Sifting through big data, UCSF researchers discover promising new treatment for spinal injury – CBS San Francisco


SAN FRANCISCO (KPIX) – San Francisco’s Ocean Beach is famous for its cold waters and powerful waves. Chris Barr loved to surf here, coming from East Bay on weekends.

On February 12, 2017, the waves beckoned.

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

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 got a call.

“Chris had an accident and, uh, he’s at Zuckerberg,” she recalls hearing over the phone.

Ms Barr packed a travel bag for her husband, thinking he might have broken an arm or a leg.

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

When Debbie Barr arrived, medical staff escorted her to a small room where she saw her husband. The emergency team had cut off his wetsuit. What she saw was terrifying.

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

Her husband suffered a serious cervical spinal cord injury. Doctors told him Chris would probably never find 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 ventilator was, ‘Unplug the plug,’” said Debbie Barr.

Unknown to Chris and Debbie, UCSF doctors at Zuckerberg had already implemented a new surgical protocol for use in patients with new spinal cord injuries.

The idea: to closely monitor a patient’s blood pressure and keep it in the “Goldilocks Zone” – neither too high nor 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 precise than what appears in current guidelines. The upper limit is lowered. Scientists at UCSF have found that too much blood flow appears to damage spinal tissue.

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

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

Doctors did not discover this approach on their own.

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

“It’s one of the perks of being here in the Bay Area,” added Dr Abel Torres-Espin, assistant professor at UCSF and also an expert in data science.

Scientists used machine learning and artificial intelligence as well as data from patient charts.

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

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

The new machine learning technique is called topology data analysis – TDA for short. The technology revealed an intriguing pattern that led to the protocol for keeping blood pressure more precisely in a narrow range.

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

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

“As soon as they are operated on, they go straight to the intensive care unit and then we make sure they maintain their mean blood pressure target,” explained Professor Debra Hemmerle, intensive care nurse at Zuckerberg and co-author of the study.

She told KPIX how the surgical team got Chris into the operating room within four hours of arriving at SF General. This was earlier than the recommended 12 to 14 hours for what’s called decompressive surgery.

Chris Barr said it’s common for those recovering from a serious spinal cord injury to start feeling or moving 72 hours or more after surgery.

“I had nothing,” Barr said. “Two weeks? Nothing. Three weeks? Still no feeling, no movement at all. So at this point, they sort of write you off. And then all of a sudden things started happening.

Barr began to feel a sensation under his neck. Within months, he could move his toe, then a limb. It was slow, but it kept progressing. He then began to feed.

“I remember the first day he ate a piece of chocolate. Like he grabbed a bite and put it in his mouth and we clapped, ”Debbie said.

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

Today he can walk alone. Although he has other medical issues to deal with as a result of his injury, he said that – without a doubt – what started at Zuckerberg San Francisco General and continued with his pursuit of other promising treatments has brought his fruits.

ICU nurse Hemmerle remembers seeing him and being stunned.

“He got up from his wheelchair and took a few steps and – I’m moved because it still gives me chills,” Hemmerle said, tears in his eyes.

Spinal cord injuries affect approximately 18,000 patients in the United States each year. The lifetime costs to the patient and the cost to society are enormous.

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

“Instead of having hundreds of samples, you have thousands. There is no reason that we cannot have thousands of topics. I mean, we’re only scratching the surface, ”Barr said.

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 are the most common cause of work-related disability.


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