Stroke

Lab Notes – Fall 2017

E-Cigarettes Not a Safe Alternative

Using a new low-cost, 3-D-printed testing device, UConn researchers found that e-cigarettes loaded with a nicotine-based liquid are potentially as harmful as unfiltered cigarettes when it comes to causing DNA damage. The researchers also found that vapor from non-nicotine e-cigarettes caused as much potentially cancer-causing DNA damage as filtered cigarettes, possibly due to the many chemical additives present in e-cigarette vapors. Several factors impact the amount of DNA damage e-cigarettes cause, says Karteek Kadimisetty, a postdoctoral researcher in UConn’s chemistry department and the study’s lead author. “I never expected the DNA damage from e-cigarettes to be equal to tobacco cigarettes,” says Kadimisetty. “I ran the controls again. I even diluted the samples. But the trend was still there — something in the e-cigarettes was definitely causing damage to the DNA.” The findings appear in the journal ACS Sensors.

electronic cigarette


New Device Tests Heart Health

finger pricked with a spot of blood (for blood sugar test)

UConn researchers from the Department of Mechanical Engineering have developed a device that can test blood viscosity during a routine office visit. The heart must work harder to pump sticky — high viscosity — blood, and studies have shown thicker blood can indicate cardiac event and stroke risk. UConn associate professor of mechanical engineering George Lykotrafitis and doctoral candidate Kostyantyn Partola have filed a provisional patent on the small electronic device, which requires just a finger prick of blood, gives precise readings in minutes, and costs under $1,000. Currently, physicians must send large blood samples to off-site labs for analysis in a rheometer. “With this information, doctors can suggest simple lifestyle changes on the spot to prevent their patients from having a stroke or heart attack,” says Partola.


The Lack of Black Men in Medicine

Male african-american doctor

Medical school matriculation rates for black males have failed to surpass those from 35 years ago, according to a recent UConn Health analysis of data from the Association of American Medical Colleges. African-American men make up just 2.8 percent of the applicants to medical school. Out of all African-American applicants, only 38 percent are men, and black males who are unsuccessful in their first application are less likely to reapply than their white counterparts, the researchers write in the Journal of Racial and Ethnic Health Disparities. “The absence of Black males in medical school represents an American crisis that threatens efforts to effectively address health disparities and excellence in clinical care,” wrote authors Dr. Cato T. Laurencin and Marsha Murray.


Lifting Spirits Doesn’t Require Many Reps

25KG weight

More physical activity is not necessarily better when it comes to improving your mood, especially if you spend most of your day sitting, UConn and Hartford Hospital researchers found in a recent study. The work, published in the Journal of Health Psychology, found that people who led sedentary lives and engaged in light or moderate activity showed the greatest improvement in overall sense of well-being. Further, the study found no positive or negative association between high-intensity physical activity and subjective well-being, contradicting a widely reported recent study that found high-intensity workouts significantly lowered some people’s sense of well-being.

3-D Printed Model Allows Brain Surgeons to Rehearse

by Kim Krieger

Dr. Charan K. Singh, right, threads a catheter through a 3-D printed model of arteries in the brain while speaking with Dr. Clifford Yang, one of the  model's creators, at UConn Health.

Dr. Charan K. Singh, right, threads a catheter through a 3-D printed model of arteries in the brain while speaking with Dr. Clifford Yang, one of the model’s creators, at UConn Health. Peter Morenus


The first time a young surgeon threads a wire through a stroke victim’s chest, up through the neck, and fishes a blood clot out of the brain may be one of the most harrowing moments in their career. Now, a UConn Health radiologist and a medical physicist have made it easier for them to get some practice first. The team made a life-size model of the arteries that wire must pass through, using brain scans and a 3-D printer. They will make the pattern freely available to any doctor who requests it.

Five years ago, the Food and Drug Administration (FDA) approved mechanical thrombectomy — using a wire to pull clots out of the brains of stroke victims. A trap at the end of the wire opens like a little snare that captures the clot, which is then dragged out of the patient.

After a couple months of tweaking, a UConn Health radiologist and a medical physicist found they could print a true-to-life teaching model of the brain’s major arteries for about $14.

A lot can go wrong on that journey. One of the most dangerous complications is also one of the most likely: another clot can be accidentally knocked loose from the walls of the arteries and get stuck in the heart, the lungs, or elsewhere in the brain. Computer simulations of the procedure exist, but they are prohibitively expensive for many medical schools to purchase. Yet interventional radiologists and neurosurgeons need to train extensively before they work on a real person.

