Clinical Innovations

Together for the Kids

By Lauren Woods

Dr. Emily  Germain-Lee  with a patient at the Albright Center at Connecticut Children's Medical Center.

Dr. Emily Germain-Lee with a patient at the Albright Center at Connecticut Children’s Medical Center.
Erin Blinn Curran/ Connecticut Children’s Medical Center


National recognition by external sources such as U.S. News & World Report comes as no surprise to the thousands who pass through Connecticut Children’s Medical Center each year.

What may be unexpected to those patients is that such success is the fruit of a more than 50-year legacy of the pediatric department at UConn School of Medicine advancing pediatric medicine, research, and education in Connecticut — and putting the health of the state’s tiniest residents first.

The life-changing work done by UConn’s Department of Pediatrics is made possible by a special partnership: Connecticut Children’s Medical Center is the teaching hospital where medical students, pediatric residents, and fellows are trained, as well as the home of the faculty’s clinical care work.

“UConn’s Department of Pediatrics’ strong relationship with Connecticut Children’s is excellent and seamless. There is no us and them. We are truly one, and we couldn’t excel without each other,” says Dr. Bruce T. Liang, the dean of the UConn School of Medicine since 2015. Liang has helped expand the two institutions’ joint recruitment of world-renowned physician-scientists and has led much of their growth in pediatric research.

For the Greater Good

The seeds of excellence in pediatric care in the Hartford area were planted in 1967 with the founding of UConn’s Department of Pediatrics, shortly before the medical school admitted its first class in 1968. UConn John Dempsey Hospital offered pediatric hospital care when it opened in 1975. Hartford-area hospitals had an informal agreement not to duplicate pediatric specialty services — patients were transferred among the hospitals based on their specialty care needs.

Connecticut Children’s was born in April 1996 after Newington Children’s Hospital, Hartford Hospital, and John Dempsey voluntarily closed their pediatric services so a comprehensive children’s hospital could open. It was established by state legislation and a 99-year lease of land on Hartford Hospital’s campus for 1 dollar per year. St. Francis Hospital and Medical Center’s pediatric programs were also incorporated. Uniquely, the leadership structure of the new pediatric hospital required that the same individual serve as both UConn’s Department of Pediatrics chair and Connecticut Children’s physician-in-chief.

“I am honored to have seen firsthand the strong evolution in pediatrics since my 1980s UConn pediatric residency training,” says Dr. Juan C. Salazar, who has served in that joint leadership role at UConn and Connecticut Children’s since 2013. “It is amazing that the strengths of four different Hartford hospitals came together for the greater good of our children and continue to offer the best pediatric care. It’s been an incredible success, allowing us to grow pediatrics clinically and educationally, along with our research mission.”

Salazar cites pediatric endocrinologists Dr. David Weinstein and Dr. Emily Germain-Lee as “two of several perfect examples of how the partnership of Connecticut Children’s and UConn really works seamlessly, with clinical services provided at Connecticut Children’s while robust laboratory research and clinical trials are under way at UConn.”

For 2018–19, U.S. News & World Report ranks Connecticut Children’s among the best hospitals in four pediatric specialties: cardiology and heart surgery, diabetes and endocrinology, neonatology, and urology. As one of the state’s largest care providers with 300 faculty members, UConn’s Department of Pediatrics has 31 medical and 13 surgical specialties.


Dr. David Weinstein, head of the Glycogen Storage Disease Program at UConn Health and Connecticut Children’s Medical Center, walks with Alyssa Temkin through the new clinic at Connecticut Children’s.

Dr. David Weinstein with a patient
Peter Morenus


For a Brighter Future

In addition to translational research and top clinical care, UConn Health’s mission includes a third focus on teaching the practitioners of tomorrow. UConn is the largest educator for the state’s pediatric medicine workforce, as up to 60 percent of pediatricians in Connecticut have graduated from UConn’s medical school or its pediatric training programs.

Historically, UConn has also provided the largest pipeline of medical students into the state’s pediatric residency programs — each year up to 20 percent of UConn’s graduating medical school class chooses to specialize in pediatrics, entering residency training programs here or around the country.

“Along with research advancements, our significant focus is the education and training of our next generation of pediatricians and pediatric specialists, many of whom stay right here in Connecticut to serve the state,” says Liang.

UConn and Connecticut Children’s continue to strengthen their partnership in all three areas by building relationships with other organizations.

The two institutions in 2016 joined with another collaborator, The Jackson Laboratory (JAX) for Genomic Medicine located on UConn Health’s campus, to recruit Dr. Ching C. Lau, an internationally recognized pediatric brain and bone tumor clinician and researcher.

UConn and Connecticut Children’s look forward to growing their alliance, Liang says, and are planning joint physician-scientist recruitments in the fields of medical genetics and gastroenterology, as well as further collaborations in maternal-fetal medicine.


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World-renowned physician-scientists across specialties bring to life the vision of Connecticut Children’s Medical Center and UConn School of Medicine’s Department of Pediatrics. Read on to learn about three of the groundbreaking physician-scientists who are currently dedicated to improving the lives of children in Connecticut and around the world.


A Vision for the Future of Pediatric Cancer

In 2016, Connecticut Children’s and UConn joined with another collaborator, The Jackson Laboratory (JAX) for Genomic Medicine located on UConn Health’s campus, to recruit Dr. Ching C. Lau, an internationally recognized pediatric brain and bone tumor clinician and researcher, from Texas Children’s Hospital in Houston.

