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Children’s Brain Care Institute Physicians Awarded Grant for Study on Brain Damage After Cardiac Arrest

PITTSBURGH, April 11, 2014 – Two critical care physicians, both members of the Brain Care Institute at Children’s Hospital of Pittsburgh of UPMC and associate directors of the Safar Center for Resuscitation Research, were recently awarded an R01 grant from the National Institutes of Neurological Disorders and Stroke to fund a study focused on brain damage after cardiac arrest in infants and children.

Hülya Bayir, MD, professor of critical care medicine, environmental and occupational health, and pediatrics at the University of Pittsburgh, and Robert Clark, MD, chief of pediatric critical care medicine at Children’s Hospital of Pittsburgh of UPMC, will conduct multidisciplinary research for the study called “Mitochondria-Targeted Redox Therapy for Cerebral Ischemia in Developing Brain.” The goal is to synthesize, develop, and test novel mitochondria-targeting therapeutics to meaningfully improving neurological outcome and quality of life in infants and children who suffer from brain damage caused by cardiac arrest, which can cause long-term disability.

National Survey Links Teen Binge Drinking and Alcohol-Brand References in Pop Music

PITTSBURGH, April 8, 2014 – Binge drinking by teenagers and young adults is strongly associated with liking, owning and correctly identifying music that references alcohol by brand name, according to a study by the University of Pittsburgh and Norris Cotton Cancer Center.

Based on a national, randomized survey of more than 2,500 people ages 15 to 23, the findings suggest that policy and educational interventions designed to limit the influence of alcohol-brand references in popular music could be important in reducing alcohol consumption in teens and young adults. The results are published online in the journal Alcoholism: Clinical & Experimental Research.

“Every year, the average adolescent is exposed to about 3,000 references to alcohol brands while listening to music,” said lead author Brian A. Primack, M.D., Ph.D., associate professor of medicine and pediatrics and director of the Program for Research on Media and Health in Pitt’s School of Medicine. “It is important that we understand the impact of these references in an age group that can be negatively affected by alcohol consumption.”

Alcohol is considered the third-leading, lifestyle-related cause of death in the U.S., according to the Centers for Disease Control and Prevention.

“Brand references may serve as advertising, even if they are not paid for by the industry,” said senior author James D. Sargent, M.D., co-director of the Cancer Control Research Program at Norris Cotton Cancer Center in New Hampshire and professor of pediatrics in the Geisel School of Medicine at Dartmouth College. “This is why it is useful to examine the influence of brand mentions.”

Of the 2,541 participants who completed the survey, 1,488, or 59 percent, reported having had a complete alcoholic drink, defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of hard liquor at one time. Of those, 18 percent reported binging — or drinking heavily over a short period of time — at least monthly, and 37 percent reported having had problems, such as injuries, due to alcohol.

In the survey, which could be completed either online or on paper, participants were given the titles of popular songs that include alcohol mentions and asked if they liked or owned the song. They also were tested to determine if they could spontaneously recall what brand of alcohol was mentioned in the lyrics.

Survey participants who could correctly recall alcohol brands in songs had more than twice the odds of having had a complete alcoholic drink, compared to those who could not recall the brand, even after adjusting for factors including age, socioeconomic status, and alcohol use by friends or parents. The participants who could identify the alcohol brands in songs also had greater odds of having ever binged on alcohol.

“A surprising result of our analysis was that the association between recalling alcohol brands in popular music and alcohol drinking in adolescents was as strong as the influence of parental and peer drinking and an adolescent’s tendency toward sensation-seeking,” said Dr. Primack. “This may illustrate the value that this age group places on the perceived opinions and actions of music stars.”

Dr. Primack said that one possible solution could be to empower adolescents with critical thinking skills. “Media literacy is a growing educational methodology that may be successful in helping young people make healthier decisions,” he said. “In the case of alcohol, it may be valuable to help them understand how alcohol-brand references in music may manipulate their thoughts and emotions to sell them a product.”

Additional authors on this research are Auden McClure, M.D., M.P.H., and Zhigang Li, Ph.D., both of the Geisel School of Medicine at Dartmouth College.

This work was supported by National Cancer Institute grants K07-CA114315 and R01-CA077026, and a SYNERGY Scholars Award from the Dartmouth Center for Clinical and Translational Research.

