Author: yec14002

Lab Notes – Summer 2017

Melanoma’s Signature

illustration of a melanoma cell

Dangerous melanomas likely to metastasize have a distinctive molecular signature, UConn Health researchers reported in the February issue of Laboratory Investigation. Melanomas are traditionally rated on their thickness; very thin cancers can be surgically excised and require no further treatment, while thick ones are deemed invasive and require additional therapies. But melanomas of intermediate thickness are harder to judge. The researchers measured micro-RNAs produced by melanoma cells and compared them with the micro-RNAs in healthy skin. Micro-RNAs regulate protein expression in cells. The team found that melanomas with the worst outcomes produced lots of micro-RNA21 compared to melanomas of similar thickness with better outcomes. In the future this molecular signature could help dermatologists decide how aggressively to treat borderline melanomas.


Chili Pepper and Marijuana Calm the Gut

The medical benefits of marijuana are much debated, but what about those of chili peppers? It turns out that when eaten, both interact with the same receptor in our stomachs, according to UConn Health research published in the April 24 issue of Proceedings of the National Academy of Sciences. The scientists found feeding mice chili peppers meant less gut inflammation and cured those with Type 1 diabetes. Why? The chemical capsaicin in the peppers bonds to a receptor found in cells throughout the gastrointestinal tract, causing the cells to make anandamide — a compound chemically akin to the cannabinoids in marijuana. The research could lead to new therapies for diabetes and colitis and opens up intriguing questions about the relationship between the immune system, the gut, and the brain.

illustration of chili peppers and marijuana in the gut


Isolating Their Target

brain scan

Brain cells of individuals with Angelman syndrome fail to mature, disrupting the ability of the cells to form proper synaptic connections and causing a cascade of other developmental deficits that result in the rare neurogenetic disorder, according to UConn Health research. Neuroscientist Eric Levine’s team used stem cells derived from Angelman patients to identify the disorder’s underlying neuronal defects, an important step in the ongoing search for potential treatments and a possible cure. Previously, scientists had relied primarily on mouse models that mimic the disorder. The findings were published in the April 24 issue of Nature Communications. While Levine’s team investigates the physiology behind the disorder, UConn developmental geneticist Stormy Chamberlain’s team researches the genetic mechanisms that cause Angelman.


The Cornea’s Blindness Defense

eye

The formation of tumors in the eye can cause blindness. But for some reason our corneas have a natural ability to prevent that from happening. Led by Royce Mohan, UConn Health neuroscientists believe they have found the reason, findings that will be detailed in September’s Journal of Neuroscience Research. They link the tumor resistance to a pair of catalytic enzymes called extracellular signal-regulated kinases 1 and 2. When ERK1/2 are overactivated in a specific type of cell, the “anti-cancer privilege of the cornea’s supportive tissue can be overcome,” says Mohan. That happens in the rare disease neurofibromatosis-1. “These findings may inform research toward developing better strategies for the prevention of corneal neurofibromas,” says Dr. George McKie, cornea program director at the National Eye Institute, which funded the study.

A Path With Less Pain

Genetic Clues Show Which Breast Cancer Patients Are Prone to Post-Treatment Agony

By Kim Krieger

woman chooses between two marked paths


Sickness and pain go together. We think of them as a matched pair, a married couple. Pain signals sickness, sickness causes pain. But this is not always the case. Especially in early stage cancer, often there is no pain — until the patient is treated.

UConn Health researchers have discovered genetic clues that could eventually reveal which people might be vulnerable to post-treatment pain, they reported in the June issue of Biological Research for Nursing.

“We’ll hear women say ‘If I knew the pain would be this bad, I’d have rather died of breast cancer,’” says Erin Young, a UConn Health pain geneticist. Young and her research partners wondered: Can we really call such treatment a “cure”? It would be better if we could know in advance which patients might suffer from which treatments.

Young worked with data collected as part of a broader study involving nurse-scientist and director of UConn’s Center for Advancement in Managing Pain Angela Starkweather, neuroscientist Kyle Baumbauer, and colleagues at the University of Florida and Kyung Hee University in Seoul, South Korea. Young’s analysis found that common variants in two genes contribute to certain symptoms during and after chemotherapy treatment for breast cancer. The results could one day help patients, and their nurses and doctors, make informed treatment decisions and prepare for — or avoid — damage to patients’ quality of life.