As medical director of hematology-oncology at Connecticut Children’s and head of the Division of Pediatric Hematology-Oncology in the Department of Pediatrics at UConn, Lau’s JAX-based laboratory aims to leverage new, sophisticated genomic medicine techniques, mouse models, and therapeutic treatments to choose the best therapy for patients and discover new treatments.

When he was awarded the inaugural Martin J. Gavin Endowed Chair in Hematology/Oncology at Connecticut Children’s, Lau said he was attracted to the vision and dedication of Connecticut Children’s Medical Center.

“I dream that one day when I look at a child diagnosed with cancer, I can look him or her in the eye and say, ‘You will be cured without having to come to the hospital for therapy. You just have to go home and take this medicine,’” he said.

Lau is focused on accelerating the pace and success rate of clinical trials in pediatric cancer patients. “Although the incidence of cancer among children is much lower than that in adults,” he says, “it can be just as deadly. And because of the smaller number of patients available, clinical trials of new treatments for pediatric cancers are conducted at a much slower pace. Typically patients are enrolled in clinical trials after their cancers progress or are found not to be responsive to standard therapy.”
As a result, he says, pediatric cancer patients are exposed to side effects of standard therapy without therapeutic benefit. “This is a particularly serious problem for children because they are still undergoing normal growth and are particularly vulnerable to the side effects of anticancer drugs.”

By using the combined approach of genomic medicine and accurate mouse models to choose the best therapy for each patient, Lau hopes to improve the speed and outcome of clinical trials as well as to reduce unnecessary side effects for children with cancer.

One way he’s speeding up the process is through Smash Childhood Cancer, an initiative he’s spearheading for the U.S. alongside international researchers and IBM to find prospective treatments for childhood cancers by conducting millions of virtual experiments to help pinpoint promising drug candidates for further study using IBM’s World Community Grid.

“This kind of research expedites finding new treatments for childhood cancers,” Lau says. “Crowdsourcing computer processing power enables us to perform millions of experiments virtually and will save us years of experiments. It is bringing us that much closer to finding the right drug for each type of cancer.”

 

Administering New Therapy — and Hope

In late July, a patient named Jerrod received a drug infusion that he’s been waiting for his entire life.

Jerrod was the first patient to receive a promising investigational gene therapy to treat glycogen storage disease type Ia, the rare, potentially deadly genetic disorder he was born with. Dr. David Weinstein, a world-renowned pediatric endocrinologist and director of the Glycogen Storage Disease Program at Connecticut Children’s Medical Center and UConn Health, has been working to develop the treatment for two decades and calls the trial “a big leap forward for GSD.”

Healthy livers store excess sugar from food and release it into our bloodstreams when we need it as processed sugar enzymes called glycogen. However, in the seven forms of GSD, the liver fails to break down glycogen into glucose, causing the body’s blood sugar levels to drop dangerously low, which can lead to seizure or death. Patients stay alive by consuming a cornstarch mixture every few hours to keep their blood sugar up.

The gene therapy undergoing the Phase 1/2 clinical trial, approved by the FDA in April, delivers a new copy of the gene to the patient’s liver to replace deficient sugar enzymes and jumpstart the body’s glucose control. Studies in animal models have already shown the promising gene therapy to be safe, effective, and long-lasting.

The clinical trial is in conjunction with the biopharmaceutical company Ultragenyx and will soon expand from UConn Health in the U.S. to other sites including Canada, Spain, and the Netherlands.

“This gene therapy is hope for all us GSD patients,” says Jerrod, who asked that his last name be withheld. “We are all extremely excited. Dr. Weinstein is a savior and so is the entire GSD program.”

Weinstein moved his GSD program — the largest in the world — to Connecticut Children’s and UConn Health in early 2017. His multidisciplinary team cares for 600 patients from 48 countries.

“The strong synergies and collaborative team science happening at UConn and Connecticut Children’s are world class and the most fertile ground to make a GSD cure reality,” says Weinstein.

 

Writing the Rulebook

Dr. Emily Germain-Lee, a professor of pediatrics and chief of pediatric endocrinology and diabetes, moved her first-of-its-kind Albright Center from Johns Hopkins School of Medicine and Kennedy Krieger Institute to UConn and Connecticut Children’s in October 2016. She has cared for more patients who have a specific rare set of endocrine diseases than any other doctor in the world.

“She has redefined the field of pediatric endocrinology,” Salazar said when the hire was announced. “Patients and families travel from all over the world seeking Dr. Germain-Lee’s care.”

Germain-Lee’s patients suffer from pseudohypoparathyroidism and its related disorders, including Albright hereditary osteodystrophy (AHO), a rare inherited bone disorder caused by a genetic mutation that often leads to short bones and short stature. It is also frequently accompanied by severe multihormonal dysfunction in the body.

This summer, Germain-Lee co-authored the first international guidelines to help doctors around the globe diagnose and manage patients with the diseases. The new guidelines call for human growth hormone treatment for the vast majority of the patients who are at risk for short stature due to growth hormone deficiency. Germain-Lee was the first to discover that part of the reason why AHO patients are short is that two-thirds of them have a growth hormone deficiency.

Her long-term global clinical trial studies have shown the promising benefits of growth hormone treatment, including its ability to drastically increase a patient’s short stature to their original destined height potential while also improving their lipid levels and reducing obesity. With her research in the final stages, Germain-Lee is working toward gaining FDA approval of the therapy, which would be the first new therapy for the disorder in 70 years.

“I am thrilled to be a part of the combined power of UConn School of Medicine and Connecticut Children’s Medical Center for advancing children’s health and discovering new treatments of disease through research,” says Germain-Lee.