Magee-Womens’ Maribeth McLaughlin Named Chair-Elect of American Hospital Association’s Maternal and Child Health Governing Council

PITTSBURGH, March 25, 2014 – Maribeth McLaughlin, chief nursing officer and vice president of patient care services at Magee-Womens Hospital of UPMC, has been named chair-elect of the American Hospital Association’s (AHA) Maternal and Child Health Governing Council. She will assume the role of chair in 2015.

The governing council is comprised of 14 senior executives from the nation’s top women’s and children’s hospitals and health care providers. As a council member, Ms. McLaughlin will advise the AHA on public policy, advocacy and new issues in maternal and child health.

“The AHA leadership position will offer a tremendous opportunity to examine and analyze trends in women’s health across the nation,” said Ms. McLaughlin. “We’ll share experiences with other members on everything from nurturing a healthier workforce – to specific clinical information, such as the elective induction of births.”

“Passion for women’s health is key to this role,” said Leslie Davis, president and chief executive officer of Magee. “Maribeth is incredibly knowledgeable, well-positioned, and clearly viewed as someone to turn to for examples of best practices.”

In addition, Ms. McLaughlin recently assumed the presidency of the Council of Women’s and Infants’ Specialty Hospitals, comprised of 13 non-competing hospitals with high-volume obstetrical care, which collaborate and share information about programs, best practices and national policy.

In her role at Magee, Ms. McLaughlin has been instrumental in promoting interdisciplinary partnerships, developing evidence-based policies and procedures and standards of care, facilitating continuing quality improvement programs and ensuring patient safety and compliance.

Ms. McLaughlin received her nursing degree from Duquesne University and her Master of Public Management from Carnegie Mellon University.

Integrating Mental Health Services in Pediatric Practices Feasible, Effective, Pitt Finds

PITTSBURGH, March 24, 2014 – Brief behavioral and mental health programs for children can be effectively provided within pediatric practices as an alternative to being referred to a community specialist, University of Pittsburgh Schools of the Health Sciences researchers found in a National Institutes of Health-funded randomized trial.

Behavioral health treatment provided in the pediatrician’s office resulted in improved access to care, greater participation by both the child and their caregiver in treatment programs, and higher rates of treatment completion, without burdening the pediatric practice, researchers report in the April issue of the journal Pediatrics.

“Treating both physical and behavioral health in the office of the child’s pediatrician is an achievable goal that provides many benefits to the child, caregiver and pediatrician” said lead author David Kolko, Ph.D., professor of psychiatry, psychology, pediatrics, and clinical and translational science in Pitt’s School of Medicine. “When the behavioral health treatment was provided in the pediatrician’s office, participants were more than six times as likely to complete the program, as they were when it was provided at a specialty care clinic outside the pediatrician’s office.”

Dr. Kolko and his colleagues recruited more than 300 children and their caregivers at eight community pediatric practices affiliated with Children’s Hospital of Pittsburgh of UPMC who had been referred for treatment of behavioral problems, though many also had attention-deficit/hyperactivity disorder (ADHD) or anxiety. This study is the third one completed by Services for Kids in Primary-Care (SKIP), a program that integrates behavioral health services into primary pediatric and family medicine practices (more information available at www.skipproject.org).

In this trial, half the children received “doctor office collaborative care,” where a trained behavioral health clinician, known as a care manager, collaborated with the child’s pediatrician to deliver mental health services in the pediatrician’s office. The other half received “enhanced usual care,” where the patients received educational materials and were referred to a local mental health specialist outside the pediatrician’s office who accepted the child’s health insurance.

The participants averaged 8 years old and two-thirds were boys. Most had a primary diagnosis of ADHD, followed by disruptive behavior disorder and anxiety disorder. Only 10 percent previously had received ADHD medication.

In the program at the pediatrician’s office, the child and their caregiver participated in six to 12 individual or family sessions within six months where the mental health clinician worked on individualized goals to address the behavioral health issue and reviewed educational materials to help achieve those goals. The clinician communicated with the pediatrician in regular meetings and through progress notes.

In both the in-office and outside specialist programs, the pediatrician was updated on the patient’s care and could prescribe medication for the child when necessary.

Of the participants assigned to the care manager at the pediatrician’s office, 99.4 percent began treatment programs and 76.6 percent completed them. Of those assigned to a specialist outside the office, 54.2 percent began treatment and 11.6 percent completed it.

