In this installation of Neuronomics, Kristen E. Strubberg reviews the 2012 New York Times bestselling autobiography Brain on Fire: My Month of Madness, by New York Post writer Susannah Cahalan. In June of 2018, Netflix adapted Brain on Fire to film staring Chloë Grace Moretz. As an eminent student of the human brain, Kristen breaks down this much appraised journey into Cahalan’s rare disease.

When I went to find a copy of Brain on Fire at what is generously called a book store during these dark digital days, I wove through the aisles to the psychology section. To my sense of order and categorization and based on my knowledge of what the book was about – a memoir of “madness” – psychology seemed appropriate.

I traced the shelves until I came to the crammed corner of testimonials, as I think of them, given far too little space. I run the titles once, twice, it’s not there. Then, on the shelf above I find a copy flaunting a cover that doubles as an advert for the Netflix adaptation. But this is the only copy, out of place, no tell-tale gap in the spines from whence it came.

I contemplate settling for the “tie-in” edition, but I’m curious where the other copies are? It is a highly relevent, relatively new book – where are her sisters? Not on the new release carousal, I already inspected that display.

Thinking again about the book’s story, I realize there is only one other place it could be. I stride a few rows behind Psychology to medicine and there, neatly in row and occupying space only allotted to new and revenue pumping titles, I find the original edition. But why medicine?

This a memoir of “madness,” is it not? Albeit one with a very neurological component, but what psychological malady doesn’t have some roots in the grey matter between the ears?

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Brain on Fire: Medicine or Psychology? 

As I begun to read, I realized that of the two classifications, medicine is the closer fit for this hybrid retelling of one women’s month from hell.

Brain on Fire is more mystery than traditional memoir. Author Susannah Cahalan keeps the reader engaged as her family and rotating team of specialists struggles to diagnose an elusive ailment that has deranged her mind and convulsed her body.

Throughout the narrative of her harrowing days of illness however, I felt detached from the Susannah whose brain was burning from anti-NDMA receptor autoimmune encephalitis. This is not unlike Susannah the author. Mostly, this is due to to the fact that the author/narrator remembers very little of the actual illness at its apex.

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What is Anti-NDMA Receptor Autoimmune Encephalitis?

The NDMA receptor, the target of her self-attacking immune system, is found throughout the cerebral cortex, home of the brain’s higher functions.

As these important receptors became increasingly destroyed by wayward immune cells, the reader can see Susannah’s cognitive function being stripped away as the disease progresses.

Following Susannah’s symptoms, it’s not surprising to learn that the second highest concentration NMDA receptors is the hippocampus, the brain region responsible for consolidating a person’s experiences into memory.  

With this vital memory-maker also being besieged by this disease, the fact that her recall from her time in the hospital remains inaccessible fits the picture of her illness.

Susannah Cahalan from the Second Hand

All the stories and descriptions are second hand accounts from family and Cahalan’s medical records. While a blessing for the author – who wants to remember the worst demons unleashed – it sets this book apart from other memoirs of mental illness or neurological trauma.

Brain on Fire in some ways bridges V. S. Ramachandran and Oliver Sacks’ neurological mysteries, and the pathos of a brain reassembling after disease such as Lori Schiller’s The Quiet Room. But the second pillar of the bridge has a hole, admitted by the author in her preface, because the emotional torrent associated with the disease is digested retroactively. Albeit from myriad sources composed contemporaneously.

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Uncertain revelations toward reaching enduring truths

Cahalan tries to venture conclusions about self and deeper self, and provides clear neurological scaffolding for the self, but she admittedly is not certain if she can pull any enduring revelations about herself from the ordeal.

As such, the book boils down to a medical mystery novel that it is superb accomplishment. However as a window into the deeper truths of the mind, or a catharsis from emotion and personal triumph, it is lacking.

Write to Kristen E. Strubberg at kstrubberg@tgnreview.com

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In the field of medicine, one of the long sought Holy Grail’s is the ability to adapt any blood supply to any patient – making any blood type into a universal donor Type-O. Last week, researchers from the University of British Columbia announced that they may have discovered a way to convert any donor blood type to the much valued universal donor Type-O. Their findings, presented at a national meeting of the American Chemical Society represents the most momentous step towards this dream since the identification of the ABO blood groups over 200 years ago.

Know Your Type – The Hard Science of Your Blood

If you’ve ever given blood or had a medical procedure, chances are you’ve been asked your blood type. What many don’t know is that when categorizing human blood, there is a whopping thirty-five different grouping systems. However, the ABO blood group, of which most are familiar, is by far the most important.

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As with the thirty-four other blood group systems, the ABO blood grouping types are differentiated and organized by chemical markers on the surface of red blood cells (RBCs).

What Determines Your Blood Type? What is a Universal Donor Type-O?

The ABO system differentiates genetically specific polysaccharide clusters that adorn the outer cell walls. These most important markers are called the A-antigen type and the B-antigen type and, you guessed it, folks with type-A blood have RBCs that feature the A-antigen. While those with the type-B have RBCs expressing B-antigen.