The researchers looked at the genetics of 51 women with early-stage breast cancer who had no previous chemotherapy and no history of depression. The women rated their well-being both before and after treatment for cancer, reporting on their pain, anxiety, depression, fatigue, and sleep quality. Young and her colleagues then looked for connections between genes and symptoms.

Can we really call treatment a “cure”? It would be better if we could know in advance with patients might suffer from which treatments.

They looked at three genes in particular: NTRK1, NTRK2, and COMT. These genes are already associated with pain from other research. NTRK1 is connected to rapid-eye-movement sleep (dream sleep), and a specific variant is linked to pain insensitivity. NTRK2 is associated with the nervous system’s role in pain, fatigue, anxiety, and depression. And some common versions of COMT are linked to risks of developing certain painful conditions. The researchers also chose these genes because the variants associated with pain, fatigue, and other symptoms are fairly common, making it possible to get meaningful results from a sample size of just 51 people.

After the analysis, a couple results jumped out at them. Two of the genes, COMT and NTRK2, had significant correlations with pain, anxiety, fatigue, and sleep disturbance. The other gene didn’t.

“I always like having a yes/no answer — if we get some nos, then we know the analysis wasn’t just confirming what we wanted to see,” says Young.

Such a quick look at a small sample of cancer patients can’t give all the answers as to who is going to develop postoperative and post-chemotherapy pain. But what they did find is very suggestive. Some of the gene variants were associated with symptoms before surgery. For example, women with two copies of the A variant of COMT reported more anxiety than other women did. COMT was also linked with pain, both during and after cancer treatment: women with one variant of COMT reported more pain, while women with a different variant reported less.

Fatigue also seems to have a genetic component. Women with one copy of the T variant of NTRK2 reported more posttreatment fatigue than others, and women with two copies reported much more.

Surprisingly, the genes linked to various symptoms worked independently, and didn’t work together to increase overall pain and discomfort. In other words, they weren’t synergistic; they didn’t make each other worse.

The gene variants predicted pain and fatigue above and beyond any differences explained by treatment effects.

The genes’ effects were also independent of the type of treatment the women received; the 51 women followed a number of different types of treatments: different surgeries, different chemotherapies. The gene variants predicted pain and fatigue above and beyond any differences explained by treatment effects. Other experiments by other researchers have shown the COMT variants are connected to the development of skeletal muscle pain.

“So it’s not just our study but the entire literature that suggests COMT could be playing a role in how sensitive you are to many different types of pain,” says Young.

“We are focusing on how we can identify women who are at risk of experiencing persistent pain and fatigue, as these symptoms have the highest impact on reducing quality of life after treatment,” says Starkweather. “It’s a great example of how we can make progress toward the goal of personalized health care. The next piece of the puzzle is to identify the most effective symptom-management interventions based on the patient’s preferences and genetic information.”

Young, Starkweather, and their colleagues say further research, ideally looking at a person’s whole genome, is needed to refine the connections between genetic profiles and the risk of pain. With that knowledge, patients could work together with their care team to develop individualized symptom-management plans. Properly prepared patients would feel more control and less suffering. And perhaps the cure would no longer hurt worse than the disease.

Matching Medicine to the MS Patient

UConn Health researchers have discovered why drugs for an aggressive form of multiple sclerosis work in the lab but fail in real patients: Each primary progressive multiple sclerosis patient has uniquely defective stem cells, perhaps making the debilitating illness a prime candidate for precision medicine.

By Kim Krieger

Illustration by Katie Carey

illustration of stylized silhouettes holding their perfectly matched medication


At first, Christine Derwitsch thought she was just really out of shape. She and her husband had gone out for a hike. They went hiking often, but this time, by the summit of the first hill she had to sit down. Her legs were so heavy.

She laughed it off, saying she’d been spending too much time sitting at a desk. But over the next few months, walking became harder and harder. And gradually, Derwitsch realized something was wrong.

“I went on Facebook, and I looked at what I’d been able to do before — hiking, my sister’s wedding — and I couldn’t do that anymore. I thought, ‘This isn’t right.’”

It took her almost a year, but 29-year-old Derwitsch was finally referred to a neurologist at UConn Health, who diagnosed her with primary progressive multiple sclerosis (PPMS). It was a relief to finally understand what was happening to her legs, but the news wasn’t good; there were very few treatment options available.

Most cases of multiple sclerosis have a pattern of illness and then remission: symptoms flare up, then go away, then flare up again. There are effective drugs that help patients extend the periods of remission, and someone diagnosed with MS in his or her 20s may live comfortably for decades.

