain vital day-to-day functions, nurses and doctors can focus on using their resources to generally improve healthcare and medicine. And that’s only the tip of the iceberg. These days there are maintenance nanobots, exoskeletons that allow paraplegics to regain mobility, and even robots like the daVinci Surgical System, which has done over twenty thousand surgeries since 2000 [1]. Whether it is improving cost, surgical techniques, or even design, what comes next will ensure, medicine will never be the same. Most technology in pop culture is centered on video games. Not many people focus on the applications the industry has to other fields. But Oculus VR may change all that with the Oculus Rift. The Rift is Image courtesy of biology.rutgers.edu
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an immersive virtual reality headgear that, using two OLED displays near the viewers’ face and headphone attachments, brings users into whole new worlds. The Rift has revolutionized the industry, and, since then, people have taken full advantage of it in order to augment current healthcare. For instance, it is currently used in conjunction with local anesthetics to provide patients with more relaxing surgical experiences [2]. The Oculus is also playing a new role in therapy; patients are using the Oculus for visualization training when adapting to prosthetic limbs or to overcome Phantom Limb Disorder- a psychological condition in which amputees continue to experience pain sensations through the “invisible” limb that had been removed immediately before. However, this “phantom” is immobile in most patients and usually locked in a painful position. Yet with the Oculus, patients are able to see visual recreations of their missing limbs. Simply seeing their limbs virtually has been reported to alleviate pain and provide symptomatic relief to patients. It seems that just a short escape into a virtual reality can make the real world much easier to bear. From brain computer interfaces and overlays to artificial intelligence based healthcare and new applications in nanoscience, technology is more and more becoming part of our lives and medicine. By expanding on existing technology and pushing the boundaries of what we currently believe is possible, the worlds of science fiction become reality. By facing the impossible and forging on, we have created, and not been born into, the world of the 21st century. For this is a world in which we persevere and innovate for ourselves and for our fellow man. So if we simply stop, so would the world. 21
QA &
With Dr. Regina Faulkner, Ph.D.
by ARMAUN ROUHI
AR: Today I am here with Dr. Regina Faulkner, Ph.D., a Postdoctoral Research Associate in Neuroscince at the Hollis Cline Laboratory of The Scripps Research Institute. As a previous guest speaker to the Future Doctors of America Club on the topic of Neuroscience and Neurological Research, Dr. Faulkner has much to share with us today about every aspect of her field.
followed by my Ph.D. in Neuroscience from UC Davis in 2009. Immediately thereafter, I began working as a Postdoctoral Research Associate at The Scripps Research Institute.
AR: What are you currently researching at the Scripps Research Institute? RF: I am interested in how the regions of the brain connect to one another during early developAR: Dr. Faulkner, when did you ment. This process is thought to know that you wanted to pursue a be perturbed in many neurodevelcareer in neuroscience research? opmental disorders. I investigate RF: I became interested in Neurothe processes involved in making science during high school, but I connections in both the normal and didn’t know how I would turn that interest into a career until college. I diseased state. I’m also interested in the role of experience on shaping considered a career as a Physician, the brain. I study the role of visual but then I took a Developmental Neurobiology course during college stimulation on the formation of the visual processing areas of the brain that exposed me to Neuroscience by altering visual input and investiresearch for the first time and I immediately knew that it was what I gating the consequences on neural development. wanted to do. AR: What education did you have to get to where you are today? RF: I received my BS in Neurobiology and Physiology from UC Davis, 22
AR: What tools, machines, or instruments do you use to conduct research? RF: I do a great deal of microscopy
in my research. This involves using confocal or multi-photon microscopes to look at single, fluorescently labeled cells within the developing brain and the electron microscope to see all the way down to the level of a single synapse. using confocal or multi-photon microscopes to look at single, fluorescently labeled cells within the developing brain and the electron microscope to see all the way down to the level of a single synapse. AR: In your opinion, what is the most challenging aspect of neurological research? RF: We still have a lot of work to do to understand the mechanisms behind neurodevelopmental disorders like Schizophrenia, ADHD, and Autism. For patients waiting for treatment, the progress is frustrating slow. However, the brain is the most complex organ in the human body. It has approximately 100 billion neurons and trillions of synapses. To understand the subtle differences between the different neuron types, to learn how they are connected, and how they communicate with
one another is a very complicated task. Those discoveries are likely to be at the heart of understanding neurodevelopmental disorders. AR: What role does your research play in allowing neurologists to treat their patients? RF: My research is basic science, and it is discoveries made at the basic science level which pave the way for breakthroughs affecting human health. We are studying the mechanisms by which the brain forms and as such, we discover possible therapeutic targets for brain disorders. AR: Given that we frequently hear many riveting stories of advancements in the research of Alzheimer’s and other neurodegenerative diseases, what is the future of neurological research in your opinion? RF: I think it will involve developing new technologies to study neuron types and connections within the brain. We also need to improve technology to study the human brain in action. These types of advances can have huge impacts on our understanding of the diseases of the brain.