The program in the pediatrician’s office also was associated with higher rates of improvement in behavioral and hyperactivity problems, lowered parental stress, better treatment response and consumer satisfaction.

Beyond the child and their caregiver, pediatricians whose offices received the in-office program reported greater efficacy and more confidence in their skills to treat ADHD, compared with the outside specialist program.

“In fact, the participating pediatric practices in this clinical trial later hired their own mental health clinicians to continue delivering on-site services, after the trial had ended,” said Dr. Kolko. “Still more research is needed to understand how pediatric practices adapt clinical and financial strategies to make an in-office behavioral health provider a sustainable resource. Perhaps pediatricians who observe the program in operation may be willing to find a way to support these resources and make that service work.”

Additional co-authors on this study are Stephen Wisniewski, Ph.D., Pitt Graduate School of Public Health; Jonathan Hart, M.S., Western Psychiatric Institute and Clinic of UPMC; Dara Sakolsky, M.D., Pitt School of Medicine; John Campo, M.D., Ohio State University; and Amy Kilbourne, Ph.D., University of Michigan.

This research was supported by NIH’s National Institute of Mental Health grant no. 063272.

Children’s Names New Chief of Pediatric Endocrinology

PITTSBURGH, March 18, 2014Children’s Hospital of Pittsburgh of UPMC has named Radhika Muzumdar, MD, chief of the Division of Pediatric Endocrinology, Diabetes and Metabolism. Dr. Muzumdar also has an appointment within the University of Pittsburgh School of Medicine as associate professor of Pediatrics and Cell Biology. She comes to Pittsburgh from Albert Einstein College of Medicine and The Children’s Hospital at Montefiore in Bronx, N.Y.

Dr. Muzumdar brings expertise in basic research in endocrinology to Children’s, and as the principle investigator for seminal research on the role of insulin-like growth factors and novel peptides that regulate glucose homeostasis during aging, she is supported by National Institutes of Health (NIH) R-01 funding.

Dr. Muzumdar, a member of the Society for Pediatric Research, has been elected to various leadership roles in national and international subspecialty societies. She also has been recognized for her teaching abilities and mentoring in clinical medicine and biomedical research, and will lead Children’s NIH T32 fellowship training grant.

Cancer Research at Children’s Focused on Limiting Tumor Growth

Recent research within the Division of Pediatric Hematology/Oncology at Children’s Hospital of Pittsburgh of UPMC has focused on inhibiting the growth of tumors by using drugs that prevent them from developing a blood supply, thus starving the tumor and limiting its growth. This approach rests on the assumption that the blood vessel supply of tumors originates from normal cells, termed endothelial cells.

However, research conducted in the lab of Edward Prochownik, MD, PhD, director of oncology research in the Division, has shown that human cancer cells themselves can, under certain conditions, transform into these endothelial cells and contribute to the tumor vasculature. Like the tumor cells, and unlike normal endothelial cells, the “tumor-derived endothelial cells” readily acquire resistance to therapies aimed at inhibiting their growth. This finding may explain why therapies aimed at inhibiting tumor blood vessel growth have failed to meet expectations.

Dr. Prochownik is also The Paul C. Gaffney Professor of Pediatrics, and Professor of Microbiology & Molecular Genetics at the University of Pittsburgh School of Medicine.

New Webcam System at UPMC Connects Families with Newborns in Intensive Care Units at Children’s and Magee

PITTSBURGH, Feb. 18, 2014 – New parents and family members can check in on their infants hospitalized in UPMC’s neonatal intensive care units (NICUs) any time of day and from anywhere in the world thanks to a new camera system installed in the NICUs at Children’s Hospital of Pittsburgh of UPMC and Magee-Womens Hospital of UPMC.

Children’s Hospital and Magee-Womens Hospital are two of only three hospitals in the state to implement this password-protected webcam system called NICVIEW, which, through an internet connection, gives families a virtual connection to their newborns.

The early hours and days after having a newborn that requires intensive care are critical for the parents, the baby and the family. A newborn in the NICU causes separation and anxiety for everyone involved and can occur for many reasons – a mother may not see her newborn for a few days if she remains in the hospital after delivery, a sibling might not meet his new brother or sister, or a grandparent may be long distance. The NICVIEW system allows family and friends, who are given a unique username and password, to log in and visit the baby from anywhere in the world.