UConn Health cardiac radiologist Dr. Clifford Yang and medical physicist intern David Brotman knew they could help young doctors feel more comfortable with the mechanics.


Because of the prohibitive costs of computer simulation programs, often the first time a surgeon threads a wire into a stroke victim’s brain to remove a blood clot is during the doctor’s first surgery. Using brain scans and a 3-D printer, a UConn team made a life-size model of the arteries surgeons must navigate during the procedure so they can practice first. The pattern is available for free to any doctor who requests it.


“What matters is the ability of the doctor to be confident in guiding the wire,” says Brotman. He and Yang found a brain scan of a patient with typical blood vessel structure and used the scan to design a 3-D model of the blood vessels. Finding a good scan was easy: UConn has an immense library of scans from computed tomography (CT) and magnetic resonance imaging (MRI) of patients. The tough part was converting the data into something a 3-D printer could interpret. Brotman and Yang found and modified publicly available software to do that, and after a couple months of tweaking, they found they could print a true-to-life teaching model of the brain’s major arteries for about $14.

Technically called a brain perfusion phantom, the model is surprisingly delicate. Holding it in your hand brings home just how small the arteries are, even in an adult man. The top arch of the aorta in the chest, big enough to slide an adult’s pinky finger through, connects to the carotid in the neck and then on to the Circle of Willis in the brain, which is no thicker than a fat piece of yarn. The circle has six branches. Each branch supplies blood to one-sixth of the brain. It is in these branches that clots are most likely to get stuck and cause serious damage.

“We are using this model to teach students,” says UConn interventional radiologist Dr. Charan Singh. “Obviously, it won’t feel like the human body. But it will improve their knowledge of anatomy and give them basic technique on how to move the catheter.”

What matters is the ability of the doctor to be confident in guiding the wire.

Singh demonstrates how a slight twist can violently flip the catheter, which is dangerous. It could knock off new clots into the bloodstream. The model isn’t perfect — there are several different ways a person’s aorta can be shaped, and the other veins can vary too. But students can get good practice with it, Singh says.

Dr. Ketan Bulsara, UConn’s chief of neurosurgery, also likes the technology. He cautions that individual anatomy varies too much for it to be used as the only training tool to learn mechanical thrombectomy, but says that it could potentially be used to visualize other conditions, such as brain tumors. Surgery for brain tumors has significant lead time, and modeling the tumor in advance could personalize and improve patient care.

“Creating these high-level 3-D models customized for individual patients has the potential to significantly improve outcomes and reduce operative times by enhancing surgical planning,” Bulsara says.

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.”

The Power of MRI

A UConn Health physician is seen reviewing an MRI brain scan.

A UConn Health physician is seen reviewing an MRI brain scan. At UConn Health, doctors are pioneering ways to use MRI technology to diagnose and monitor a range of conditions affecting many parts of the body Photo: Peter Morenus


Magnetic resonance imaging (MRI) has come a long way since the technique was first used in the U.S. in the late 1970s. UConn Health is now taking this powerful, non-invasive imaging tool to the next level.

UConn Health physicians in a variety of specialties are using the technology — which captures images of the inside of the body using a large magnet rather than radiation — in new ways to detect and monitor illnesses.

Prostate Cancer

Dr. Peter Albertsen, chief of UConn Health’s Division of Urology, currently follows 100 patients with localized prostate cancer, which is slow-growing, using advanced multiple-parametric MRI imaging. The technology has now replaced ultrasound as the imaging method of choice for prostate cancer. The technique yields multiple imaging sequences of the prostate, providing information about the anatomy, cellular density measurement, and vascular supply.

There is growing evidence to support the idea that the best treatment plan for low-grade prostate cancer is “watchful waiting” to monitor its progression, instead of immediate surgery or radiation. Albertsen’s practice of active surveillance, and not intervention, for localized prostate cancer was reinforced by a recent long-term study published in September in the New England Journal of Medicine, on which Albertsen served as a consultant.

The technology is extraordinarily helpful, allowing us to avoid invasive biopsy testing and associated risks of bleeding and infection.

