Grants Funded

Abstract

Project Summary: Fluorescence lifetime imaging microscopy (FLIm) is a handheld imaging modality that aims to improve intraoperative decision making for peripheral nerve injuries. Peripheral nerve injury (PNI) is the most common neurologic injury in the U.S with an estimated $150 billion in indirect and direct costs. In the brachial plexus birth injury population intraoperative tools to identify those patients that warrant reconstruction versus observation remain inaccurate. Specifically, no modality exists to define the severity and precise zone of chronic peripheral nerve injury. FLIm has been used by our group to identify an acute crush injury in sheep with high accuracy. The aims of this proposal are to demonstrate FLIm's capacity to identify recoverable from irrecoverable injuries in the rat model. Secondarily we aim to show FLIm's accuracy in defining the precise zone of injury in this model. The proposed experiments will utilize a stretch injury rat model which has been shown to replicate brachial plexus birth injury. Additionally, we will use a recoverable crush injury in the rat model. These injuries will be compared to their preinjury levels using FLIm. A machine learning algorithm will then be used to train FLIm. Electrical measurements known as electrodiagnostic studies will be used for comparison to FLIm. Finally, we will use tissue analysis techniques known as immunofluorescent imaging to correlate the severity and precise zone of zone injury to FLIm's measurements. These projects are anticipated to take place over the course of a year. Our lab is seeking a grant to cover expenses for animal purchase, animal husbandry, and post experimental tissue analysis. Our estimated budget meets the $10,000 offered by the ASPN/PSF combined research grant. At the completion of these studies, we anticipate that FLIm will distinguish recoverable from unrecoverable injuries for in-continuity nerve injuries in the rat model. In the future we will translate this work to peripheral nerve injuries in the human population. Accurately identifying the zone and severity of chronic nerve injury may help peripheral nerve surgeons determine which patients can be observed and which warrant surgery.

Impact Statement: Brachial plexus birth injuries are a devastating form of peripheral nerve injury (PNI) with a 14-65% chance of complete recovery. Fluorescence lifetime imaging microscopy (FLIm) aims to improve intraoperative decision making for such in-continuity injuries. The proposed project is designed to identify the prognostic utility of FLIm in chronic peripheral nerve injury. Currently electrodiagnostic studies (EDS) are the standard intraoperative tool to distinguish recoverable from irrecoverable in-continuity nerve injuries. Unfortunately, EDS remains inaccurate, making recovery unpredictable. As such by the completion of these studies, we anticipate we will have sufficient evidence to translate FLIm to human chronic peripheral nerve injuries.

Biography
My motivations for my career in human health comes from my childhood memories visiting my family in rural India, where many pediatric injuries were neglected. My first experience with human health research was as a biochemistry undergraduate at UC Davis developing assays to test novel bacterial cell division inhibitors under the mentorship of Professor of Chemistry Jared Shaw. As a medical student at UC Irvine, I chose to pursue an epidemiological approach to studying musculoskeletal health. The result was a master’s degree in Global Health Sciences at UC San Francisco and research fellowship with the Institute for Global Orthopaedic Trauma with Dr. Richard Coughlin. My thesis work focused on predictors of lower extremity amputation in Nicaragua and implementing a limb salvage flap course for Orthopaedic surgeons from low-resource settings. Finally, as a Plastic Surgery resident at UC Davis Medical Center, I focus on clinical outcomes and animal studies in hand surgery. Under the mentorship of hand surgeon Dr. Clifford T. Pereira, my research focuses on surgical outcomes of geriatric distal radius fractures and label free real-time imaging techniques for nerve injuries. For this most recent project I was awarded the AFSH Resident Fast Track Grant #3678. With the goal of a career in adult and pediatric hand surgery, I aim to combine my basic science beginnings with my training in global health to tackle the devastating problem of peripheral nerve injury.