“When a baby is hospitalized in the NICU, this can be a very stressful and frightening time for families and it is even more difficult when they can’t be at the hospital with their baby,” said Beverly Brozanski, M.D., clinical director, Children’s Neonatal Intensive Care Unit. “Being able to view their newborn on the camera is very reassuring and helps parents stay connected with the baby as well as the medical team.”

Thirty cameras are installed in the NICU of each hospital. The cameras are mounted above the baby’s incubator, which provides families access to a live video stream that they can watch from a computer or mobile device at six appointed times throughout the day. The cameras are turned off during change of shift and during routine care hours.

“In a NICU setting, parents are looking for any way to bond with their newborn,” said Roberta Bell, Magee-Women’s Hospital NICU clinician. “We’re also encouraging breast-feeding mothers to log on and watch their baby in real-time while pumping as a way to increase production.  We’ve received very positive feedback from women who have had this option.”

The NICVIEW system is designed to comply with the Health Insurance Portability and Accountability Act (HIPAA), which requires confidential handling of patient information.

Children’s received funding for the NICVIEW system from the Snee-Reinhardt Foundation. Magee was initially funded through a grant from the hospital’s Volunteer Service Board. The fundraising efforts of the Magee-Womens Research Institute and Foundation through the funds raised at the 2013 Savor Pittsburgh event will support the purchase of an additional 30 cameras this spring.

Developer of Innovative Surgical Technique Leads New Center for Colorectal Issues at Children’s Hospital of Pittsburgh of UPMC

PITTSBURGH, Feb. 12, 2014Children’s Hospital of Pittsburgh of UPMC has recruited an internationally renowned surgeon, Luis De la Torre, M.D., to establish the new Colorectal Center for Children that will serve as a resource for children from around the world with complex colorectal issues.

Children’s Colorectal Center for Children will provide multidisciplinary medical and surgical care for children who are born with or acquire issues of the bowel or rectum. Dr. De la Torre, who pioneered a unique, less invasive surgical approach to the treatment of Hirschsprung’s disease, specializes in the diagnosis, treatment and rehabilitation of children with complex colorectal conditions, including anorectal malformations; cloaca; fecal incontinence; idiopathic constipation; bowel management; colostomy care; appendicostomy; colon polyps; anal fistula; anal abscesses; and colorectal problems in children with myelomeningocele.

“Dr. De la Torre is recognized as a leader in his field and his recruitment to Children’s enables us to establish a multidisciplinary center that focuses not only on the diagnosis and treatment of these conditions, but on the quality of life of these patients,” said George K. Gittes, M.D., surgeon-in-chief at Children’s and the Benjamin R. Fisher Chair of Pediatric Surgery at the University of Pittsburgh School of Medicine. “Dr. De la Torre is an innovative surgeon, but his focus is on providing comprehensive and ongoing care that allows children with these complex colorectal issues to return to lives that are as normal as possible.”

The Colorectal Center for Children will provide comprehensive diagnosis, appropriate treatment and intestinal rehabilitation for children with these complex disorders. The Center will include specialists within gastroenterology, pediatric surgery, and urology with additional training in colorectal diseases, and pediatric nurses specializing in the treatment of wounds, colostomies and bowel management. Pediatric radiologists and pathologists specializing in diseases of the colon also are a part of the center.

“One of the goals of the Colorectal Center is to help recover children’s quality of life and integration into society, including the possible challenges of puberty, sexual function and childbearing as they relate to colorectal issues,” said Dr. De la Torre, a surgeon in the Division of Pediatric General and Thoracic Surgery.

Dr. De la Torre, also associate professor of surgery at the Pitt School of Medicine, comes to Children’s from Hospital Ángeles Puebla in Mexico, where he was founding director of the Colorectal Center for Children and chief of Pediatric Surgery.

Dr. De la Torre completed his residency training in Pediatrics and Pediatric Surgery at the Instituto Nacional de Pediatría at Universidad Nacional Autónoma de México, a hospital internationally known for contributions in the field of pediatric colorectal surgery. He also completed a fellowship in pediatric colorectal surgery at Schneider Children’s Hospital Medical Center, where he trained under internationally known Alberto Pena, M.D.