Better Ways to Heal Bones

Julie Bartucca

illustration of engineers going over blueprint of human skeleton with engineering notes on the hip bones

UConn Health is engineering innovative solutions for bone and joint problems, promoting faster recovery and less trauma to the body.


We’ve all signed a child’s colorful cast on their broken arm, gotten a call to inform us an elderly relative fell and broke a hip, or been laid up with back spasms ourselves. Maybe you’ve had a knee replacement or dealt with joint pain from years of athletic activity. It’s practically inescapable — 1 in 2 American adults suffers from a musculoskeletal disorder or injury such as arthritis, chronic back pain, fractures, or osteoporosis, according to 2016 data from the United States Bone and Joint Initiative (USBJI).

This is compounded by the fact that the U.S. has a rapidly aging population and, as people age, they lose bone density and the risks increase. Experts say the incidence of and costs to treat such issues are in danger of spiraling out of control.

But researchers at UConn and UConn Health are using a host of materials and technologies — from stem cells to spider-spun silk fibers to hydrogel to ultrasound waves — to strengthen bones and joints and accelerate recovery from musculoskeletal diseases and injuries.

“Musculoskeletal injuries are among the most common reasons to see a doctor. If we can take care of those faster and more effectively, patients can get back to their activities and work faster.”

“Musculoskeletal injuries are among the most common reasons to see a doctor. If we can take care of those faster and more effectively, patients can get back to their activities and work faster, which helps everybody,” says Dr. Augustus D. Mazzocca, director of the UConn Musculoskeletal Institute (MSI) and chair of the Department of Orthopaedic Surgery at UConn Health.

“There’s the economic impact of having people out of work, and the emotional problems of people who lose mobility and are isolated,” he says. “We’re trying to bring you back into society and get you back to what you like to do.”

To that end, UConn Health doctors also are developing ways to get you home faster after any musculoskeletal procedure, including spearheading same-day joint replacements.

Faster, Safer Recovery

UConn Health hip and knee replacement patients don’t have to wait for our clinical innovations to come to market. They can benefit from new approaches to the surgeries right now — and “right now” might also describe when they can go home post-op.

“Nearly 100 percent of my patients go home within 24 hours, and some now the same day,” says Dr. Mo Halawi, a new UConn Health orthopaedic surgeon who specializes in joint reconstruction and is spearheading an effort to minimize the time these patients spend in the hospital recuperating.

“The criteria for discharge are identical whether a patient leaves on the day of surgery or several days later. But with minimally invasive techniques, regional anesthesia, blood-conserving strategies, opioid-sparing analgesia, and immediate mobilization, patients are now achieving recovery milestones a lot quicker than before,” he says.

According to Halawi, the ideal candidate for same-day total joint replacement is one who is independent, motivated, has a good support system, and has no major risk factors for surgical complications. Much of the work is done in advance to optimize patients’ health and prepare them for surgery, allowing for the
speedy discharge.

After surgery, Halawi takes a less-is-more approach. Patients get on their feet right away and have no IV medications, drains, catheters, dressing changes, braces, or laboratory tests. Very rarely do his patients get discharged to nursing homes or rehabilitation facilities. Studies have shown that “patients recover better and have fewer complications in the comfort
of their homes,” he says.

“Hip- and knee-replacement surgery is constantly evolving, and we need to always deliver safe, effective, efficient, and evidence-based medicine to our patients. Soon, more surgeons and patients will realize that long hospital stays and recovery times are outdated,” Halawi says.

Engineering Cartilage

Though it is in the very early stages of development, UConn Health tissue engineer Syam Nukavarapu and his team have created a hybrid hydrogel system that they hope is the first step toward forming a hypertrophic cartilage template with all the right ingredients to initiate bone tissue formation, vascularization, remodeling, and ultimately the establishment of functional bone marrow to repair long bone defects.

How the more than 200 bones in an adult human skeleton form and how they are repaired if injured varies and has posed a challenge for many researchers in the field of regenerative medicine.

The cartilage template Nukavarapu and his team created appears to overcome hurdles that make it difficult for regenerative scientists to help the body’s long bones regenerate.

Two processes involved with human skeletal development help all the bones in our body form and grow. These processes are called intramembranous and endochondral ossification: IO and EO respectively.

While they are both critical, IO is the process responsible for the formation of flat bones, and EO is the process that forms long bones like femurs and humeri.

For both processes, generic mesenchymal stem cells (MSCs) are needed to trigger the growth of new bone. Despite this similarity, IO is significantly easier to re-create in the lab since MSCs can directly differentiate, or become specialized, into bone-forming cells without any additional steps.

However, this relative simplicity comes with limitations. To circumvent the issues associated with IO, Nukavarapu’s team set out to develop an engineered extracellular matrix that uses hydrogels to guide and support the formation of bone through EO.

“Thus far, very few studies have been focused on matrix designs for endochondral ossification to regenerate and repair long bone,” says Nukavarapu, who holds joint appointments in the departments of Biomedical Engineering and Materials Science and Engineering. “By developing a hybrid hydrogel combination, we were able to form an engineered extracellular matrix that could support cartilage-template formation.”

Nukavarapu’s team’s findings could be the first step to initiating the proper healing of long bones with biomedical help.

Using the Wisdom of Spider Webs

When someone breaks a load-bearing bone — the femur, for instance — doctors might install a metal plate to support the bone as it fuses and heals. But the metal can cause inflammation and irritation, and since metals are very stiff, the new bone may grow back weaker and more vulnerable to fracture.