AR: Finally, what advice would you give to high school students who are interested in pursuing a career in neuroscience? RF: Unfortunately, there aren’t a lot of opportunities in high school to learn about neuroscience. Seek out other ways to learn on your own to see if you have a passion for neuroscience. In college, I studied neuroscience as an undergraduate, but you don’t necessarily need to. Being well-rounded in disciplines like cell biology, molecular biology, and psychology is important. Regardless of what you study in college, if you want to pursue a career as a Physician or Scientist, I recommend you work in a lab. Don’t be shy, look while you’re a freshman or sophomore in college. The earlier you start, the more time you have to learn and contribute to the research that the lab is doing.
through your guest speaking venues and this wonderful Q&A. RF: It is always a pleasure! Thank you for having me. AR: There you have it, a complete look at virtually every aspect of Neuroscience from a Ph.D. at the internationally renown research institution, The Scripps Research Institute! From everyone here at The Future Doctor, we hope that you’ve enjoyed this Q&A and learned something valuable from our discussion. As you have read in previous articles of this magazine, medical research is absolutely vital to the success of a variety of operations, procedures, and treatments that physicians conduct on a regular basis. And this Q&A attests to that fact and teaches us all about the ins and outs of Neuroscience and the revolutionary research of the field. Image courtesy of http://www.scripps.edu/cline/
AR: And with that, our Q&A session has come to an end. Thank you very much for your comphrehensive answers, Dr. Faulkner, I can definitely assure you that you’ve gotten many of us interested in nueroscience and neurological research, both
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by YEONJAE HONG The brain is one of the major organs in the human body. It is responsible for many different functions and each part of the brain serves an important role everyday. It sends messages through neurons that communicate with one another by protoplasmic fibers known as axons. Axons carry the signal pulses sent by the brain to different parts of the body so that a person can function. Because of its major roles, the brain is identified as the most complex organ in the human body. If the brain does not function, humans cannot carry out life itself. When there is a tumor or a malfunction within the brain, its surgery is often the most dangerous and risky. In order to minimize the high risks and consequences, neurosurgeons perform two different types of procedures: endoscopic endonasal surgery and stereotactic radiosurgery. Endoscopic Endonasal surgery, as seen to the right, is performed by putting an endoscope through the nose up to the base of the brain to fix and remove brain defects and tumors [1]. CT scans and MRI scans taken before the surgery are used to identify where the tumor lies to maximize efficiency during surgery. The endoscope is four millimeters wide and 18 centimeters long and has a small camera attached inside so that the surgeon can see inside during the operation [1]. Several types of neurosurgeons use this surgery for various purposes. An endocrinologist will use the endoscopic surgery if the tumor is located in the pituitary gland. There are several types of pituitary gland tumors: PRL-secreting, GH-secreting, TH-secreting, and ACTH-secreting. PRL-secreting is the most common tumor that leads to infertility and sexual dysfunction. GH-secreting is rare (only 16% of people who have pituitary gland tumors have this type) and the tumor increases the secretion of growth hormones, causing the body
