When hearing about hippotherapy for the first time, most are confused as the image of a semiaquatic, large-tusked animal pops into mind. In actuality, the term stems from the Greek word “hippos” meaning “horse,” and falls under a broader category of horse-assisted therapy. Through this unconventional treatment method, patients interact with horses to promote physical and mental health.
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Five-year-old George Palmer is one of the many patients who has benefited from hippotherapy. Diagnosed with autism at age three, George is working on improving his balance, motor, and communication skills through horseback riding sessions. His father David says that George has become more vocal over the past six months of training, and remarks that: “It’s pretty wonderful just to see him enjoying himself, developing and growing” (1). 

In a typical hippotherapy session, the patient rides horseback alongside a team of instructors, a therapist, and a horse trainer. When walking, the horse’s pelvis has a 3-axial movement pattern just as humans do, and this rhythmic pattern provides sensory feedback to the patient’s brain (2). During a typical 15-20 minute session, this translates to 1,500-2,000 neuromotor inputs to the patient (3). Research has shown that this neural activation encourages posture and fine motor control, balance, core body connection, as well as improving speech, cognition, and language (2).

The applications of hippotherapy extend far beyond autism to a broad range of physical and mental disabilities. A study conducted by Vermöhlen et al. in 2017 saw significant improvements in balance, fatigue, spasticity, and quality of life in multiple sclerosis patients (4), while a 2016 study by Hsieh et al. showed major enhancements in mobility of joint functions and muscle tone functions in child patients with cerebral palsy (5). Other applications of hippotherapy include the treatment of patients with, anxiety, post-traumatic stress disorder, and those who have suffered from a stroke. 

There is still a lot to learn about the effectiveness and mechanisms of hippotherapy. Even so, the treatment has gained significant attention and validation by members of the healthcare community, who are excited by its promise for the future of physical and occupational therapy.

5-year-old George Palmer receives hippotherapy horseback riding sessions at Myrtle Beach Therapeutic Riding and Vaulting Club in Loris, South Carolina. (Image by Jason Lee for Myrtle Beach Sun News)

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Lucid dreaming is an aspect of sleeping that continues to puzzle neuroscientists. Lucid dreaming, or gaining consciousness of the fact that one is dreaming, is an area of research with exciting potential applications. While lucid dreaming has been recognized in the public consciousness since antiquity, researchers have only recently begun to understand the complex processes that trigger and differentiate lucid dreams from normal dreams. In the past several decades, new technology, such as the electrooculogram (EOG) and fMRI, has allowed neuroscientists to identify a biological basis for lucid dreams and explore their characteristics further. A recent compilation of studies on the neuroscience of lucid dreaming, published in the Handbook of Behavioral Neuroscience, provides an excellent overview of contemporary understanding and future directions for research into the phenomena. [1]

In particular, lucid dreaming offers a unique opportunity to understand higher orders of consciousness (consciousness beyond the present that allows for unique self reflection, regulation, and planning). This is an aspect of processing that is normally lost during dreams, but appears to be retained during lucid dreams. For most people, dreams consist of the “remembered present,” or a consciousness that only extends to the moment they are in, whereas during lucid dreams people appear to be able to think beyond the present moment and engage in metacognition. Due to this apparent shift in thought, researchers are able to document significant differences in brain activity during normal and lucid dreaming in order to find cortical areas associated with higher consciousness.

​In particular, by using a combination of EEG, PET, and fMRIs to track brain activity during sleep and wake, studies indicate that areas in a part of the brain called the prefrontal cortex are more active during lucid dreams than normal REM sleep, and additionally that people who report more frequent lucid dreams possess more grey matter, or neuronal cells, in these same areas. [1] Both of these pieces of evidence support the idea that cognitive processes associated with the prefrontal cortex are at work during lucid dreaming. Interestingly, these areas of the cortex have been implicated in processes like appraising one’s thoughts or feelings, and other functions that are generally lost in dreams. Further exploration of brain activity in these cortical areas has the potential for greater understanding of the complicated functions of these areas.