But PPMS is a different story.

“It’s a harder diagnosis to make because there are no attacks,” says Dr. Matthew Tremblay, Derwitsch’s neurologist at UConn Health, who specializes in treating MS.

And the same thing that makes PPMS harder to diagnose makes it harder to treat.

Most drugs for MS are designed to prevent relapses by suppressing the immune system. But PPMS patients don’t have relapses. To help them, a drug would need to help them regrow myelin, the insulation around our nerves that people with multiple sclerosis can’t reliably repair. Doctors seeking this kind of drug for PPMS keep chasing a mirage.

It’s like you bring in the National Guard to stop a riot, and [instead] they all sit down and start having lunch.

For PPMS, many researchers look for possible treatments among medications that have already been approved for other illnesses. That way they can go right from lab to patient if they show promise. And so far many medications have shown promise — in the lab. But no matter how well a compound works in the lab, it never seems to help many people in the clinic. It’s a conundrum that frustrates both doctors and patients.

But researchers at UConn Health now think they know why the drugs coming out of labs are duds. And they have an idea of how to fix it.

In a new study, UConn Health neuroscientist Stephen Crocker and his colleagues collected blood cells from patients with PPMS, as well as the patients’ siblings or spouses. Then in the lab, they “reprogrammed” the cells and turned them into neuroprogenitor stem cells.

Stem cells can turn into any type of cell in the body; neuroprogenitor stem cells are found only in the brain and specialize in turning into new brain and nerve tissue, such as the oligodendrocyte cells that re-myelinate nerves. These neuroprogenitor stem cells are known to protect the brain from injury, but this recent study was the first to ask whether these stem cells from someone with PPMS had the same ability to protect the brain as those from someone without the disease.


Christine Derwitsch

While primary progressive multiple sclerosis is harder to treat than typical MS, UConn Health researchers have found why drugs that work in the lab fail on real patients with PPMS, like Christine Derwitsch (pictured). Photo: Tina Encarnacion


To explore this question, the researchers first tried adding the stem cells to brain tissues in animals with damage similar to PPMS. Stem cells from the healthy relatives and spouses started repairing the damaged areas. But the PPMS stem cells didn’t do anything.

“It’s like you bring in the National Guard to stop a riot, and [instead] they all sit down and start having lunch,” Crocker says.

Crocker and his colleagues then tested how these stem cells were different by growing them in dishes in the lab. They collected the soup that the cells grew in, called conditioning media, and tested how this affected other cells grown in it afterward. The stem cells had left behind chemicals and proteins in the conditioned media, little messages that tell other cells that come later what they need to do.

Oligodendrocyte cells grown to maturity in media conditioned by healthy stem cells matured into nice, big oligodendrocytes with no problems. But the cells added to dishes conditioned by PPMS stem cells didn’t mature at all. Something about the neural stem cells from PPMS patients was messing up the young oligodendrocytes, leading them astray.

So members of Crocker’s research team next tested some drug candidates for PPMS and added them to the young oligodendrocytes. The drugs absolutely helped the young oligodendrocytes mature when they were growing in media conditioned by stem cells from healthy people. But the same drugs didn’t help the young oligodendrocytes when they were grown in media conditioned by diseased stem cells. In those cases, the cells responded differently every time.

As Tolstoy might have said, healthy stem cells are all alike, but stem cells with PPMS are all unhealthy in their own way. It might appear to be the same disease from the symptoms, but each patient’s PPMS seems to be caused by a different problem with that specific patient’s cells.

But that means that doctors may be able to screen drugs for brain repair on a patient-by-patient basis, Crocker says. He and his colleagues published their findings in the Feb. 1 issue of Experimental Neurology.

Tremblay has begun collaborating with Crocker as they plan the next steps to this research, looking to recruit patients for future studies.

And in the lab they’ve already found that some drugs that have been dismissed as ineffective when tested using more typical techniques may have the potential to work very well for certain PPMS patients — patients like Derwitsch.

Derwitsch hasn’t participated in the study yet, but it’s exactly patients like her who could benefit from this personalized approach.

In the meantime, she is staying mobile and positive. She credits Tremblay for getting her insurance to cover her treatment — he actually got on the phone with her insurance company, she says.

“Dr. Tremblay has so much knowledge about MS, but also a dedication and passion. Every time I have a question, he has an answer.”