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TH-secreting is very rare as 1% and increases the secretion thyroid-stimulating hormones and can result in hyperthyroidism where the functions of all the organs of the body rapidly speed up [1]. ACTH-secreting releases adrenocorticotropic hormone or ACTH which leads to Cushing’s syndrome that prolongs exposure of hormone cortisol that is used to increase blood sugar, suppress immune system, and aid metabolism of fat, protein, and carbohydrates. In order to get rid of the tumor, endocrinologists use the transsphenoidal approach (most commonly used) to remove the bone over sellar turcica located in the ear region caving into the skull to get to the pituitary gland. Removing the bone exposes both superior and inferior sinus, allowing the surgeon to operate with minimal risks [1]. A neuroradiologist will use the endoscopic surgery to remove lesions, or abnormalities in the tissue. Lesions that the neuroradiologist removes are Pituitary microadenomas, Pituitary macroadenomas, Rathke’s cleft cysts, Pituitary inflammatory disease, Pituitary metastasis, Empty Sella, Craniopharyngiomas, Meningiomas, Chiasmatic and Hypothalamic gliomas, Germinomas, Tuber, Cinereum Hamartomas, Arachnoid cysts, and Neurinomas of the trigeminal nerve [1]. When conducted by experienced neurosurgeons, the procedure of Endoscopic Endonasal Surgery utilizes the latest strides in medical technology and surgical techniques to rid patients of their life-threatening brain tumors and defects. Image courtesy of www.wnhhc.com
Under
the
Knife
Neurosurgeons use Endoscopic Endonasal Surgery to combat brain tumors and defects
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Under
the
Part Two
Knife:
Neurosurgeons synthesize Radiology and surgical procedures to treat a variety of neurological conditions
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by YEONJAE HONG The second type of procedure is the Stereotactic Radiosurgery, which is shown to the left. Because neurologists do not make incisions on the skin, Stereotactic Radiosurgery is commonly referred to radiotherapy instead of surgery [2]. The therapy uses narrow beams of radiation coming from different angles to very precisely deliver radiation to the location of the brain tumor. Like most surgeries and therapies, the neurologists determine the definite location of where the tumor is by using MRI and CT scans. Stereotactic Radiosurgery can be delivered in one or multiple doses. When given multiple times, it is known as fractionated radiosurgery because the neurosurgeon gives the therapy in multiple portions. Stereotactic Radiosurgery is useful for many different purposes. It is most commonly used to treat brain tumors ranging from benign to malignant, primary and metastatic, single and multiple, and residual. Some brain tumors that are treated are Acoustic neuroma, Glioma, and Meningioma tumors [2]. Approximately 3000 cases of Acoustic Neuroma are reported in the United States every year [2]. Acoustic Neuroma is a tumor that appears on the brain but does not invade the brain unlike other tumors. Instead, it expands to a large size, pushing the brain which can affect the vitality of a person if it causes severe pressure. Symptoms of Acoustic Neuroma are hearing loss, headaches, vomiting, altered consciousness, balance issues, pressure in the ears, Tinnitus (perception of sound), and facial pain. Glioma tumor cells originate from glial cells in the brain that support neurons inside the brain tissues. The exact cause of this tumor is unknown, but it results in headaches, nausea, vomiting, seizures, and cranial disorders for the patient. Neurosurgeons and specialists have referred to the Glioma tumor as malignant. Meningioma is a tumor from meninges which are membrane layers surrounding the central nervous system. There are no symptoms for this tumor and it is mostly benign, with some rare cases of it being malignant.
