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UPMC Celebrates 25th Anniversary of First Gamma Knife Procedure to Treat Brain Lesions Non-Invasively
PITTSBURGH – UPMC rose to 10th place in U.S. News & World Report’s annual Honor Roll of America’s Best Hospitals – making it the highest-ranked medical center in Pennsylvania. U.S. News & World Report ranked UPMC first in the state and first in Pittsburgh.
“This national recognition is a testament to the skill and dedication of our physicians, nurses and staff and to the superb care they provide every day at UPMC. Our patients and our community have come to expect this level of excellence and we are committed to assuring we deliver. Our proudest achievements come when we make a difference in the lives and health of our patients,” said Elizabeth Concordia, executive vice president of UPMC and president of the Hospital and Community Services Division. “When patients require care, the choice is clear; the nation’s best care is here at UPMC.”
Nationally, UPMC is ranked for excellence in 15 adult specialty areas and is among the top 10 in nine specialty areas: Ear, Nose & Throat; Gastroenterology; Geriatrics; Gynecology; Nephrology; Neurology and Neurosurgery; Orthopaedics; Psychiatry and Pulmonology.
Last month, U.S. News named its 2012 Honor Roll of America’s Best Children’s Hospitals, on which Children’s Hospital of Pittsburgh of UPMC ranked ninth. This year marks UPMC’s 13th appearance on the Honor Roll. Last year, the list placed UPMC 12th nationally.
“A stellar ranking such as this validates what we know to be true – that UPMC is one of the very few academic medical centers in the nation that brings together the best in patient care, top-notch facilities and superior scientists,” added Steven Shapiro, M.D., senior vice president and chief medical and scientific officer, UPMC. “The exceptional clinical services that UPMC provides, fortified by Pitt’s academic research, work hand-in-hand to help us care for patients when they need us.”
UPMC is a $10 billion global health enterprise with more than 55,000 employees headquartered in Pittsburgh, Pa., and is transforming health care by integrating more than 20 hospitals, 400 doctors’ offices and outpatient sites, a health insurance services division, and international and commercial services. Affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is redefining health care by using innovative science, technology and medicine to invent new models of accountable, cost-efficient and patient-centered care. For more information on how UPMC is taking medicine from where it is to where it needs to be, go to UPMC.com.
Chief of Pediatric Neurosurgery at Children’s Hospital of Pittsburgh of UPMC’s Brain Care Institute Receives Prestigious Award for First-of-its-kind Study of Peptide Vaccine
PITTSBURGH, April 30, 2012 – Millions of stem cells derived from the bone marrow of healthy adult donors have been implanted in the brains of two stroke survivors at UPMC, one of two sites conducting a safety and dose escalation study of the technique.
Led locally by Douglas Kondziolka, M.D., Peter J. Jannetta Professor and vice-chairman, Department of Neurological Surgery, and Lawrence Wechsler, M.D., professor and chair, Department of Neurology, University of Pittsburgh School of Medicine, the trial is the first step in determining whether bone marrow stem cells injected into the brain have therapeutic value in the healing of stroke lesions.
Funded by Mountain View, Calif.-based SanBio, Inc., the project will evaluate stroke therapy using SB623 cells, which are stem cells that are isolated from bone marrow and modified using recombinant DNA methods. The other testing site is at Stanford University.
“Lab and animal testing of these cells have shown that they are not replacing the neurons that have been lost,” explained Dr. Kondziolka. “Eventually, the transplanted cells disappear. But while they’re present, they appear to secrete factors that encourage the brain to repair itself by rebuilding neural connections or helping existing ones work better.”
The researchers are seeking participants between the ages of 18 and 75 who have had an ischemic stroke between six months and three years before study entry. Ischemic strokes occur when a blocked artery interrupts the flow of blood and oxygen in the brain, leading to cell death. Study candidates will undergo brain scans and be evaluated to ensure they have plateaued in their recovery from the stroke.
Participants receive local anesthetic and light sedation for the surgical procedure, Dr. Kondziolka said. Small incisions are made in the scalp and skull and, using scans and brain mapping technology, a probe is guided to the stroke area for deposition of the SB623 cells. Participants will be evaluated periodically for the next two years.