Honor Roll – Summer 2017

Radenka Maric, Ph.D., was named UConn’s vice president for research effective July 1, 2017. Maric was previously the CT Clean Energy Fund Professor of Sustainable Energy in the UConn School of Engineering.


Dr. Anthony G. Alessi received the 2017 President’s Award at the American Academy of Neurology’s 69th annual meeting, held this April in Boston.


UConn Health’s Board of Directors named Howard Tennen, Ph.D., the 2017 winner of its Faculty Recognition Award.


UConn Health had 34 physicians named to Connecticut Magazine’s 2017 “Top Docs” list.


Dr. Jane Grant-Kels was elected vice president-elect of the American Academy of Dermatology.


Dr. R. Lamont “Monty” MacNeil, dean of the UConn School of Dental Medicine, was appointed to a one-year term as chair-elect of the American Dental Education Association’s board of directors in March.


Dr. Augustus D. Mazzocca will receive the Arthritis Foundation’s Champion of Yes Prestigious Excellence in Medicine Award for 2017.


Kyle M. Baumbauer, Ph.D., has received the 2017 Award in Pain from the Rita Allen Foundation and the American Pain Society for his research on pain after spinal cord injury.


Dr. Linda K. Barry was named one of Savoy magazine’s Top Black Doctors for 2017.


UConn medical student Laura Hatchman and her faculty mentor Lisa Barry, Ph.D., received the Biomarkers and Frailty Best Paper Award at the American Geriatrics Society annual meeting held in May.


UConn John Dempsey Hospital was recognized with a Gold Plus rating, the highest for heart failure patient care by the American Heart Association. In addition, the hospital was added to the AHA’s Heart Failure Honor Roll for 2017.

New Neurosurgery Chief Brings Elite Expertise to UConn Health

Dr.Ketan R. Bulsara speaks with patient inside patient room in UConn Health, Farmington CT USA


Dr. Ketan R. Bulsara, a world-renowned neurosurgeon, brings an unparalleled range of expertise in treating neurological disorders to UConn Health as the new chief of the Division of Neurosurgery.

Bulsara came to UConn Health from Yale, where he built successful programs in neurovascular and skull base surgery. He has trained with the pioneers in neurosurgery and is an author on many national and international guidelines
and standards.

Bulsara is among an elite few neurosurgeons in the world with dedicated dual fellowship training in skull base/cerebrovascular microsurgery and endovascular surgery. He is directing both of those disciplines in UConn Health’s Department of Surgery in addition to serving as chief of neurosurgery.

“Dr. Bulsara is a world-class neurosurgeon who brings a level of expertise that is almost unheard of in the field,” says Dr. David McFadden, chair of the UConn Health Department of Surgery. “Whether it’s complex tumors, aneurysms, or any sort of brain- or nerve-related problem, he is well-equipped to offer a full range of treatment options.”

That includes the full spectrum of treatment of both hemorrhagic stroke and ischemic stroke. Bulsara was an early adopter of mechanical thrombectomy, a procedure in which the surgeon removes a clot from a blocked blood vessel going to the brain. Bulsara’s collaboration with UConn Health’s stroke program puts UConn Health in a position to handle these more complex cranial cases.

Bulsara also will be involved in UConn Health’s efforts to expand its epilepsy program to include neurosurgical treatments, and will be recruiting additional neurosurgeons with other areas of expertise.

“It’s always been my dream to establish a world-class destination center for neurosurgical care,” Bulsara says. “Neurosurgery, the way I look at it, is a multidisciplinary specialty. The focus of my division is to optimize patient outcome. We’ll build a team that’s tailored and personalized for every single patient. Ultimately, as a team, we provide the best care for the patients.”

Working Together for Better Public Health

Q&A with Dr. Raul Pino, commissioner of the Connecticut Department of Public Health and a UConn Health board member

Q

What are some of the major public health issues facing Connecticut?

There are many public health issues facing both Connecticut and the nation as a whole. At the Department of Public Health, our emphasis is on the Centers for Disease Control and Prevention’s 6|18 initiative, which targets six major health conditions — asthma, high blood pressure, tobacco use, hospital-acquired infections, teen pregnancy, and diabetes — with 18 evidence-based public health interventions.

Each of these conditions is common, preventable, and costly, but importantly, all have proven interventions that can be effectively employed across the health care spectrum to improve both individual and community health, saving lives and dollars. Other areas where I believe we can see good results in Connecticut by employing evidence-based interventions include addressing HIV and the rising number of syphilis cases.


Q

How can physicians assist the DPH daily to address and reduce these issues?

