I was just about to begin a year of research at Duke University Medical Center. Following interviews in the previous November I had been accepted to work as a Research Fellow in the laboratory of Dr. Ross Ungerleider MD, Professor of Surgery and Chief of Pediatric Cardiac Surgery.
Durham, North Carolina is the home of Duke University Medical Center which over the past 40 years has become one of the most productive and prestigious institutions for medical research in the world. An estimated 270 million dollars was consumed in medical research at Duke in 1997.
The set up in the cardiovascular research laboratories at Duke is quite remarkable. Seven separate laboratories are each staffed by full time technicians with one or two American surgical residents (trainees) in each lab. Each lab has a different focus and current areas of research include transmyocardial laser revascularisation, the use of adenoviral vectors for beta adrenoceptor transfer, pulmonary xenotransplantation, and new techniques for minimally invasive cardiac surgery.
Over the past 15 years the main emphasis of the research in Dr. Ungerleider's lab has been on the effects of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) during paediatric cardiac surgery. There were two operating tables in the lab and whilst one of the residents focussed his research on the pulmonary damage that follows CPB, I concentrated on the mechanisms of cerebral injury and strategies for neuroprotection, following DHCA.
During the year I was able to complete a series of about 100 studies using a neonatal piglet model of CPB and DHCA. The first series of studies involved the use of electron microscopy to determine the degree of damage to the cerebral microvascular bed following various periods of ischaemia and reperfusion. Subsequent studies used the radiolabelled microsphere technique to determine cerebral blood flow and metabolism. The contributory role of platelet activating factor and free radicals in cerebral dysfunction following DHCA were investigated. Various strategies for neuroprotection were also studied including leucocyte depletion, high dose corticosteroids and calcium channel blockade. Just before returning to Southampton I was fortunate to be awarded the 1998 Duke Research Prize for one of these studies.
In addition to the laboratory facilities, the library, information technology, medical photography and medical art departments were all outstanding. Duke University has its own network for internet access. Free connection was available to all lab fellows including a dial up facility from home. This was particularly useful in the last 10 weeks of the year during the writing up stage. The Medicine database could be accessed via the Duke Medical Center library web site and a specific reference could then either be directly saved to computer or sent by e-mail. As all local calls in the USA are free, this facility was a considerable perk. With a click of the right buttons in the referencing sotware package, the references could then be incorporated directly into a reference library for the thesis.
Ross Ungerleider was a great boss to work for. Not only was he extremely enthusiastic about research, he was extremely enthusiastic about golf, fishing and wine. On a number of occasions I was able to house sit for him when his family went on 'vacation'. The house came with its own lake but more importantly a well stocked wine cellar which we were encouraged to enjoy. Lab meetings were conducted on the golf course with compulsory enormous cigars all round.
Although I was fortunate enough to be given a small stipend by the Department of Surgery at Duke, I would not have been able to get through the year without additional financial support. I am extremely grateful to the Society of Cardiothoracic Surgeons of Great Britain & Ireland for the most generous scholarship that was made available to me.
I could not recommend more strongly a period of pure research in an institution such as Duke. Not only did it provide me unparallel facilities to enable completion and submission of an MD thesis within one year, it was also an extraordinary experience in terms of broadening my horizons and outlook. I would be very happy to hear from anyone wanting to spend a similar year in research at Duke.
Tel: 01703 738577
E-mail: Stephen Langley