UConn materials scientist and biomedical engineer Mei Wei and her team have developed an alternative to metal: a composite made with silk fibroin, a protein found in the silk fibers spun by spiders and moths and a common component in medical sutures and tissue engineering because of its strength and biodegradability.

Wei’s study found that the high-performance biodegradable composite showed strength and flexibility characteristics that are among the highest ever recorded for similar bioresorbable materials.

Working with UConn mechanical engineer Dianyun Zhang, Wei’s lab created a mix of silk and polylactic acid fibers coated in bioceramic particles. The new composite lasts about a year — large, adult leg bones can take many months to heal — and then starts to degrade. No surgery is required for removal.


Tissue engineer Syam Nukavarapu (left) examines a specimen of his hybrid hydrogel in his UConn Health lab.


Capturing the Power of Ultrasound

In the Department of Orthopaedic Surgery and the Institute for Regenerative Engineering at the UConn School of Medicine, researchers Yusuf Khan, Bryan Huey, and Lakshmi Nair are studying the combined power of gel-encapsulated bone cells and ultrasound waves to help fractured bones heal.

Physical force has been shown to stimulate bone cell regeneration for full healing, but immobilizing the fracture with a cast doesn’t allow for any movement. Khan believes that adding cells to the fracture site early on, and then directing a transdermal physical force toward the cells via low-intensity ultrasound, could accelerate fracture repair. In cases where a fracture can’t heal on its own, the therapy could provide the necessary stimulus to complete the healing process.

The team’s lab has already demonstrated the successful placement of bone cell hydrogels in mice and is working with the Department of Materials Science and Engineering to optimize the gel capsules for human use.

Harnessing Stem and Amniotic Cell Strength

Dr. Cato T. Laurencin, the Albert and Wilda Van Dusen Distinguished Professor of Orthopaedic Surgery and the director of the Institute for Regenerative Engineering at UConn Health, is developing clinical therapies to treat — and potentially reverse the effects of — osteoarthritis using human amniotic tissue, stem cells, and new combinations of the two.

An estimated 20 percent of Americans suffer from osteoarthritis, the most common degenerative joint disease and the leading cause of disability worldwide. Although current surgical and non-surgical therapies can provide some relief, none treat the root cause of the disease.

Stem cells have been proven to reduce pain and improve function in osteoarthritis patients. New studies suggest that the use of stem cells may heal cartilage, but results vary. Thanks to the host of powerful cytokines contained in amniotic tissue, many of which have been shown to decrease inflammation, Laurencin believes human amniotic tissue may overcome the limitations of current stem cell therapies, providing an ideal delivery system with added benefits.

“Soon, more surgeons and patients will realize that long hospital stays and recovery times are outdated.”

In its initial studies, Laurencin’s team has found its amnion-based delivery system can support stem cell survival, growth, and proliferation, and that the combination of amnion matrices and stem cells have immunosuppressive and anti-inflammatory effects on knee tissue cells.

“We believe amniotic tissue growth factors help drive human development and regeneration,” says Laurencin. “We are hopeful that harnessing this powerful new cell combination will help us further advance regenerative engineering for patients, especially those with arthritis or sports injuries, who want to avoid steroid treatments or are interested in next-generation therapies.”

Although it is not yet covered by insurance, amnion tissue treatment is available now to Laurencin’s patients. Laurencin’s team hopes to make the combination amnion¬stem cell therapy available within the next three years.

From the advanced research that’s changing the care of the future to the clinical changes happening now, Musculoskeletal Institute head Mazzocca says the Institute is uniquely positioned to provide the best possible care to patients.

“We try to take all the clinical people that treat musculoskeletal disease — rheumatology, osteoporosis, comprehensive spine, orthopaedics — and put it in one place, and combine them with all the researchers so they can cross-pollinate and make care better for the people of the state of Connecticut,” he says. “And there’s nobody else in the state of Connecticut that does what we do.”

Jessica McBride, Colin Poitras, and Lauren Woods contributed to this story.

Hybrid OR Expands Surgical Capabilities


This spring, neurosurgery chief Dr. Ketan Bulsara and his team were the first to perform surgery in UConn John Dempsey Hospital’s 1,200-square-foot hybrid operating room.

The team leveraged the new high-tech room and its dual advanced X-ray imaging capabilities to guide a successful minimally invasive neurological procedure.

“There are not many biplane hybrid operating rooms in the United States, and there are only a handful along the East Coast,” says Bulsara. “The biplane imaging provides surgeons multiple views and not only makes patient care safer but also allows surgeons to do things that we could not ordinarily do inside the operating room.”

The hybrid room gives surgeons the ability to perform a range of procedures in one setting, from minimally invasive treatments to the most complex neurosurgery, interventional cardiology, and vascular procedures.

“The hybrid operating room allows surgeons to choose what they feel is the best treatment for that patient,” says Bulsara.

According to Bulsara, the hybrid room enables UConn Health to continue providing world-class care to its patients while shaping the future of surgery and medicine and optimizing the personalized care given to each individual patient.

The hybrid operating room is a new tool for us that allows us to deliver health care in ways we have never been able to before.

UConn Health’s Dr. Stephen Lahey, chief of the Department of Cardiothoracic Surgery, says he couldn’t agree more.

“The hybrid operating room enables us to deliver health care in ways we have never been able to before,” says Lahey. “We now have all the advanced radiological equipment inside a huge operating room.”

All the high-tech equipment in the hybrid OR hangs from the ceiling, including imaging equipment, large plasma screens, and LED boom lights that assist surgeons with brighter and sharper lighting of the surgical field. A high-resolution video system provides real-time video and photo imaging during surgery for direct communication with the Department of Pathology or teleconferencing and live broadcasts of surgery for physician training and medical education.

