Screening Big Data, UCSF Researchers Discover Promising New Treatment for Spinal Injuries – CBS San Francisco

SAN FRANCISCO (KPIX) – San Francisco Ocean Beach is famous for its cold water and powerful waves. Chris Barr loved to sail here, driving off the East Bay on the weekend.

On February 12, 2017, the waves signaled.

“I kissed my wife goodbye, said,‘ I’m going to surf and I’ll see you in a few hours, ’” Barr recalled.

That Sunday, while surfing, Barr fell from a wave with such force that it broke his neck in eight places.

He was found floating in the water by a friend. Soon, his wife Debbie received a call.

“Chris had an accident and, um, he’s at Zuckerberg,” she recalled hearing on the phone.

Mrs. Barr packed a night bag for her husband, thinking that perhaps he might have broken an arm or leg.

She went to Zuckerberg San Francisco General Hospital. The medical center is the only Level 1 trauma center in the city and county.

When Debbie Barr arrived, medical staff escorted her into a small room where she saw her husband. The emergency team cut off his wet suit. What she saw was terrible.

“He was so cold; stone cold. He had sand all over his hair, nose and ears and I knew right away, ‘Oh, this is so much worse than a broken bone,’ ”Mrs. Barr said.

Her husband had a giant cervical spinal cord injury. Doctors told her Chris would most likely never recover any movement under his neck. Even if he survived, they explained, he would need a ventilator to breathe.

“The first thing he said to me because he was on a fan was,‘ Take out the plug, ’” Debbie Barr said.

Unknown to Chris and Debbie, UCSF physicians at Zuckerberg have already implemented a new surgical protocol to be used in patients with new spinal cord injuries.

The idea: to strictly monitor a patient’s blood pressure and keep it within the “Golden Zone” – not too high and not too low.

“The‘ right ’zone for blood pressure,” said Dr. Adam Ferguson, director of data science at UCSF Weill Institute for Neurosciences.

Dr. Ferguson explained how the blood pressure range used in this protocol is much narrower and more accurate than what appears in current guidelines. The higher limit is lowered. UCSF scientists have found that too much blood flow appears to damage a spinal cord.

Now a new study published in the journal eLife supports the benefits of this blood pressure protocol.

“Within a very narrow range of blood pressure control, these patients had much better outcomes and, in fact, unexpectedly good outcomes,” noted Dr. Ferguson.

The doctors did not discover this approach on their own.

“This is really a machine-human partnership,” Dr. Ferguson explained.

“This is one of the great things about being here in the Gulf Region,” added Dr. Abel Torres-Espin, an assistant professor at UCSF who is also an expert in data science.

The scientists used machine learning and artificial intelligence as well as data from patient records.

They tracked 118 spinal cord patients at two Bay Area trauma centers: Zuckerberg and Santa Clara Valley Medical Center.

They built an algorithm that scanned each patient’s data, processing hundreds of thousands of data points. They wanted to understand why some patients regain some motor control after a serious injury while others remain in total paralysis.

The new machine learning technique is called topological data analysis – in short TDA. The technology revealed an interesting pattern that led to the protocol for maintaining blood pressure more accurately within a narrow range.

“We were surprised, yes!” Dr. Torres-Espin noted.

The data scientists and trauma teams then took these findings from “the bench to the bed” of patients like Chris Barr.

“As soon as they get their surgery, they go straight to the ICU and then we make sure they keep their average blood pressure target,” explained Prof. Debra Hemmerle, an ICU nurse at Zuckerberg, who also co-authored the study.

She told KPIX how the surgical team entered Chris into the operating room within four hours of arriving at SF General. This was earlier than the recommended 12-14 hours for what is called decompression surgery.

Chris Barr said it’s common for those who are recovering from serious spinal cord injuries to start feeling any or a shift 72 hours or more after surgery.

“I had nothing,” said Barr. “Two weeks?” Nothing. Three weeks? Still no feeling, no movement at all. So at that point, they kind of get rid of you. And then, all of a sudden, things started to happen. “

Barr began to feel a sensation under his neck. Within months, he was able to move his toe, then a limb. It was slow, but continued to progress. He then began to feed himself.

“I remember the first day he ate a piece of chocolate. As if he grabbed a piece and put it in his mouth and we shouted for joy, “Debbie said.

Barr then received experimental stem cell treatment at the Mayo Clinic as well as a spinal stimulus clinical trial procedure at UCLA.

Today, he can walk on his own. While he has other medical issues to contend with for his injury, he said that – no doubt – what started at Zuckerberg San Francisco General and continued with his search for other promising treatments paid off.

ICU nurse Hemmerle remembers seeing him and being amazed.

“He got up from his wheelchair and walked a few steps and – I’m excited because it still gives me colds,” Hemmerle said with tears in her eyes.

Spinal cord injuries affect about 18,000 patients in the United States each year. The lifespan costs the patient and the cost to society is huge.

Barr told KPIX how data science can help further accelerate processing for him and others, but more funding and data sharing is needed.

“Instead of having hundreds of samples, you have thousands of samples. There’s no reason we can’t have thousands of themes. I mean, we’re really just scratching the surface, ”said Barr.

Dr. Ferguson believes this approach and new technique could be applied to other more common spinal problems including spinal stenosis and low back pain, which is the most common cause of work-related disability.


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