Stereotactic Radiosurgery is used to treat other neurological conditions such as trigeminal neuralgia and arteriovenous malformation. Trigeminal neuralgia is “a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head [2]. TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.)� (National Institute of Neurological Disorders and Strokes). Patients with Trigeminal Neuralgia will either feel an extreme but sporadic feeling of burning facial pain or constant aching and stabbing pain that is somewhat less extreme than the first. TN is caused by pressure of a blood vessel on the trigeminal nerve. The complex system of the brain has remained a mystery to people for many generations. Because it is the most vital organ in the human body, the surgical procedures in removing tumors, and lesions are often dangerous and risky. However, scientists are now beginning to discover new ways of treating the brain with many different procedures while maximizing efficiency. Through the use of Endoscopic Endonasal Surgery and Stereotactic Radiosurgery, neurosurgeons all over the world fight for the lives of their patientsagainst malignant brain tumors, hoping for a safe future that surely lies ahead of them. Image courtesy of www.medisim.com.tr
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QA &
With Dr. Alexander Khalessi, M.D.
by ARMAUN ROUHI
AR: Neurosurgery is often regarded as one the most difficult fields within the realm of medicine. For starters, I’m sure that we can all agree that the brain is one of the most mysterious organs in the human body and arguably the hardest to fully comprehend; now imagine operating on it on a daily basis. Today I have the pleasure of interviewing Dr. Alexander Khalessi, M.D., a practicing neurosurgeon at the UCSD Medical Center, to find out what neurosurgery really consists of, thereby seperating the facts from the fiction. As a previous guest speaker to the Future Doctors of America Club on the topic of Neurosurgery, Dr. Khalessi willl show us what it really means to be a Neurosurgeon, including everything from personal motivation to complex operations. AR: Dr. Khalessi, when did you know that you wanted to pursue a career in neurosurgery? AK: I decided to pursue a career 28
in neurosursurgery during my third year in medical school. Among the subspecialties, I realized neurosurgery would dramatically change over the thirty years I planned to practice. In managing diseases of the brain, spinal cord, and peripheral nerves, neurosurgeons have the opportunity everyday to save lives, limit disability, and treat pain. It further remains one of the most technically challenging and fulfilling professions within the medical field. AR: After high school, what education did you receive to be where you are today? AK: To become a neurosurgeon, I completed four years of college, four years of medical school, and seven years of residency. As someone who does both open cranial surgery and uses catheters to treat problems in the brain, I completed an additional fellowship to master these additional procedures. However, standard neurosurgery is
fifteen years of total education and training. AR: After completing those fifteen years of education and training to become a neurosurgeon, what procedures were you then, and still, capable of performing on patients with specific conditions or diseases? AK: I specialize in complex cranial surgery for vascular problems and tumors of the brain. I also perform carotid endarterectomies for blockages of the arteries in the neck. I additionally perform the full spectrum of catheter-based interventions for aneurysms, AVMs, stroke, and pediatric neurovascular problems. Lastly, I am trained in spine surgery and will occasionally operate on trauma or tumor patients. AR: What tools, machines, or instruments do you use to conduct these procedures and operations? AK: When conducting endovascular procedures, we performed the procedure in an angiography suite with
a room full of inventory involving catheters and devices. I partner with companies in evaluating and developing these devices; I further participate in clinical trials. In the operating room, we use drills, microscopes and sophisticated navigation equipment to guide openbrain surgery. AR: In your opinion, what is the most challenging aspect of your profession? AK: Unfortunately, certain conditions remain beyond our power to treat. Supporting families when you cannot alter the natural history of the disease remains the most humbling and most challenging part of my job.
geon. Aside from training the next generation of surgeons, the development of new techniques and treatments remains the most satisfying part of my practice at UCSD.
neurosurgery.
AR: That final question brings this question and answer session to a close. Dr. Khalessi, thank you very much for your time today, your comAR: How have current procedures mentary on the field of neurosurgery within your field become more ad- has been greatly appreciated and vanced since thirty years ago? truly inspiring! AK: Literally no procedure I perform AK: Thank you for the opportunity today was performed the same way to talk about neurosurgery in this or at all thirty years ago. magazine!