The first six patients received 2.5 million cells; the next six will receive 5 million cells; and the final six, 10 million cells, Dr. Wechsler said. Between each dose escalation, the participants will be carefully monitored to verify the process is safe.
He noted that every year, 800,000 Americans have strokes, making it the fourth leading cause of death and the leading cause of adult disability. Even small changes in neurological function can lead to a big effect on function.
“A little gain in leg strength could mean the difference between requiring a wheelchair and walking. The ability to grip could mean being able to feed yourself,” Dr. Wechsler said. “Cell therapy for stroke and other neurological disorders holds great promise, but first we must methodically test these techniques to ensure safety before we can determine their effectiveness.”
For more information on the SanBio study, contact study coordinator Julia Billigen at 412-605-3959 or BilligenJB@upmc.edu.
First-of-its-kind Study of Peptide Vaccine by Pittsburgh Researchers Shows Evidence of Immunological Response in Children with Gliomas
PITTSBURGH, April 2, 2012 – In a first-of-its-kind study, researchers from Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh Cancer Institute (UPCI) Brain Tumor Program have demonstrated that peptide vaccines in children with gliomas, the most common type of brain tumor, not only were well-tolerated but also showed evidence of immunological responses. The results of the study will be presented during a press conference today at the AACR Annual Meeting 2012 in Chicago.
The study, led by Ian F. Pollack, M.D., F.A.C.S., F.A.A.P., chief, Pediatric Neurosurgery at Children’s Hospital’s Brain Care Institute and co-director of UPCI’s Brain Tumor Program, and Dr. Regina I. Jakacki, M.D., director of Pediatric Neuro-Oncology, enrolled 27 children with gliomas, including 16 with newly diagnosed brainstem gliomas, five with newly diagnosed cerebral high-grade gliomas and six with recurrent gliomas. Each child received serial doses of a peptide vaccine, which stimulates an immune response to a protein fragment present on their tumor cells.
“We’ve found that this vaccine is tolerated well with limited systemic toxicity, but we’ve also observed that there are some patients who have immunological responses in the vaccine target in the brain that can cause swelling and transient worsening and, subsequently, some of those children can have very favorable responses,” said Dr. Pollack, the Walter Dandy professor of neurological surgery and vice chairman for academic affairs in the department of neurological surgery at the University of Pittsburgh School of Medicine. “We’ve also demonstrated immunological responses in the majority of the kids.”
Children with eligible tumor types received a vaccine targeting glioma-associated antigen (GAA) proteins, including EphA2, IL13Rα2 and survivin, every three weeks, for a total of eight doses.
“These kids, who, for the most part, have intact and very strong immune systems, seem to mount an immune response against the vaccine very effectively at rates that may be even higher, I think, than have been noted in studies in adults,” Dr. Pollack said.
Among the 22 cases evaluated, three children had rapidly progressive disease, 15 had stable disease for more than three months, three had sustained partial responses, and one had prolonged disease-free status after surgery. An immune response analysis, which was completed in seven children, revealed responses in six children: to IL13Rα2 in five cases, EphA2 in three and survivin in three.
“This was the first study of its type that examined peptide vaccine therapy for children with brain tumors like this,” Pollack said. “The fact that we’ve seen tumor shrinkage in children with very high-risk tumors has been extremely encouraging and somewhat surprising.”
The study was funded by the National Institutes of Health and the Pediatric Low-Grade Glioma Initiative.
For more information about Dr. Pollack, Dr. Jakacki, or Children’s Hospital, visit www.chp.edu.
New High Definition Fiber Tracking Reveals Damage Caused by Traumatic Brain Injury, Pitt Team Reports
PITTSBURGH, March 2, 2012 – A powerful new imaging technique called High Definition Fiber Tracking (HDFT) will allow doctors to clearly see for the first time neural connections broken by traumatic brain injury (TBI) and other neurological disorders, much like X-rays show a fractured bone, according to researchers from the University of Pittsburgh in a report published online today in the Journal of Neurosurgery.