Doctors, particularly primary care physicians, are the main point of contact with the public for health education. We need to engage practitioners in addressing the six major health conditions with their patients — screening for the conditions; educating in advance to enhance prevention of disease; and providing effective, evidence-based treatments when needed. Physicians play a critical role on the front lines of health care to shift our focus from treatment to prevention through lifestyle changes and other healthy choices. They are an indispensable part of the continuum of care between DPH, health care practitioners, and public health.


Q

As DPH commissioner, what drives your daily public health passion and mission?

I am convinced that we — as a nation, a state, and as public health professionals — can do more than we are currently doing to impact public and population health. Addressing the health disparities that continue to plague our population, costing millions of lives and countless health care dollars, is what drives me. We are so fortunate to live in one of the richest countries, and states, in the world, yet we spend so little on public health. My mission is to spread the message that modest investments of money, time, and effort in proven education and prevention methods can lessen these disparities, which will save millions of dollars in health care costs and, more importantly, save lives.


Q

Tell us about your connection to UConn Health and what you hope to accomplish as a member of the board of directors.

I am a 2009 graduate of the UConn Master of Public Health program and receive my own health care at UConn Health. Spending time there for my education and health care has really crystallized for me that UConn Health is the epicenter of clinical care and education in Connecticut. UConn Health is where advances in science and medicine happen, which allows patients to get the best in cutting-edge care. As a member of the board of directors, I am looking to learn and understand better the role that this large institution plays in public health work. I hope my passion for public health and the elimination of health disparities will allow me to give a voice to the importance of integrating education, prevention, public health, and clinical care in order to strengthen our health care system, curb rising health care costs, and foster healthy communities and individuals.

Magnifying Nursing Excellence

nurses do rounds inside UConn Health


UConn Health has launched its journey to Magnet nursing excellence recognition by the American Nurses Credentialing Center of the American Association of Nursing (AAN).

“Magnet designation is the ultimate honor for a hospital’s high-quality nursing,” says Sue Ellen Goodrich, RN, nursing director of Professional Practice for UConn Health. “Research shows us that stellar nursing practice truly makes a difference in patient care and outcomes.”

To pave the road to Magnet status for its more than 1,200 nurses, UConn John Dempsey Hospital is raising patient safety, satisfaction, and evidence-based outcomes benchmarks to above the national average while increasing nurse satisfaction, retention, collaboration, research, and professional development opportunities.

Of the 5,564 hospitals in the U.S., only 6.6 percent are Magnet-designated, with 460 total Magnet hospitals worldwide.

The Magnet Recognition program, created in 1990, is based on 14 “Forces of Magnetism” characteristics grouped into five pillars: Transformational
Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovation, and Improvements; and Empirical Outcomes.

To jump-start the Magnet journey, UConn Health has adopted a nursing professional practice model of compassion, integrity, collaboration, and innovation, with improvement initiatives aimed at preventing patient falls, central line–associated blood stream infections, catheter-associated urinary tract infections, and hospital-acquired pressure ulcers. UConn Health has also joined the national program NICHE (Nurses Improving Care for Healthsystem Elders).

“We look forward to building an even stronger foundation of nursing excellence while providing greater benefits to our patients and nurses,” says UConn Health Chief Nursing Officer Ann Marie Capo, RN, whose leadership and vision was pivotal to starting the Magnet process.

Event Spotlight: Global Genomics Conference

Genomics and Society: expanding the ELSI universe


UConn Health and The Jackson Laboratory Host Global Genomics Conference

Good genomics research requires healthy curiosity, powerful data analysis, rigorous scientific methodology — and a strong ethical grounding. UConn Health and the Jackson Laboratory for Genomic Medicine co-hosted the Ethical, Legal, and Social Implications Research Program’s (ELSI) fourth-annual conference June 5 through 7 to explore how ethical decisions surrounding genomic discoveries are informed by the legal and social context of our society.

Nearly 300 people attended the three-day “Genomics and Society: Expanding the ELSI Universe” conference, which brought experts from around the world to UConn Health in Farmington, Connecticut, to discuss both what we can do with our genomic knowledge and the responsibilities that come with that power.

“The increase in genomic testing and technology are fueling breakthrough discoveries here in Connecticut and around the globe for heart disease, cancer, and a host of rare diseases,” said Dr. Bruce T. Liang, dean of UConn School of Medicine. “However, these promising personalized medicine therapies and our greater genetic knowledge may also come with a steep societal price if we don’t address the associated concerns in a timely fashion.”