Those people who are type-AB have RBCs that display both antigen species. Type-O RBCs, on the other hand, do not express either antigen type. This is what makes Type-O so important in blood transfusion scenarios. 

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It’s these all important antigens that make blood donation a precise science. Any mismatch and the A/B antigens will begin invoking a devastating and potentially lethal immune response in a recipient whose blood type does not match their donor (with the exception of Type-AB). That is why the gold standard for donation is Type-O – no antigens, no fuss, no muss.

Now, science may have finally been able to convert other blood-types to Type-O.

New Trick from the Old Corpse – Creating Universal Donor Type-O

When looking for a new, gentler enzyme to process any type of donor blood to the universal donor Type-O, Dr. Stephen Withers decided to go back to the source: the human body.

Specifically, he ventured into the gut – the microbiome of the moment – where several known microorganisms utilize mucins that line the intestinal track. These mucins, which aid in digestion, are structurally similar to the sugars of blood type antigens.

Using ecological techniques, Withers and his colleagues isolated a family of enzymes which, through forced evolution in E. coli, are now able to the remove the blood antigen sugars 30 times as fast as any previous enzymatic approach. Hence creating the conduit that converts blood to Type-O.

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What’s Next?

For now, Wither is working with the Centre for Blood Research at UBC to demonstrate reproducibility of the universal donor conversion process. So far he has transformed Type-A blood to universal donor Type-O. Type-B and Type-AB have yet to be tested. Moreover, the modified blood will need to be assessed for viability before clinical testing can begin.

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Last November, researchers from Southern Cross University announced the first successful transplantation of new coral onto the Great Barrier Reef. The healthy coral polyps represent the first of what conservationists hope to be many of such lifesaving boosts to the reef following less successful attempts to graft healthy coral to the bleached bones of the reef.

“Reseeding” the Great Barrier Reef

The story of the healthy coral begins during the reef wide spawning in November 2016. Research leader, and discoverer of the “sex on the Reef” phenomenon Professor Peter Harrison led his team to Heron Island and collected large amounts of coral sperm and eggs. Once safely returned to the lab, the gametes were allowed to fertilize and grow to the larval stage in a controlled and closely monitored environment.

After rearing over one million larvae, the “baby coral” were returned to the reef and settled in patches protected by mesh tents. When the scientists returned to Heron Island eight months later, they found 100 juvenile corals flourishing in the reef.

Why “Reseeding” Works

The technique of re-introducing newly grown corals to previously blighted areas of a reef is a method Prof. Harrison calls “larval reseeding”. Crucially, Harrison’s system transplants coral before they have fixed on hard surface and metamorphosed into a primary polyp, ready to begin asexual reproduction of a new coral colony.

Resettling coral at this stage in their life cycle is far less traumatic than current approaches which focus on introducing mature coral colonies from other reefs or from colonies grown in a nursery. Specifically, coral gardening can involve dividing colonies in pieces and implanting the portions in region of reef requiring renewal.

The coral gardening methodology has shown questionable success but Harrison’s “reseeding” is returning positive results. His team first demonstrated reseeding’s potential on areas of reef in the Philippines which had been decimated by dynamite or blast fishing (link). Now, following the success of the November 2016 larval class, Prof. Harrison is already looking at the class of 2017:

“…we returned to Heron Island for the November 2017 coral spawning and used the technique again to collect coral spawn and…I’m excited to announce that we’ve already observed successful settlement of the new coral larvae this year so it’s worked again.” – Prof. Peter Harrison

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A New Lifeline for the Great Barrier Reef

Shortly after the announcement of Harrison’s success, University of Queensland researcher’s identified 112 regions of “robust source reef” that work to heal the reef.

To qualify as a “source reef”, the scientist had dynamic criteria such as resistance to bleaching, consistent inter connectivity to other portions of the the reef through reliable ocean currents, and lower vulnerability to crown-of-thorns starfish which have been an additional scourge to the reef over recent years.

Although the source reefs equal only 3% of the system, during the annual spawn, they are positioned so that fertilized eggs can reach almost half of the entire reef. If optimized using Harrison’s reseeding technique, the reef’s “cardiovascular system” as researcher’s have dubbed the new source reefs, may be able to pump new blood into blighted areas that were previously out of reach.

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The ongoing quest to better see inside human bodies has made a major breakthrough. Researchers at the University of Edinburgh have successfully built an imaging device that can effectively see through the human body. Medical science has progressed significantly with imaging technology over the last century. Devices like X-Rays and MRI’s are used clinically as a matter of course. This new technology has limitless potential clinical applications, and may help overcome the limitations and risks of current medical scanning. This new visualization technique is due to the most abundant particles in the universe: photons.