AR: What advice would give to high school students are interested in pursuing a career in neurosurgery? AK: I would urge students to explore their personal and intellectual passions at each stage of their education. Recognize true commitment to neurosurgery is a sacrifice AR: What role does neurological and a calling. The profession reresearch play in allowing neurosur- quires substantial personal sacrifice, geons to treat their patients? but your patients will inspire you AK: The cases we are not able to and repay that sacrifice many fold. successfully treat are the motivation Without question, I have the best for our research efforts and why I job in the world. We need good chose to be an academic neurosur- people so I hope you consider
AR: This second Q&A is, unfortunately, our last in this inaugural issue of the magazine. Neurosurgery is an equally prestiguous and intricate field within medicine, and hopefully this Q&A has succeeded in simplifying the field down for you. Now, whether you are curious or serious about entering Neurosurgery in the future, you will surely be well versed in the content of this field of medicine.
Dr. Khalessi and his team of neurosurgeons conducting a procedure in the operating room with the use of navigation equipment. Images courtesy of Dr. Alexander Khalessi, M.D.
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The Psychiatry Corner A brief introduction to the world of human thought and emotion
by JOSEPH BAER The brain is by far the most complex organ in our body. Billions of tiny cells called neurons control everything we do - when we sleep, when we eat, how we feel, everything. Psychiatry is a medical field that delves into the vast mental disorders of the brain; psychiatry literally translates to ‘medical treatment of the soul’. Psychiatrists see and treat patients as well as conduct research on how the brain functions and the prevention of psychiatric disorders. A mental disorder is defined as any abnormality in the brain that affects daily life. The most common form of mental disorders are a group called Anxiety Disorders [1] such as Post Traumatic Stress Disorder or any phobias one might have. Mental disorders are collected and classified in a manual called the Diagnostic and Statistical Manual of Mental Disorders, with the current iteration being the 5th edition (DSM-5). The DSM-5 allows doctors an easy manual for diagnosing patients with mental disorders. But what causes a mental disorder? A mental disorder has innumerable causes, but it most commonly boils down to the production and use of neurotransmitters in the brain. A neurotransmitter is a chemical that is transmitted between two neurons and is received by a receptor [1]. When a neurotransmitter reaches its corresponding receptor, the 30
receptor releases a signal through the neuron. While neurotransmitters normally are produced in the brain, they can be found in things we eat as well. For instance, inside tea there is a neurotransmitter called GABA, or gamma aminobutyric acid, that affects the firing of neurons. In order for these chemicals and neurotransmitters to enter the brain via the bloodstream, they must pass through the brain blood barrier. Like the wall and membrane of any human cell, the brain blood barrier is semipermeable; it only lets certain chemicals pass through. And because GABA is found in the brain but is blocked by the blood barrier, the chemical must be produced within the brain, as it cannot be obtained externally. The world of the brain is very complex in other ways as well, especially in regards to a type of chemical known as an agonist. An agonist mimics neurotransmitters like GABA, with the only contrast being that some agonists can actually cross the brain blood barrier. This allows drugs like morphine, a common painkiller, to work in our bodies. The opposite of an agonist is an antagonist. Unlike an agonist, which mimics the effects of a neurotransmitter, an antagonist does the contrary; it actually blocks the receptor of a neurostransmitter, much like competitive inhibition on an enzyme’s active site. By blocking the recept-
tor, the antagonist also blocks the entire neurotransmitter. For example, say the dopamine receptor (see the next article) is blocked by an antagonist, what would happen? One’s ability to feel happy would be suppressed and replaced by a constant feeling of depression and listlessness [1]. Therefore, agonists and antagonists play a fundamental role in the treatment of mental disorders, and by understanding them, psychiatrists and doctors are able to develop new methods of treating patients with severe disorders. The brain is undoubtedly complex and difficult to work with; a treatment that may work for one patient might not for another, or certain dosages may be higher or lower for different patients. These are some of the many issues psychiatry faces in the treatment of mental disorders, but if there’s anything incontrovertible about the field, it is that doctors and psychiatrists will keep working to tame the varying complications of the brain, aiming to facilitate the health of their patients and ultimately, mankind. Image courtesy of www.nanobrainimplant.com