Keynote speakers from the National Institutes of Health (NIH) and universities across the country spoke about the ethics of genomics in the clinical setting; the relationship between genes, ancestry, and identity; and the NIH’s All of Us initiative. All of Us seeks to broaden the genetic database used for research in the United States so that it more accurately reflects the citizenry and the differences in lifestyle, environment, and biology encountered in different populations across the country.

Much of the funding for ELSI comes from the National Human Genome Research Institute, with the goal of supporting research that anticipates and addresses the societal impact of genomic science. The institute has four broad priorities: genomic research; tracking how that research influences health care; exploring how social norms and beliefs affect how we understand genetic advances and how we use them; and legal, regulatory, and public policy issues. Workshops at the conference covered specific topics from those areas, including the implications of genetic testing in the criminal justice system; the uses and misuses of the gene editing technique known as CRISPR; and the controversies over the appropriate use of genetics in psychiatric, neurologic, and behavioral fields.

More information about the ELSI project.

The Healing Power of Fat

digital rendering of inside throat


Fat cells are increasingly being used in cosmetic and reconstructive plastic surgery, and now UConn Health has restored one patient’s lost voice by leveraging the power of fat.

In 2013, Ed Favolise, 70, a retired superintendent of schools in Connecticut, had surgery to remove a precancerous tumor from his chest. Part of the tumor encased a nerve that was severed during surgery, leaving his right vocal cord paralyzed and a major gap between his vocal cords.

For three years, Favolise’s voice was limited to a squeaky, high-pitched whisper while he pursued remedies at three different medical centers. After five surgeries and continuous vocal therapy, Favolise turned to the Voice Center at UConn Health.
Dr. Denis Lafreniere, chief of the Division of Otolaryngology, teamed up with Dr. Andrew Chen, chief of the Division of Plastic Surgery, to offer an innovative solution.

In the operating room, Lafreniere and Chen withdrew fat cells from Favolise’s abdomen, processed and measured them to make sure they had enough pure fat cells, and placed them directly into his injured vocal cord via a needle injector through a laryngoscope. The result? A permanently plumped vocal cord that’s in the proper position to contact the left vocal cord.

“My speech improved immediately and significantly,” says Favolise. “My experience shows that sometimes you need to be willing to take a chance on a pretty surprising, promising alternative medical solution and procedure.”

Diagnosing Disruptions in the Autonomic Nervous System

UConn Health Hospital Building


Since the bodily functions it controls are automatic and involuntary, people don’t think much about their autonomic nervous system (ANS). But ANS dysfunction can indicate serious medical problems, and early detection is key to avoiding complications.

UConn Health is home to the only testing laboratory in the state dedicated to diagnosing disruptions in the body’s ANS.

ANS is the control center that regulates the body’s automatic functions, including stress response, heart rate, blood pressure, digestion, and urinary functions. Interruptions in the system can occur if there is a disruption in communication between the brain, spinal cord, and peripheral nerves.

Abnormal ANS reflexes can be a sign of medical conditions such as cardiovascular problems, diabetic neuropathy, and Parkinson’s or other neurodegenerative diseases.

“A series of simple ANS tests can help a patient finally find potential answers and treatment options for lingering, undiagnosed symptoms,” says UConn Health neurologist Dr. Matthew Imperioli. “The Neurology Department’s ANS Lab at UConn Health is proud to be filling a patient-care gap to meet the needs of patients
across Connecticut.”

Testing at UConn Health’s ANS lab can be performed in less than an hour by Imperioli, who has advanced fellowship training in this growing neurology subspecialty. Since it opened in May 2016, the lab has been busy assessing patients referred by neurology and primary care physicians searching for answers for their patient’s symptoms, such as recurrent fainting or dizziness.

The panel of four tests hunts for any abnormal ANS reflexes. Quantitative sudomotor axon reflex testing (QSART) uses specialized electrode technology on the arm and leg to measure sweat capabilities. Simultaneous heart rate and blood pressure technology captures any variability during deep breaths and forceful exhales.

Also, an automated tilt table with EKG and specialized heartbeat-to-heartbeat blood pressure monitoring repeatedly checks for any changes as a patient rotates from a lying-down position to nearly standing.

“Early detection of an ANS disorder is critical so we can prevent patient falls or injury, avoid health complications, prescribe the correct medications, and improve a patient’s quality of life sooner rather than later,” Imperioli says.