Protecting Cancer Patients’ Heart Health

Kim Agnes looks at heart

Dr. Agnes Kim, director of the Cardio-Oncology Program at UConn Health, uses new echocardiography strain imaging to detect signs of potential heart problems in cancer patients, before clinical symptoms are evident.


There are currently more than 15 million cancer survivors in the U.S., and that number is expected to grow to 20 million within 10 years. But as more patients survive cancer, the risk of developing cardiovascular health issues from lifesaving chemotherapy and radiation treatments also is increasing.

In an effort to detect cardiac health risks or conditions early, UConn Health has begun tracking cancer patients with an advanced heart imaging test before, during, and after chemotherapy and radiation therapy.

New echocardiography strain imaging allows cardiologists to hunt for early warning signs of heart muscle function changes or damage within the heart tissue. The in-depth strain analysis is powered by traditional ultrasound technology, which uses high-frequency soundwaves to create a sonogram of the pumping heart.

Dr. Agnes Kim, director of the Cardio-Oncology Program at the Pat and Jim Calhoun Cardiology Center at UConn Health, says it’s very important to monitor cancer patients for any signs of cardiac toxicity.

“Echo strain imaging has been compared to a canary in a coal mine,” she says. “We are so grateful that our cancer patients have access to this latest technology so that we can monitor and intervene early if any warning signs are present.”

Studies have shown that confirming any changes in heart muscle strain can help doctors predict whether a patient is at risk for cardiotoxicity and its side effect of future heart failure. A decline in heart strain of 15 percent or more suggests cardiotoxicity, and doctors may prescribe cardio-protective drugs, such as beta-blockers or ACE inhibitors, or modify the patient’s chemotherapy dosage.

Possible cardiotoxicity side effects from chemotherapy medications include a lowering of overall heart muscle function, which can lead to heart failure, formation of blood clots, or an increase in blood pressure. The side effects of radiation therapy also can lead to damaged heart muscle, heart valves, and arteries, or impact the lining of the heart.

Kim launched the Cardio-Oncology Program in 2014 to ensure UConn Health had an integrated program of oncologists and cardiologists, allowing for coordinated care to address the potential risks to heart health that can arise from cancer treatment.

The program also is studying the presence of serum biomarkers in the blood for predicting whether a cancer patient is at high risk for cardiotoxicity, as well as tracking cancer patients’ long-term heart health to analyze the impact of additional clinical care protections.

Neuroimaging Technique Raises Stroke Treatment Standard

Dr. Leo Wolansky

Dr. Leo Wolansky, chair of the UConn Health Department of Radiology, shows the types of images CT perfusion scanning yields to help determine the best course of action in stroke treatment.


UConn John Dempsey Hospital is among only a few hospitals in the state to offer a new neuroimaging technique to patients who’ve suffered the most common type of stroke, potentially quadrupling the narrow window for intervention to 24 hours from the onset of symptoms.

The cutting-edge technique, which involves new software called RAPID, facilitates computed tomography (CT) perfusion imaging in emergency settings by making radiologic interpretation of perfusion data simpler, a particularly crucial feature when treating emergency stroke patients.

This helps physicians determine which patients are good candidates for a highly specialized neurosurgical and interventional radiological procedure called mechanical thrombectomy. The lifesaving procedure is only available at a few hospitals in the state; UConn Health Chief of Neurosurgery Dr. Ketan Bulsara performed UConn John Dempsey Hospital’s first-ever mechanical thrombectomy in November.

“It enables us to easily check how large an area of the brain is deprived of blood flow,” says Dr. Leo Wolansky, chair of the UConn Health Department of Radiology. “We can distinguish between the part of the brain that’s already dead [cerebral infarction] and the part of the brain that is in danger of dying [ischemic] but can be saved.”

In October, UConn Health rolled out the perfusion imaging program a week after processing its first functional MRI case for surgical guidance. The innovations are part of a system-wide initiative by UConn Health leadership to provide cutting-edge technology and recruit top physicians familiar with its use, such as Wolansky, in order to provide the finest care for neurological conditions.

Historically, when a patient has cerebral infarction, the most common type of stroke, the race is on to administer a clot-dissolving medication known as a tissue plasminogen activator (TPA). Mechanical thrombectomy traditionally has also been an option with a very limited timespan. With the introduction of advanced imaging such as RAPID, patients now can be treated safely for up to 24 hours of their stroke if the CT perfusion scan is favorable.

“We can tell if there is brain that can be saved, even beyond the previously accepted window of time for thrombectomy,” Wolansky says. “This creates the possibility of treating many ‘wake-up’ strokes, people who went to sleep well, but woke up eight hours later with a stroke.”

The results of a major study known as the DAWN trial, released in May 2017, showed good outcomes for stroke patients who were treated with thrombectomy up to 24 hours after the event.

Cooling Off Chemotherapy’s Side Effects

UConn Health’s Carole and Ray Neag Comprehensive Cancer Center is the only Connecticut institution outside Fairfield County to offer its breast cancer patients optional scalp-cooling therapy to reduce their chances of hair loss from chemotherapy treatments.

“Chemotherapy-induced temporary hair loss is one of the most common and stressful side effects breast cancer patients experience,” says Dr. Susan Tannenbaum, chief of the Division of Oncology and Hematology at UConn Health. “Anything we can do to limit a woman’s distress while she undergoes breast cancer care is essential for the patient’s overall holistic health.”

Research studies have shown that the FDA-cleared DigniCap, made by Dignitana Inc., is nearly 70 percent effective in reducing hair loss by at least half in breast cancer patients receiving chemotherapy.