In the report, the researchers describe the case of a 32-year-old man who wasn’t wearing a helmet when his all-terrain vehicle crashed. Initially, his CT scans showed bleeding and swelling on the right side of the brain, which controls left-sided body movement. A week later, while the man was still in a coma, a conventional MRI scan showed brain bruising and swelling in the same area. When he awoke three weeks later, the man couldn’t move his left leg, arm and hand.
“There are about 1.7 million cases of TBI in the country each year, and all too often conventional scans show no injury or show improvement over time even though the patient continues to struggle,” said co-senior author and UPMC neurosurgeon David O. Okonkwo, M.D., Ph.D., associate professor, Department of Neurological Surgery, Pitt School of Medicine. “Until now, we have had no objective way of identifying how the injury damaged the patient’s brain tissue, predicting how the patient would fare, or planning rehabilitation to maximize the recovery.”
HDFT might be able to provide those answers, said co-senior author Walter Schneider, Ph.D., professor of psychology at Pitt’s Learning Research and Development Center (LRDC), who led the team that developed the technology. Data from sophisticated MRI scanners is processed through computer algorithms to reveal the wiring of the brain in vivid detail and to pinpoint breaks in the cables, called fiber tracts. Each tract contains millions of neuronal connections.
“In our experiments, HDFT has been able to identify disruptions in neural pathways with a clarity that no other method can see,” Dr. Schneider said. “With it, we can virtually dissect 40 major fiber tracts in the brain to find damaged areas and quantify the proportion of fibers lost relative to the uninjured side of the brain or to the brains of healthy individuals. Now, we can clearly see breaks and identify which parts of the brain have lost connections.”
HDFT scans of the study patient’s brain were performed four and 10 months after he was injured; he also had another scan performed with current state-of the-art diffusion tensor imaging (DTI), an imaging modality that collects data points from 51 directions, while HDFT is based on data from 257 directions. For the latter, the injury site was compared to the healthy side of his brain, as well as to HDFT brain scans from six healthy individuals.
Only the HDFT scan identified a lesion in a motor fiber pathway of the brain that correlated with the patient’s symptoms of left-sided weakness, including mostly intact fibers in the region controlling his left leg and extensive breaks in the region controlling his left hand. The patient eventually recovered movement in his left leg and arm by six months after the accident, but still could not use his wrist and fingers effectively 10 months later.
Memory loss, language problems, personality changes and other brain changes occur with TBI, which the researchers are exploring with HDFT in other research protocols.
UPMC neurosurgeons also have used the technology to supplement conventional imaging, noted Robert Friedlander, M.D., professor and chair, Department of Neurological Surgery, Pitt School of Medicine, and UPMC Endowed Professor of Neurosurgery and Neurobiology. He is not a member of this research study.
“I have used HDFT scans to map my approach to removing certain tumors and vascular abnormalities that lie in areas of the brain that cannot be reached without going through normal tissue,” he said. “It shows me where significant functional pathways are relative to the lesion, so that I can make better decisions about which fiber tracts must be avoided and what might be an acceptable sacrifice to maintain the patient’s best quality of life after surgery.”
Dr. Okonkwo noted that the patient and his family were relieved to learn that there was evidence of brain damage to explain his ongoing difficulties. The team continues to evaluate and validate HDFT’s utility as a brain imaging tool, so it is not yet routinely available.
“We have been wowed by the detailed, meaningful images we can get with this technology,” Dr. Okonkwo said. “HDFT has the potential to be a game-changer in the way we handle TBI and other brain disorders.”
Co-authors include lead author Samuel L. Shin, Ph.D., Allison J. Hricik, M.S., Megan Maserati, and Ava M. Puccio, Ph.D., all of the Department of Neurological Surgery; Timothy Verstynen, Ph.D., Sudhir Pathak, M.S., and Kevin Jarbo, all of LRDC; and Sue R. Beers, of the Department of Psychiatry, all of the University of Pittsburgh.
The study was funded by the Defense Advanced Research Projects Agency.
For video and images, contact Anita Srikameswaran.
PITTSBURGH, Oct. 10, 2011 – Seven years after a motorcycle accident damaged his spinal cord and left him paralyzed, 30-year-old Tim Hemmes reached up to touch hands with his girlfriend in a painstaking and tender high-five.
