1. Research, Medical Students, and Physicians: Personal Experience
Sung-Tsang Hsieh, MD, PhD
Department of Anatomy and Cell Biology
National Taiwan University College of Medicine
Department of Neurology
National Taiwan University Hospital
Taipei
Taiwan

2. Medical student Era Background:
Graduation from high school in 1976
Medical student of National Taiwan University (NTU): 1976~1983
only very vague impression about “medical research”
the only concept about “experiments”: laboratory courses in biology, chemistry, and physics, et al: hand-on experience on “known phenomena”

3. Resident Era
Neurology resident in National Taiwan University Hospital (NTUH): 1985~1988
Medical care of patients: including diagnosis, medications, and rehabilitation
Neurodegegenerative diseases: progressive loss of neurons at various levels of the neural axis
Alzheimer disease
Parkinson disease
Spinocerebellar degeneration
Peripheral neuropathy

4. Research course during Residency
“Flavor” of laboratory works during Neurology residency
Pathology training
Radiology Training
Basic science training: the gate to PhD studies
Department of Pharmacology, Prof. MC Tsai (蔡明正教授)
neuromuscular junction physiology with phrenic nerve/diaphragm preparation

5. Master Student Era Harvard School of Public Health: 1988~1989
Epidemiology
Biostatistics
Critical thinking and logical reasoning of research data and interpretation

6. PhD Student Era
Johns Hopkins University Department of Neuroscience: 1989~2003
Imagination and learning techniques
Thesis: neurofilaments and myelination

7. Postdoc Era Johns Hopkins Hospital Department of Neurology: 1993~1995
To explore the unknown world: “mission impossible” with learned techniques and logic and comprehensive designs
Experimental degeneration of nerve terminals in the skin

8. Faculty Era National Taiwan University Medical Center: 1995~
Joined appointment
Department of Anatomy and Cell Biology
Department of Neurology

9. Researches in NTU (1) Skin biopsy for cutaneous nerve degeneration
Animal models
Human studies on neuropathy: peripheral nerve degeneration in diabetes, chemotherapy-induced, inflammation/autoimmune disease etc

10. Skin biopsy for neuropathy
Dying-back neuropathology in DM and toxic length-dependent neuropathy
Skin biopsy for “free nerve ending”
Hsieh ST, Encyclopedia of Pain, 2007

11. 3 mm punch skin biopsy 2 weeks later one year later
3 mm in diameter; no suture (only compression for several minutes is required)
excellent wound healing within 2 weeks
minimally invasive compared to standard sural nerve biopsy

12. Normal skin innervation
Epidermis
Dermis
Intrapeidermal nerve fiber (IENF): varicose appearance in the epidermis; stained with anti-protein gene product 9.5 (PGP 9.5), a pan-axonal marker
Quantifiable: IENF density

13. Researches in NTU (2)
Physiology of pain: contact heat evoked potential (CHEP)
Physiological signatures of pain

14. Researches in NTU (3)
Neuroimaging of pain: functional magnetic resonance imaging (fMRI)

16. Interactions with Medical students
Medical students: laboratory studies during summer or weekends
Innervation of gastric mucosa in diabetes performed by a smart medical student of NTU: a paper published in Experimental Neurology before graduation from Medical School, currently in PhD program of Duke University

20. Implications of gastric mucosa innervation studies
Reduced gastric mucosa innervation in diabetes:
a new mechanisms for gastroparesis in diabetes
pathology documentation of nerve degeneration in gastrointestinal neuropathy in diabetes

21. MD-PhD
A bridge between laboratory works and clinical applications or experimental approaches to investigate clinical problems
Endangered species (NIH): time-consuming and exhausted efforts
Importance: Translation research, basic-clinical correlation, bench-to-bedside

22. Perspectives Research minds in clinical practice:
New mechanisms through experiments
New diagnostic tests
New therapeutic strategies
Collaborations among diverse disciplines

23. Thanks for your attention and Wish you a pleasant memory of trip in Taiwan