​Additionally, physiological data on lucid dreaming could potentially be used to investigate pharmacological approaches to trigger lucid dreams, possibly for treatment of various psychological disorders, especially PTSD and chronic nightmares. [1] Several recent studies have found that by administering a drug that increases access to the neurotransmitter acetylcholine, people have an increased likelihood of experiencing a lucid dream. For someone suffering from PTSD who consistently experiences intense flashbacks during dreams, being able to gain conscious control and change the narrative of a dream has the potential to reduce emotional distress. Similarly, with further research into activating the metacognitive processes associated with lucid dreaming, some neuroscientists see the potential to understand and treat psychosis, as those same functions are often lost during a psychotic experience. The applications for research into lucid dreaming is incredibly broad, and many ideas have yet to even be explored in depth.

Citations:
[1] Benjamin Baird, Daniel Erlacher, Michael Czisch, Victor I. Spoormaker, Martin Dresler,
Chapter 19 - Consciousness and Meta-Consciousness During Sleep,
Editor(s): Hans C. Dringenberg, Handbook of Behavioral Neuroscience, Elsevier, Volume 30, 2019, Pages 283-295, ISSN 1569-7339, ISBN 9780128137437, https://doi.org/10.1016/B978-0-12-813743-7.00019-0.
(http://www.sciencedirect.com/science/article/pii/B9780128137437000190)

Image from: Filevich et. al, 2015

These thick green swaths may look like algae, but the offending organisms are actually cyanobacteria, somewhat misleadingly called ‘blue-green algae’. Like algae, cyanobacteria are photosynthetic: they store the sunlight they receive as nutritionally-packed sugars. Like other photosynthetic organisms, they’re limited by nitrogen and phosphorus, the two main components of any fertilizer. When the weather is right and resources are abundant, they’re well-equipped to take advantage. A HAB can quickly cover an entire lake, or, in the case of the Wallkill, 30 miles of river [2]. ​

​Undergoing a surgical operation to remove a tumor may be the only way to save a cancer patient’s life. Yet even with a potentially life-saving operation, cancer cells left in the body post-surgery can begin to grow again and lead to cancer recurrence. Cancer recurrence isn’t uncommon — for example, pancreatic cancer has a 40% chance of recurring after surgery, bladder cancer has a 50% chance of recurring post-surgery, and advanced soft tissue sarcoma has a nearly 100% chance of recurrence [1]. Even though surgically removing the tumor may appear to be beneficial in cutting cancer out of the body, it can actually “increase [the] shedding of cancer cells into circulation,” thereby promoting the growth and spread of cancerous cells throughout a patient’s body [2]. In the end, surgery can actually be counterproductive to treating cancer.

Recently, researchers at UCLA have developed a sprayable gel for surgeons to use after removing a tumor that boosts the immune response to any remaining cancerous cells left in the area. Cancer cells usually overproduce CD47, a protein that sends “don’t eat me” signals to phagocytic cells, which essentially makes them invisible to immune cells and allows them to grow without being killed [3]. The gel– which consists of the blood clotting proteins thrombin and fibrinogen, along with CaCO3 nanoparticles laden with antibodies– slowly releases anti-CD47 antibodies at the site of the tumor. These antibodies block CD47 from sending out their signal, allowing the cancerous cells to become visible to the immune system. Macrophages and other phagocytic cells can then respond to the cancer cells and kill them.

​In addition to bolstering the innate immune response, the adaptive immune response becomes stronger due to the macrophages presenting tumor-specific antigens to T-cells [4]. The adaptive immune system can then fully destroy the cells. In a clinical setting, this gel could potentially have a huge impact on decreasing the chance of cancer recurrence. Researchers found that mice who underwent surgery for advanced melanoma and were sprayed with the gel remained tumor-free for over 60 days. Not only can the gel prevent tumor recurrence in the same site, but studies in mouse models have shown that it also can prevent distant tumor spread, decreasing the chance of cancer forming in another area of the body, a process known as metastasis [5]. 

​Another benefit to using this gel is that patients wouldn’t have to undergo additional chemotherapy, immunotherapy, or radiation treatments post-surgery to kill any remaining cancer cells. All of these treatments cause unwanted side effects to the patient such as hair loss, nausea, or illness. 

