Week 8 - Safaa Mouline

How is it that it's already been 8 weeks? This last week consisted of more preliminary analysis on structural connectivity/functional connectivity differences in MS, peri and post menopause. Last week, I was hitting some walls with this analysis (which is still obviously preliminary since I have no menopause data, so I'm using age as a proxy for now), but this week, I tried a few methods that look promising for now. The first was a partial regression between structural disconnectivity scores for each of the 86 brain regions and age, run separately for female and male datapoints, controlling for disease duration. This showed 13 regions with statistically significant age-related increases in disconnectivity in the female model, compared to 0 in the male model. The fact that the effect was specific to women, despite controlling for disease duration and equalizing sample sizes, is (very) preliminary evidence of a sex-specific aging pattern in structural connectivity that could be linked to menopause. The second method was a mediation analysis testing whether structural disconnection mediates the relationship between age and EDSS disability scores. Of the regions tested, 7 showed up as statistically significant mediators in women, and these overlapped with the 13 regions from the partial regression analysis, most of which are in the subcortex or part of the frontoparietal networ. This convergence across two independent analyses suggests that not only does aging disproportionately disrupt connectivity in these regions in women, but that this disruption may be a biological pathway through which aging leads to greater disability in women with MS. Fingers crossed the clinic can conduct a menopause-MS study soon, so that actual menopause data can be acquired.  


This week I also had the opportunity to observe two surgeries led by Dr. Fahey, a thyroidectomy and a parathyroidectomy. During the thyroidectomy, I observed the surgeon use a nerve stimulator to identify and preserve the recurrent laryngeal nerve, which runs close to the thyroid and must be carefully avoided to prevent postoperative voice complications, and it was fascinating watching the precise dissection required to isolate and remove the gland while protecting surrounding structures. I also enjoyed watching Dr. Fahey mentor the residents throughout this procedure; he would observe their technique closely, particularly their suturing and tissue handling, and offer feedback. I caught the end of the parathyroidectomy, at the point where blood was being sent to the lab to check parathyroid hormone levels. Because PTH has a very short half-life of only a few minutes, a significant drop after removal confirms that the correct gland was excised and that the remaining glands are functional, so the team had to repeat this process a few times until the levels dropped sufficiently. Fortunately they did, sparing the need for cryopreservation of the tissue and allowing the surgery to end.


Overall, this clinical experience has given me a deeper understanding and appreciation of where my data comes from. As a computational researcher, it is easy to treat imaging datasets somewhat abstractly and to think about scanner effects, preprocessing pipelines, and statistical models without fully connecting them to their origins. Shadowing MS clinic appointments has been a meaningful reminder that behind every MRI scan I work with is a patient with a complex clinical history and story. I'm so grateful for this experience, for everyone who made it possible, and especially to Dr. Gauthier for being a wonderful mentor. I'm looking forward to continuing this work and to future collaborations with Dr. Gauthier and the MS clinic. 

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