While a patient undergoes intravenous chemotherapy treatments, the computerized cooling cap system circulates cooled liquid through a tight-fitting silicone cap. The cooling therapy works to limit chemotherapy’s side effects by constricting the scalp’s blood vessels, which limits the drug’s reach to the hair follicles and also slows the rate of hair cell division.

The technology’s arrival was spearheaded by donations from UConn Health professors Dr. William B. White and Nancy M. Petry, Ph.D., of the Pat & Jim Calhoun Cardiology Center, among others, and grant funding awarded to the UConn Foundation by the CT Breast Health Initiative.

Veteran’s Hearing Restored


UConn Health is using advanced cochlear implant technology to restore hearing in patients living with severe hearing loss. U.S. Navy veteran Peter Jacobs, 78, of Harwinton, Connecticut, is one of those grateful patients.

At age 18, Jacobs joined the navy and worked as a naval ship gunner. But the long-term repercussions of loud noise exposure during his military service included severe hearing loss, which surfaced in recent years.

“Anything that involved hearing, I was left out of. I couldn’t even hear at funerals,” said Jacobs. “But when I lost the ability to hear sirens and couldn’t talk on the phone, then I had to do something.”

Jacobs consulted UConn Health’s advanced ear, nose, and throat team of Dr. Daniel S. Roberts and audiologist Hillary Siddons, Au.D., about his candidacy for a cochlear implant, an electrical device that bypasses the native hearing mechanism to allow a patient to hear.

“Our recommendations for each patient are based on the degree of their hearing loss and how well a patient can understand words,” says Siddons. “If someone can understand less than 60 percent of conversations, they are likely a candidate for a cochlear implant.”

“When they first turned my cochlear implant on, it was amazing,” says Jacobs. “The best sound, other than my wife, is when I open a window and I can hear the birds. That’s wonderful.”

Following his positive patient experience, Jacobs now recommends cochlear implant technology to his fellow veterans and others who may be struggling with hearing loss.

“My message is do it, because it’s going to change your life,” says Jacobs.

“Cochlear implantation is a spectacular technology,” says Roberts. “It takes a patient from not being able to hear at all to being able to talk on the telephone. Some of the most dramatic outcomes that I have seen, and the happiest patients, are those after a cochlear implant.”

Roberts and his team care for patients experiencing hearing loss, tinnitus (ringing in the ears), and dizziness. Additionally, his surgery practice encompasses cochlear implantation and skull base surgery for acoustic neuromas and malignant or benign tumors.

New Epilepsy Monitoring Technology Tailors Patient Care

by Lauren Woods

Research At The Birkbeck Babylab Into Brain And Cognitive Development LONDON, ENGLAND - MARCH 03: Research assistant Katarina Begus, prepares a 'Geodesic Sensor Net' for an electroencephalogram (EEG) experiment at the 'Birkbeck Babylab' Centre for Brain and Cognitive Development, on March 3, 2014 in London, England. Researchers at the Babylab, which is part of Birkbeck, University of London, study brain and cognitive development in infants from birth through childhood. The scientists use various experiments, often based on simple games, and test the babies' physical or cognitive responses with sensors including: eye-tracking, brain activation and motion capture. (Photo by Oli Scarff/Getty Images)

The new epilepsy unit will feature a high-density geodesic EEG with more than 250 sensors in a cap like the one pictured. Oli Scarff/Getty Images


UConn Health is now home to a high-tech Epilepsy Monitoring Unit.

Located on the first floor of the new tower at UConn John Dempsey Hospital, the unit has two large patient rooms with state-of-the-art technology; 24-hour video observation capabilities; the latest in advanced electroencephalography (EEG) monitoring; and a dedicated team of neurology and neurosurgery doctors, nurses, and staff.

If needed, patients can be monitored for up to several days so doctors can determine whether the seizures are caused by epilepsy, what kind of seizures they are, and where they originate, says Dr. L. John Greenfield, chair of the Department of Neurology at UConn Health and a nationally-recognized epilepsy specialist. The monitoring information is critical to figuring out the best way to halt the seizures.

For patients with epileptic seizures, the information gathered helps doctors create a personalized clinical care plan and choose the most appropriate medications or adjustments for the patient’s seizure type.

For patients who may need surgical intervention to control their seizures, the new unit will allow doctors to precisely localize where the seizures start in the brain to see if neurosurgery might be a beneficial treatment option. According to Greenfield, if the seizure starts in the temporal lobe, there is a 70 to 80 percent chance the seizures can be cured with brain surgery.

Greenfield hopes the data and insights gained from the new unit’s video and EEG monitoring will advance future brain research and clinical care for epilepsy patients. The new unit will soon offer high-density geodesic EEG recordings that can sample patient brain wave data using more than 250 electrode sensors contained in a wearable, stretchy web that fits over the head like a swim cap. This device can pinpoint epileptic activity with much higher precision than traditional EEGs, which record signals using only 19 electrodes.

“With the combination of our state-of-the-art monitoring unit, clinical care, research, and our new chief of neurosurgery, Dr. Ketan Bulsara, UConn Health can now provide comprehensive care for patients with epilepsy and with seizures due to brain tumors or vascular malformations,” saya Greenfield. Bulsara specializes in skull base, endovascular, and tumor neurosurgery.

Pinpointing Risk Factors to Prevent Postoperative Delirium

by Lauren Woods


With rising surgery demands among the growing population of older adults, the UConn Center on Aging and UConn John Dempsey Hospital are teaming up to identify older patients at the greatest risk of developing postoperative delirium in order to prevent it.