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Dopamine
The chemical behind our thoughts and emotions
by KYLE KISSINGER In a brain that people love to describe as awash with chemicals, one chemical always seems to stand out: Dopamine. The molecule behind all our most sinful behaviors and secret cravings. Dopamine is love. Dopamine is motivation. Dopamine is attention. Dopamine is human thought and emotion. What is dopamine? Dopamine is one of the chemical signals that passes information from one neuron to the next in the tiny spaces between them [1]. When it is released from the first neuron, it floats into the space (the synapse) between the two neurons, and it bumps against receptors for it on the other side that then send a signal down the receiving neuron. That sounds very simple, but when you scale it up from a single pair of neurons to the vast networks in your brain, it quickly becomes complex. The effects of dopamine release depend on where it’s coming from, where the receiving neurons are going and what type of neurons they are, what receptors are binding the dopamine (there are five known types), and what role both the releasing and receiving neurons are playing. And dopamine is busy! It’s involved in many different important pathways. But when most people talk about dopamine, particularly about motivation, addiction,attention, or lust, they are talking about the 32
dopamine pathway known as the mesolimbic pathway, which starts with cells in the ventral tegmental area, buried deep in the middle of the brain, that send their projections out to places like the nucleus accumbens and the cortex. Increases in dopamine release in the nucleus accumbens occur in response to emotional or physical stimuli. In this brain area at least, dopamine isn’t addiction or reward or fear. Instead, it’s what we call salience. Salience is more than attention: It’s a sign of something that needs to be paid attention to. This may be part of the mesolimbic role in attention deficit hyperactivity disorder and also a part of its role in addiction. So dopamine has to do with our thoughts, emotions, and actions. It shows us what, with a single molecule, the brain can do. Image courtesy of www.dmh.ms.gov
THE MCAT The “SAT” of medical school admissions
by ROMEO IGNACIO The MCAT, widely considered as an arduous, yet necessary exam for most aspiring medical students, is a four-part exam that plays a key role in medical school admissions. The exam is scored out of 45 points, with a score of 37+ being considered as competitive. The four main parts, which all fall under time constraints, are the biological section, the Chemical and Physical section, the Psychological section, and the Critical Analysis and Reasoning Section. The Biological Section requires you to use general concepts from college and even high school classes, such as how adaptation works, how a living organism survives, and how cells and organs operate in a body. In total, you have 59 questions with a time limit of 95 minutes [1]. Understanding how various systems of the body function, the relationship of homeostasis in a body, and the functions of various organs and organ systems are one of the vital concepts you need to understand for a high score. The Chemical and Physical section requires you to apply knowledge from former concepts from college courses such as the mechanical and physical functions of tissues, organs, and organ systems. This mainly focuses on chemical and physical concepts in medicine. Some topics in this section
section may include the functions of tissue, organs, and organ systems. The Psychological section tests your understanding of how a living human functions emotionally Questions from the Psychological section are related to psychology, sociology, biology, and research methods [1]. For example, you will be tested on how the environment of a person determines the future of their everyday life. Most of these topics should be covered in college so don’t fret over this one section. The Critical Analysis and Reasoning sections involve you to analyze various scientific information and social sciences to give solutions to given medical scenarios. This may one of the most difficult sections since it requires you to apply knowledge from the information that is given. These questions will ask you to read a passage and answer the appropriate questions based on the passage [1]. In addition to many subjective factors like interviews, extracurriculars, and application essays, your admission to medical school is also determined by your MCAT score. A score of 21 or lower will allow you to attend some a more basic medical school. To get into a more prestigious medical school, you would