Mr. Hemmes, of Evans City, Pa., is the first to participate in a new trial assessing whether the thoughts of a person with spinal cord injury can be used to control the movement of an external device, such as a computer cursor or a sophisticated prosthetic arm. The project, one of two brain-computer interface (BCI) studies underway at the University of Pittsburgh School of Medicine and UPMC Rehabilitation Institute, used a grid of electrodes placed on the surface of the brain to control the arm.
It was a unique robotic arm and hand, designed by the Johns Hopkins University Applied Physics Laboratory, that Mr. Hemmes willed to extend first toward the palm of a researcher on the team and a few minutes later, to his girlfriend’s hand.
“I put my heart and soul into everything they asked me to do,” he said immediately after his achievement. “I got to reach out and touch somebody for the first time in seven years.”
“Seeing Tim reach out with a mechanical arm to touch his girlfriend was an unexpected and poignant bonus for all of us who are involved with this exciting project,” said co-principal investigator Michael Boninger, M.D., director of the UPMC Rehabilitation Institute.
“This first round of testing reinforces the great potential BCI technology holds for not only helping spinal cord-injured patients become more independent, but also enhancing their physical and emotional connections with their friends and family,” added Dr. Boninger, who also is professor and chair of the Department of Physical Medicine and Rehabilitation at Pitt’s School of Medicine. “It further motivates us to make this technology useful and available to those who need it.”
On Aug. 25, an electrocortigraphy (ECoG) grid, about the size of a large postage stamp, adapted from seizure-mapping brain electrode arrays, was placed on the surface of Mr. Hemmes’ brain during a two-hour operation performed by co-investigator and UPMC neurosurgeon Elizabeth Tyler-Kabara, M.D., Ph.D., assistant professor, Department of Neurological Surgery, Pitt School of Medicine.
“Before the procedure, we conducted several functional imaging tests to determine where his brain processed signals for moving his right arm,” she explained. “We removed a small piece of his skull and opened the thick layer of protective dura mater beneath it to place the grid over that area of motor cortex. We then put the dura and skull back with the wires on the outside of the skull but under the scalp.”
Dr. Tyler-Kabara tunneled the connecting wires under the neck skin to exit from the upper chest, where they could be periodically hooked up to computer cables. Six days per week for the next four weeks at home and on campus, Mr. Hemmes and the team tested the technology. The researchers used computer software they developed in earlier studies to interpret the neural signals sensed by the brain grid.
After watching a computer-generated figure move an arm, Mr. Hemmes began trying to guide a ball from the middle of a large television screen either up, down, left or right to a target, within a time limit. With practice, he could do this two-dimensional task without any computer assistance or what the researchers call “100 percent brain control.” He then performed a similar task with the arm, reaching out to touch a target on a large, desk-mounted panel.
It wasn’t the simultaneous thought-and-move process that he knew before becoming paralyzed. Instead, he imagined flexing his thumb, which created a brain signal pattern that the computer then interpreted as “move left,” or bending his elbow to move the object right, explained co-principal investigator Wei Wang, M.D., Ph.D., assistant professor, Department of Physical Medicine and Rehabilitation, Pitt School of Medicine.
“He mentally associated specific motor imageries with desired movement direction,” he said. “It required concentration and patience, but this process seemed to get easier for him with practice, just like when someone learns to drive a car with a manual transmission. In future studies, we also will test other approaches, including the participant simply thinking up for up, down for down, and so on.”
After about eight sessions, Mr. Hemmes tackled more complicated tasks. While wearing special goggles to properly view a three-dimensional TV screen, he moved the ball in the previous directions, and also to the front or back. He also practiced moving the arm in all directions, culminating in the joyful moments after formal testing had been completed when he reached out to Dr. Wang and to his girlfriend. Dr. Tyler-Kabara removed the ECoG brain grid and wiring in a short operation the next day, Sept. 22.
The researchers are now analyzing the data, and are seeking at least five more adults with spinal cord injuries or brainstem strokes who have very little or no use of their hands and arms for additional studies.
They also are looking for participants for a year-long trial of another kind of brain-computer interface that is a 10-by-10 array of tiny electrode points that penetrate the brain tissue by less than 1/10th of an inch and pick up signals from 100 individual neurons. Two of these grids will be put in place, one in the brain region that controls hand movement, and one in the region that controls the arm, said co-principal investigator Andrew Schwartz, Ph.D., professor, Department of Neurobiology, Pitt School of Medicine.