Patients with delirium have an altered level of alertness and are sometimes excessively drowsy, hyper-alert, or agitated. Although postoperative delirium is usually short-term, lasting hours or days, the brain may not recover for weeks or months in older adults. If the condition is not identified and addressed, delirium can lead to a decline in an older patient’s surgical recovery and cognitive and physical health, a need for caregiver or nursing home care, or potentially an increased risk of death.

“Our goal is to do everything in our power to screen older patients before surgery for delirium’s risk factors and to prevent it after surgery — or at least minimize its duration and effect,” says UConn Center on Aging’s Dr. Patrick Coll, who has been working closely with surgeons and anesthesiologists to modify preoperative delirium screening protocols at UConn Health. “All doctors really should be adding delirium-risk-factor screening to their preoperative evaluations for patients age 75 and above.”

Risk factors for postoperative delirium in older patients include prior delirium after a surgery, underlying or existing cognitive impairment such as dementia or Alzheimer’s disease, heavy alcohol consumption that increases withdrawal risk, depression, frailty, malnutrition, immobility, infection, or taking certain medications.

Historically, surgery risk-prevention primarily focused on such areas as cardiac or pulmonary health. Last year, the American College of Surgeons and the American Geriatric Society issued new guidelines for optimal geriatric surgery patient management, which for the first time included screening for delirium risk before and after surgery.

“If a patient is deemed high-risk, the patient should have a geriatric assessment prior to surgery to help mitigate their risk and, after surgery, the hospital care team should plan to very closely monitor the patient,” said Coll.

The hospital care team can take simple, proactive steps to quickly reorient an older patient after surgery, Coll says. Even having a patient’s reading glasses and hearing aids readily available can make a big difference, as well as avoiding or limiting medications that can contribute to delirium, such as opioids.

With the help of aging expert Dr. Lavern Wright, UConn Health’s NICHE (Nurses Improving Care for Healthsystem Elders) program is expanding its scope to the surgical floors of the hospital to reduce older patients’ risk of delirium and other health complications. Further, all nurses now have access to the Confusion Assessment Method (CAM) tool and an electronic medical record order set to guide them in decreasing delirium’s impact.

In addition, Dr. Richard Fortinsky and his team are studying the effect of visiting clinical care teams at the homes of older adults with a history of delirium and other cognitive vulnerabilities to improve patient outcomes. This study, funded by the Patient-Centered Outcomes Research Institute, involves an in-home care program featuring a nurse practitioner who assesses older adults for delirium using a brief version of the CAM. The nurse practitioner also assesses for depression and dementia and teaches the patient and family members how to manage these conditions at home.

Dr. Alessi and the Concussion (R)evolution

by Peter Nelson

an artsy illustration of a brain overlooking a landscape brain


“You wanna fight? You damn stupid fool,” says Jackie Gleason’s character, trainer Maish Rennick, to Louis “Mountain” Rivera (played by Anthony Quinn) in the 1962 film “Requiem for a Heavyweight.”

“Don’t you understand? The odds are, all you’ll wind up is a mumbling idiot — a stuttering jerk. Why don’t you go home?”

Dr. Anthony Alessi, UConn Health associate clinical professor of neurology and orthopedics and director of the UConn NeuroSport Program, has been giving fighters similar messages, albeit more tactfully phrased, for the last 21 years as the consulting neurologist during boxing matches at Mohegan Sun. He has gone on to study head trauma in other sports, how to measure recovery, how to gauge when an athlete is ready to return to play, and how to prevent head injuries. But he got his start as a “fight doctor.”

After working as an athletic trainer at Mount St. Michael Academy in the Bronx, Alessi eventually opened a neurology practice in Norwich, Connecticut. He started working with the Yankees’ Double-A team, and noticed during his hospital shifts that he was looking at many baseline, prefight brainwave EEGs for boxers on the cards at Mohegan Sun casino.

“The Connecticut boxing commissioner invited me to come down to watch a fight,” Alessi says. “After the fight, he said, ‘How would you like to work with us?’ I said, ‘Do I get to end the fight?’”
“He said, ‘We want you to.’ I’ve been ending fights since 1996.”

There’s no such thing as a minor concussion. And as I tell students, if you’ve seen one concussion, you’ve seen one concussion. They’re all different.

Alessi admits it’s odd for a neurologist to work in a sport where the entire goal is to induce maximum cognitive impairment in your opponent — but that’s exactly what makes his presence imperative.

“In mixed martial arts, you have the ability to tap out,” Alessi says. “In boxing, they can’t quit. But you’d be surprised how many times you go into the corner and the fighter doesn’t want to come back out. That’s the first question I ask them, and if they say no, I end the fight. He’ll still get paid, and I’ve saved his life.”

The American Academy of Neurology has backed off from its edict in the 1980s that boxing should be banned, instead calling for measures including more regulations and formal neurologic examinations for fighters. Alessi says more and more neurologists have gotten involved in the sport, screening individuals to determine whether they should fight.

Besides protecting individual athletes, Alessi has used boxing as a lens through which to view the larger picture surrounding head trauma.

“As the public awareness about long-term brain damage from concussions developed, I realized it was like I had my own lab,” he says.

More to Learn

The world has known for a long time about the dangers of head trauma, the syndrome codified in 1928 when New Jersey forensic pathologist Dr. Harrison Stanford Martland published a paper in The Journal of the American Medical Association on fighters and coined the term “punch drunk.”