have to score around a 37 or higher [1]. There are two major types of medical schools. Allopathic schools allow students to pursue any field of medicine after receiving a Doctor of Medicine degree (M.D.) upon graduation. Similarly, Osteopathic schools also allow students to pursue any field of medicine, but they award graduating students with a Doctor of Osteopathic Medicine (D.O.) degree [1]. Also, Osteopathic schools, which are primarily located on the East Coast, are not considered as prestiguous as Allopathic schools. In conclusion, there are many, if not countless, ways to study for the MCAT. Just like the SAT, it takes practice, discipline, and hard work to earn that ideal score. With this information on the exam and overall medical school admissions, you will be sure to score that high MCAT score and get into the medical school of your dreams. Image courtesy of www.thetowerpulse.net
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Citations Disproving the Ten Percent by Ethan Chung [1] Bailey, Regina. “What Does the Limbic System Control in the Brain?” About.com Biology. IAC, n.d. Web. Neuroplasticity: Your Brain’s Incredible Power to Change by Sukruth Kadaba [1] Torres, Mike. “Neuroplasticity: Your Brain’s Amazing Ability to Form New Habits | Refocuser.” Refocuser RSS. Refocuser, 27 May 2009. Web. Sleep & Receptivity: The Science Behind One of Our Most Appreciated Activities by Joseph Baer [1] Kresser, Chris. “How Artificial Light Is Wrecking Your Sleep, and What to Do about It.” Chris Kresser. Chris Kresser, 22 Feb. 2013. Web. In Spite of All Odds: Johns Hopkins Neurosurgeons Tackle a Rare Strand of Glioblastoma by Jessica Ho [1] Centofanti, Marjorie. “Hopkins Medicine Magazine ”Hopkins Medicine - In Spite of All Odds. Hopkins Medicine, 2005. Web. Decoding Dementia: Solving the Complexity of Alzheimer’s Disease by Ashwath Raj [1] “Alzheimer’s Disease & Dementia.” Alzheimer’s Association. Alzheimer’s Association, 2015. Web. Deep Brain Stimulation: Conquering Parkinson’s Disease One Scan at a Time by Gurleen Gill [1] WebMD. “Parkinson’s Disease Center: Symptoms, Treatments, Causes, Tests, Diagnosis, and Prognosis.” WebMD. WebMD, 25 June 2011. Web. Oligodendroglia: Disregarded Brain Cells Are Found to Be Key to ALS Development by April Xie [1] “Result Filters.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. Purkinje Cells: A Closer Look at One of the Brain’s Most Vital Components by Brian Huo [1] Barski, Jaroslaw J., Jana Hartmann, and Christine R. Rose. “Calbindin in Cerebellar Purkinje Cells Is a Critical Determinant of the Precision of Motor Coordination.” The Journal of Neuroscience (2003). The Journal of Neuroscience. Society for Neuroscience, 2003. Web. Synesthesia: Seeing the World Differently by Joseph Baer [1] Sachs, Georg. “A Colorful Albino: The First Documented Case of Synaesthesia, by Georg Tobias Ludwig Sachs in 1812.” Taylor & Francis. Routledge, 22 July 2009. Web.
Technology in Medicine by Ashwath Raj [1] Duvinage, Matthieu, Thierry Castermans, Mathieu Petieau, Thomas Hoellinger, Guy Cheron, and Thierry Dutoit. “Performance of the Emotiv Epoc Headset for P300-based Applications.” BioMedical Engineering OnLine 12.1 (2013): 56. Web. Under the Knife Pt. I & II by Yeonjae Hong [1] “Endoscopic Endonasal Approach (EEA).” Neurosurgery at the University of Pittsburgh. N.p., n.d. Web. [2] “Stereotactic Radiosurgery (Radiation Therapy): Johns Hopkins Comprehensive Brain Tumor Center.” Stereotactic Radiosurgery (Radiation Therapy): Johns Hopkins Comprehensive Brain Tumor Center. N.p., n.d. Web. The Psychiatry Corner: A Brief Introduction to the World of Human Thought and Emotion by Joseph Baer [1] “The Numbers Count: Mental Disorders in America.” NIMH RSS. National Institute of Health, n.d. Web. Dopamine: The Chemical Behind Our Thoughts and Emotions by Kyle Kissinger [1]Brookshire, Bethany. “What Is Dopamine For, Anyway? Love, Lust, Pleasure, Addiction?” Slate Magazine. Slate.com, n.d. Web. 16 Oct. 2014. The MCAT: The “SAT” of Medical School Admissions by Romeo Ignacio [1] “About the MCAT Exam.” About the MCAT Exam. Medical College Admission Test, Apr. 2015. Web.
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