To See Inside Human Bodies: How It Works

In a paper recently published by researchers at the University of Edinburgh and Heriot-Watt University, researchers utilized a time sensitive single-proton avalanche detector or a SPAD array. The array is coupled with a fiber optic probe to visualize the position of a light source through the tissues of the human body – by capturing rogue photons known as “ballistic” and “snake” protons.  The SPAD array detects these photons and translates them into images which allow the researchers – and future clinicians –  to locate the light-emitting optic fiber from within human tissue.

Ballistic and Snake Photons

Photons are elementary particles of light with no mass that travel at the speed of light. Photons are emitted from myriad energy sources in the universe. When photons encounter an object with any mass, they scatter around the object.

The origin of photons at the atomic level

Ballistic photons – unlike other types of photons – are light particles that can penetrate mass over very short distances. With its unique ability to remain intelligible when imaged, ballistic photons illustrate human tissues and objects not otherwise visible through conventional imaging. In combination with snake photons that also have less of an ability to scatter, these two particles are used to examine the internal anatomy of a patient – which has proven to be a revolution method to see inside human bodies.

The abilities of ballistic and snake photons are showing a very unique way to aid internal procedures such as an endoscopy.

The In-And-Out of An Endoscopy

The dreaded, but necessary, endoscope.

If anyone has ever endured an endoscopy, it is a memorable and unpleasant experience. The endoscope is a camera attached to a long, flexible tube-like probe with a fiber optic light that is used to image and visualize the internal spaces of the body such,as the small intestine, lungs, and esophagus.

The Endoscope In Action

The endoscopy procedure is an extremely useful examination that can evaluate, diagnose, or even aid surgical procedures. Yet prior to this newest imaging innovation, determining the scopes precise location in the body has been an inexact science.

With standard technology, doctors have gauged the endoscopes position by using a combination of anatomical expertise, images provided by the camera itself, and mastery of the endoscopes steering mechanism. Technology such as x-rays are also used to support the procedure.

Endoscopes are often very accurate and safe. Yet pinpointing the location of a scope in the body is an educated clinical deduction.

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Future of Medical Imaging

Though clinical imaging has advanced a great deal, technology such as CT scans, x-rays, and MRI’s present their own risks.

X-ray imaging and CT’s both emit considerable radiation to achieve their imaging resolution. In doing so, it is forcing clinicians to determine the proper balance of a patients current medical needs against long term risks of exposure. This quandary has spurred research to find minimally invasive methods of medical imaging, that present little or no risk to patients, and are more accurate than the technological status quo. The creation of a Single Photon Detector array is but the tip of the iceberg for expanding the horizon of safer and more accurate diagnostic tools to see inside human bodies.

Sources: Ballistic and Snake photon imaging for locating optical endomicroscopy fibres

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New research released last month shows HIV patients treated with the current recommended medical regimen are achieving life expectancy nearly equal to that of the general population. Although no cure yet exists for HIV, therapies developed in the past thirty years have now significantly prolonged the lives of individuals for whom previously a positive diagnosis was a death sentence.

The study, published in the Lancet, demonstrated an unprecedented 10-year increase in life expectancy for individuals diagnosed with HIV/AIDS in 2010 compared to 1996. Moreover, a significant cohort of individuals diagnosed and treated for HIV between 2008 and 2010 showed life expectancy reaching that of the general population. A portion of the positive trend the paper’s authors attributed to is better treatment of HIV comorbidities, and healthier lifestyle following diagnosis. The predominant explanation, however, was the refinement of ART or antiretroviral therapy.

Antiretrovirals: HIV Game Changers

ART is a combination of drugs – typically three – that prevents the HIV virus from replicating in the human body. ART accomplishes this by each drug disrupting the viral replication process of HIV at different points in the cycle. In this manner, viral load in the body remains low and the immune system remains robust. This innovative treatment was first introduced in 1996, and overtime has been refined with fewer side effects to discourage noncompliance.

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HIV and The Numbers

The Lancet study analyzed data from the Antiretroviral Therapy Cohort Collaboration (ART-CC). Specifically, they focused on patients who began ART between 1996 and 2010. Using the survival rate of patients after one, two, and three years of ART therapy, the researchers were able to extrapolate average life expectancy of patients on ART. Furthermore, they were able to compare the changes of life expectancy depending on the calendar year in which a patient initiated ART.

According to the study, between 1996-1999 and 2008-2010, life expectancy increased approximately 10 years. More impressive still, they found a 20 year old patient who started ART between 2008-2010, and has a projected life expectancy of 78 years; in the 1980’s, life expectancy was barely 18 months.

There is absolutely no doubt a great deal of progress must still be made in fighting HIV/AIDS, however the progress that has been made in the last 30 years is extraordinary. While by no means an adequate substitute for a cure, current treatments have made reality an outcome that was unthinkable during the early phase of HIV/AIDS awareness. Unquestionably, a wholesale medical feat is at hand with these findings – and its celebrated arrival could not have come a moment too soon.

Sources: BBC World News, The Lancet, AIDS Info, Health Communities

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