Today, it seems that new findings on head injury are in the news daily. Since 2001, more than 60,000 scientific papers on chronic traumatic encephalopathy (CTE) and brain trauma have been published, raising awareness at both the public and professional levels, leading to protocols where athletes are pulled from games at the first sign of concussion. Trainers are taught to perform a SCAT5 (Sport Concussion Assessment Tool, 5th edition), elaborating on the questions the old cigar-chomping cornermen used to ask fighters between rounds: “What’s your name? What day is it? Do you know where you are?”

The SCAT5 is used because the greatest and most immediate danger to concussion sufferers is second-impact syndrome, a fatal edema caused by a second head trauma sustained before the brain has had time to repair torn tissues, ruptured blood vessels, or damage at the cellular level from an earlier injury. Other organs have room to expand if they swell. The brain, encased in a hard shell, does not.

“There’s no such thing as a minor concussion,” says Alessi, who teaches at the UConn School of Medicine. “And as I tell students, if you’ve seen one concussion, you’ve seen one concussion. They’re all different. In most cases, a single concussion should not cause permanent damage, but a second concussion, soon after the first, does not have to be very strong for its effects to be permanently disabling or deadly.”


Throughout his career, neurologist Dr. Anthony Alessi has served as a consultant for professional boxers and football and baseball players, as well as UConn student-athletes.

Throughout his career, neurologist Dr. Anthony Alessi has served as a consultant for professional boxers and football and baseball players, as well as UConn student-athletes. Over the decades, he has witnessed a sea change in the way people talk about, prevent, and treat head injuries in contact sports. Peter Morenus


The problem with studying concussions is that you can’t line up a variety of test subjects of various ages and sizes, take baseline measurements, and then hit them in the head with a 13-pound bowling ball moving 20 mph — the equivalent, experts estimate, to taking a punch from a pro boxer. You can’t then compare those results to the results from hitting them with 6-pound bowling balls moving 40 mph, or to what the results would be if you hit them once an hour, or once a day for a month, or in the side of the head instead of the front.

“Ninety percent of the time, after a concussion, you wait 10 days and the athlete is going to be okay. But we still don’t know what the long-term effects might be. We know how the cells repair themselves, but we don’t know what kind of debris might be left behind once the cells heal,” Alessi says.

Playing Smarter

In July, Boston University released the results of a study of the brains of 202 deceased football players, 111 of whom had played in the NFL. All but one of the NFL players’ brains were found to have CTE.

Alessi is, of course, aware of the current discussion of CTE in relation to professional sports, but he attends from a scientist’s detached distance.

“There’s an association with football, but it doesn’t mean there’s causation. It’s an important difference. There’s a lot of selection bias.”

Those who donate their brains, Alessi says, may be looking for a biological explanation for their depression, for example.

Alessi is more concerned that attention is being paid in the wrong places.

“It’s a pyramid,” he says. “There are only 1,800 professional football players. In college football, there are 54,000. In high school football, about a million. In youth football, you have over 3 million children. Another 3 million children play youth soccer, and a half million play youth hockey. So you have 6.5 million young athletes playing high-velocity collision sports, all with brains that are still developing.”

Children lack both the myelin sheathing that protects older brains and the developed neck musculature that helps older athletes avoid injury. In addition to working with UConn student-athletes and teams, Alessi advises youth sports programs and is concerned for the younger athletes.

“They’re smaller and they don’t move as fast, so the force of impact is less, but they’re more vulnerable,” Alessi says. “We used to think if you let kids play full-contact sports, it will toughen them up — not true. The more contact you have, the greater the risk.

“There’s also inadequate medical attention at those levels,” he says. “We’re not paying attention to where our resources should be placed the most.”

The Korey Stringer Institute (KSI), a national sports safety research and advocacy organization based at UConn, recently urged state high school athletic associations to implement life-saving measures after KSI conducted the first comprehensive state-by-state assessment of high school sports safety polices. Each state received a score based on the extent to which it met best- practice guidelines addressing the four leading causes of sudden death among secondary school athletes, which include head injuries.

Requiring the presence of certified athletic trainers at every secondary school athletic event and training coaches on concussion symptoms are among the bare-minimum guidelines, which are endorsed by leading sports medicine organizations in the United States.

Still, progress has been made.

Banning checking and headers in youth hockey and soccer and reducing full-contact practices to once a week for professional and college football have been linked to reduced injuries, Alessi says. But many youth football teams still have full-contact practice five days a week.

No one wants collision sports to go away, Alessi says, but instead of striving to play harder, he believes we can strive to play smarter.

“You have to ask, what’s to be gained from high-velocity impact at a young age? The fastest-growing youth sport in America today is flag football. Archie Manning [former pro-football quarterback and father of Peyton and Eli Manning] didn’t let his sons play youth football. Tom Brady never played youth football. A lot of really good professional athletes in the NFL knew that they could build skill without getting hit,” Alessi says.

“I think there’s a lot to be gained by us changing the rules. We’ve made a lot of headway with all neurologic injuries in sports. Legislation isn’t required to deploy common sense.”

Thanks to the work of Alessi and people like him, athletes know the risks before they step on the field or in the ring. While there’s always more research to be done, at the very least, we’ve replaced the comical cartoon image of the cross-eyed concussion victim — with the lump rising from his noggin and stars and birds circling his head — with reliable information. The kind of information an athlete in a collision sport needs to make informed decisions and to play safely, avoiding injuries when possible and returning to play only when it’s safe to do so.

“If you gotta say anything to him,” Maish Rennick says of “Mountain” Rivera at the end of the movie, “tell him you pity him. Tell him you feel so sorry for him you could cry. But don’t con him.”