Liver Disease

UConn Health is the first in Greater Hartford to use MRI to measure the stiffness of patients’ livers to reveal disease without the need for biopsy. Its MR elastography technique involves placing a paddle on a patient’s skin over the liver during MRI to create vibrations and measure the velocity of the radio waves penetrating the organ. This can indicate a stiffer liver and help diagnose fibrosis, cirrhosis, a fatty liver, or inflammation associated with hepatitis. The initiative is led by Dr. Marco Molina, radiologist in the Department of Diagnostic Imaging and Therapeutics.

“The technology is extraordinarily helpful, allowing us to avoid invasive biopsy testing and associated risks of bleeding and infection,” Molina says. “Plus, with the obesity epidemic, patients developing nonalcoholic steatohepatitis (NASH), or fatty liver, can receive earlier diagnosis and take action to reverse their disease’s progression with diet and exercise.”

Breast Cancer

The new Women’s Center at UConn Health has opened its state-of-the-art Beekley Imaging Center, featuring advanced breast cancer screening. Dr. Alex Merkulov, associate professor of radiology and section head of women’s imaging, and his team are conducting research to test the effectiveness of using an abbreviated, five-minute MRI scan to confirm or rule out a breast cancer diagnosis. Typically, an MRI test takes 20 minutes, but researchers are seeing that a briefer MRI scan of just a few minutes can help provide a definitive answer to whether an abnormal breast growth is cancer or not — and potentially help women avoid the biopsy process.

Arthritis

The UConn Musculoskeletal Institute is now researching the use of MRI to assess and map the strength, weakness, and underlying makeup of a patient’s cartilage, especially for those with arthritis. The tool can allow orthopedic experts to identify any thinning or loss of cartilage in the body, which signifies moderate to late-stage disease. In early stages of arthritis, MRI can help pinpoint early morphological and subtle biochemical changes in cartilage.

Neurological Disorders

In neuroradiology, UConn Health is using the power of MRI to differentiate brain tumors, to detect strokes, to assess dementia, to diagnose multiple sclerosis, to evaluate traumatic brain injury, to find the source of epilepsy, and to guide brain surgery. In March 2017, leading neuroradiologist Dr. Leo Wolansky joins UConn Health to advance its research and chair the Department of Diagnostic Imaging and Therapeutics. Wolansky’s neuroimaging research has focused on enhancing understanding of MRI and its contrast agents, especially for multiple sclerosis and brain tumors. He also specializes in the hybrid imaging modality PET-MRI.

“Thanks to the power and advancement of MRI, doctors can see early evidence of disease and seize the opportunity to intervene and improve their patients’ health,” Molina says.

New Neurology Chair Sees UConn’s Possibilities

UConn Health Exterior, Farmington CT


Dr. L. John Greenfield looks forward to helping push UConn Health’s Department of Neurology to the next level as its new chair.

Greenfield, a nationally known epilepsy expert, came to UConn Health in early September from the University of Arkansas for Medical Sciences College of Medicine, where he also served as chair of neurology. He will also serve as the academic chair of neurology at Hartford Hospital.

“I see a lot of possibilities at UConn,” Greenfield says.

These include goals of establishing an epilepsy monitoring unit, developing a high-density electroencephalography (EEG) facility, and continuing to expand the stroke, neuromuscular, MS, and movement disorders programs.

Because we’re training the next generation of neurologists, we’re focused on … doing research and developing new treatments.

Greenfield’s arrival as UConn Health’s third epilepsy specialist puts the department at a “critical mass for moving things to the next level,” he says.

Previously, UConn Health has relied on Hartford Hospital for inpatient monitoring of epilepsy patients to determine if they are candidates for epilepsy surgery. Greenfield hopes UConn can establish its own unit for the initial phase of the process. He plans for continued and expanded collaboration with neurologists at Hartford Hospital in epilepsy and other areas. Neurologists at UConn and Hartford Hospital already work closely together in training neurology resident physicians and fellows.

UConn Health is also developing a high-density EEG facility, which would be a resource for the region, he says. Traditional EEGs monitor brainwaves using 15-20 electrodes. A high-density EEG involves a special cap with more than 250 contact points, providing more detailed information on where seizures are coming from, along with other potential uses.

The department also plans to hire more doctors to support its successful movement disorders, neuromuscular, MS, and stroke programs, according to Greenfield, while continuing to provide top-quality care in more “bread and butter” neurological disorders, such as chronic headaches.

“The fact that we’re accessible, very highly trained and patient focused, and an academic medical center gives us an edge against our competitors,” Greenfield says. “Because we’re training the next generation of neurologists, we’re focused on not only using the latest techniques and information so we can teach them, and also doing research and developing new treatments.”