“We anticipate that these penetrating grids can pick up very clear signals from the brain to reveal what motion is intended by the participant,” Dr. Schwartz said. “The second grid will allow us to see what might be possible in controlling the fine movement of the fingers and hand, which is far more complicated but also could offer more useful function for the participant.”
In his other experiments, a monkey implanted with the penetrating grid has been able to use an APL arm to reach out and hold a doorknob-like object, building on earlier work in which a monkey was able to grasp a marshmallow with a gripper device on a less sophisticated robotic arm and feed the treat to itself.
The team plans to make the technology wireless, and to include sensors in the prosthesis that can send signals back to the brain to simulate sensation.
It might be possible to connect brain-computer interfaces to existing devices that stimulate muscle fibers in the arm and hand, in effect bypassing the spinal cord injury to allow these individuals to use their own limbs again, the researchers said. That approach could be studied in future trials.
An example of multi-agency cooperation, funding for the two projects comes from the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health; the U.S. Department of Defense’s Defense Advanced Research Projects Agency; and the U.S. Department of Veterans Affairs, as well as UPMC University of Pittsburgh’s Clinical and Translational Science Institute.
For more information about the trials, call 1-800-533-UPMC (8762).
Visit UPMC.com/BCI for downloadable video of Mr. Hemmes’ participation in the trial.
PITTSBURGH, Sept. 6 – The UPMC Stroke Institute has received the American Heart Association/American Stroke Association’s Get With The Guidelines® Stroke Gold Plus Achievement Award. The award recognizes UPMC’s commitment to providing excellent care for stroke patients, according to evidence-based guidelines.
To receive the award, the UPMC Stroke Institute achieved 85 percent or higher adherence to all Get With The Guidelines-Stroke Achievement indicators for two or more consecutive 12-month intervals and achieved 75 percent or higher compliance with six of 10 Get With The Guidelines-Stroke Quality Measures.
Physicians at the UPMC Stroke Institute offer comprehensive stroke care to more than 1,500 patients annually and lead efforts to partner with area community hospitals to initiate acute stroke treatment. The availability of this service has resulted in more than 200 interventional treatments in the past year.
“With a stroke, time lost is brain lost, and the Get With The Guidelines–Stroke Gold Plus Achievement Award demonstrates UPMC’s commitment to being one of the top hospitals in the country for providing aggressive, proven stroke care,” said Tudor Jovin, M.D., director of the UPMC Stroke Institute.
In addition to the Get With The Guidelines-Stroke award, UPMC also has received the association’s Target: Stroke Honor Roll, for improving stroke care. Over the past quarter, at least 50 percent of eligible ischemic stroke patients have received intravenous rt-PA, a clot-busting agent, within 60 minutes of arriving at the hospital (known as “door-to-needle” time).
“The UPMC Stroke Institute is to be commended for its commitment to implementing standards of care and protocols for treating stroke patients,” said Lee H. Schwamm, M.D., chair of the Get With The Guidelines National Steering Committee and director of the TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston. “The full implementation of acute care and secondary prevention recommendations and guidelines is a critical step in saving the lives and improving outcomes of stroke patients.”
Get With The Guidelines–Stroke uses the “teachable moment,” the time soon after a patient has had a stroke, when they are most likely to listen to and follow their health care professionals’ guidance. Studies demonstrate that patients who are taught how to manage their risk factors while still in the hospital reduce their risk of a second heart attack or stroke.
“The time is right for UPMC to be focused on improving the quality of stroke care by implementing Get With The Guidelines–Stroke,” said Lawrence Wechsler, M.D., chairman, University of Pittsburgh Department of Neurology. “Stroke incidence is decreasing, but the aging population will result in an increase in the number of strokes.”
According to the American Heart Association/American Stroke Association, stroke is the third-leading cause of death in the United States and a leading cause of serious, long-term disability. On average, someone suffers a stroke every 45 seconds; someone dies of a stroke every three minutes; and 795,000 people suffer a new or recurrent stroke each year.