Despite these incredible discoveries, there’s still a long way to go before the gel can be used in humans. The researchers have to optimize the concentrations of anti-CD47 antibodies, fibrinogen, and CaCO3 nanoparticles to more effectively boost the immune response. Future testing could take years to complete. Nevertheless, this preliminary gel has proven to be effective at reducing the chance of post-surgical cancer recurrence. 

Cancer surgeries could now potentially be a one-and-done deal, with one surgery having the ability to completely remove all cancerous cells. Finding a way to make surgery more effective will impact the majority of cancer patients, as most cancers typically require surgery as part of the treatment.

​There are a few reasons why this gel could become standard practice for surgeons to use in the future. First, it’s fairly simple to produce, with the main three ingredients being fibrinogen, thrombin, and CaCO3 nanoparticles. All of these molecules can be created in a lab and tweaked to obtain the right concentration. Secondly, the gel can be used for most types of cancers. Because most cancer cells overexpress CD47 to hide themselves from the immune system, having a general anti-CD47 antibody can effectively make those cells visible to the immune system and able to be phagocytosed. Lastly, it causes no extra harm to the patient. As opposed to chemotherapy or radiation therapy, which both negatively impact a patient’s body, this gel seemingly has no side effects on the patient, as shown by mouse models. 
While there’s still a long way to go before seeing this gel being used in clinical trials, with the advent of this gel comes the hope that one day cancer patients won’t have to fear cancer recurrence after surgery.

Image from the American Chemical Society

Citations:
[1] Primeau AP. Cancer Recurrence Statistics. [Internet] [Cited 2019 Oct 4]. Available from: https://www.cancertherapyadvisor.com/home/tools/fact-sheets/cancer-recurrence-statistics/

[2] Tohme S, Simmons R, Tsung A. Surgery for Cancer: A Trigger for Metastases. American Association for Cancer Research [Internet]; 2017 Mar 22. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380551/

[3] Stanford Institute for Stem Cell Biology and Regenerative Medicine. CD47 [Internet] [Cited 2019 Oct 5]. Available from: https://med.stanford.edu/stemcell/CD47.html.

[4]  Chen Q, Wang C, Zhang X, Chen G, Hu Q, Li H, et. al. In situ sprayed bioresponsive immunotherapeutic gel for post-surgical cancer treatment. Nature Nanotechnology [Internet]. 2018 [Cited 5 Oct 2019]; volume (14), 89-97. DOI: s41565-018-0319-4

[5] Paddock C. Spray gel could reduce cancer spread after surgery. [Internet] [Cited 2019 Oct 5]. Available from: https://www.medicalnewstoday.com/articles/324009.php

          ​Imagine putting your hand down on a hot stovetop and not even realizing you are burning. A life without pain – without analgesics, without anxiety – sounds liberating. It is, however, also dangerous – to need someone to inform you of injuries, to be unaware of the fact that you may be hurting your body without even realizing it. For Jo Cameron, this is her reality: the now 71-year-old woman has spent her entire life without feeling pain. It has only recently come to light that her lack of sensation is due to two unusual genetic mutations, and this discovery could lead to innovative treatments for pain and anxiety in the years to come.

​Jo Cameron, 2019 (Image by Mary Turner for The New York Times) (1)

          ​Breast cancer is the most prevalent cancer in women with more than 2 million new cases reported in 2018. While breast cancer often appears as an umbrella term for cancerous growth of breast tissue, this cancer can be divided into 21 distinct histological (differing in tissue) subtypes and at least 4 different molecular (differing in genetic mutation) subtypes, each with characteristic risk factors, response treatments, and outcomes. With this variation, it is increasingly apparent that instead of treating breast cancer as a single disease, targeted therapies, designed with specificity for each unique patient, are necessary.

          While the rise of smartphone usage has allowed for  people to remain connected at all times, it has also led to an unfortunate increase in traffic accidents.  Distracted driving, which accounts for about 25% of all US traffic accidents, are largely due to texting while driving [1]. A recent study from the American Journal of Criminal Justice determined that the reasoning behind texting while driving could be  attributed to low self control.

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by Rahul Jayaram '21
​edited by Rishi Patel '21