Dr. De La Torre is author of more than 35 peer reviewed articles and numerous book chapters, with many focusing on Hirschsprung’s disease, rehabilitation of children with congenital, acquired and complicated colorectal diseases. He also belongs to the editorial committees of four pediatric surgery journals.

For more information about Dr. De la Torre and the Colorectal Center for Children, please visit www.chp.edu/CHP/colorectal+center+for+children.

Mood-stabilizing Drug Could be New Treatment for Inherited Liver Disease, Says Pitt/Children’s Team

PITTSBURGH, Feb. 3, 2014 – Opening up a can of worms is a good way to start hunting for new drugs, recommend researchers from Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine. In a study published today in the Public Library of Science One, they used a primitive worm model to show that a drug typically used to treat agitation in schizophrenia and dementia has potential as a treatment for α-1 antitrypsin (AT) deficiency, an inherited disease that causes severe liver scarring.

In the classic form of AT deficiency, which affects 1 in 3,000 live births, a gene mutation leads to production of an abnormal protein, dubbed ATZ, that unlike its normal counterpart is prone to clumping, explained David H. Perlmutter, M.D., physician-in-chief and scientific director, Children’s Hospital, and Distinguished Professor and Vira I. Heinz Endowed Chair, Department of Pediatrics, Pitt School of Medicine.

“These protein aggregates accumulate in liver cells and eventually lead to scarring of the organ or to tumor formation,” Dr. Perlmutter said. “If we could find a drug that slows or stops this process, we might be able to prevent the need for liver transplantation in these patients.”

To find that drug, Dr. Perlmutter’s team worked with Pitt’s Stephen Pak, Ph.D., assistant professor of pediatrics, and Gary Silverman, M.D., Ph.D., Twenty-five Club Professor of Pediatrics, Cell Biology and Physiology, who developed a model of AT deficiency in Caenorhabditis elegans, or C. elegans, a harmless microscopic worm or nematode typically found in soil. Previous experiments conducted by Drs. Pak and Silverman, in which more than 2,000 compounds were screened, showed that fluphenazine, a drug approved for human use as a mood stabilizer, could reduce ATZ accumulation in the worm, so the team studied it further.

Worms that produce ATZ die sooner than normal ones, which typically have a life span of fewer than 20 days.  Those that were exposed to fluphenazine, however, had lower burdens of ATZ and lived more than a day longer that untreated animals. The lifespan of normal worms was unchanged by fluphenazine exposure. The researchers also labeled with fluorescent markers intracellular structures called autophagosomes, which help clear abnormal proteins out of the cell in a process called autophagy. Fluphenazine exposure was associated with a greater presence of autophagosomes, suggesting that increased autophagy led to reduced ATZ accumulation.

Follow-up experiments showed that fluphenazine reduced ATZ accumulation in several mammalian-cell line models of AT deficiency, D. Silverman said.

“We found when we gave this drug for three weeks to mice with the disease, autophagy is activated, the abnormal protein load is diminished, and liver scarring is reversed. It’s truly amazing,” he said. “And because fluphenazine is already being safely prescribed for other conditions, it should be easier to bring it to clinical trials for AT deficiency.”

The project also reveals the power of the worm model to rapidly screen drug candidates, Dr. Perlmutter noted.

“This is the first extensive investigation of a drug that was discovered through the C. elegans screening method,” he said. “It’s remarkable that you can take a completely unbiased, high-content screen using a primitive organism and end up identifying a drug that reduces the accumulation of an abnormal protein in mammalian cell lines and a living mouse. It’s proof-of-principle of this research pipeline. Furthermore, this drug is very similar pharmacologically to carbamazepine, another mood stabilizer that we found to enhance autophagy and reverse liver fibrosis in the mouse model of α1-antitrypsin deficiency.”

Other co-authors of the paper include Jie Li, M.D., Ph.D., Linda P. O’Reilly, Ph.D., Joshua A. Benson, Yan Wang, Ph.D., Tunda Hidvegi, Ph.D., Pamela Hale, Christine Dippold, and Michael Ewing, all of the University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC.

The project was funded by U.S. Public Health Service grants DK079806, DK081422, DK076918, and DK096990, and a grant from the Hartwell Foundation.

UPMC Physician First Author of Paper in New England Journal of Medicine

Jon Watchko, MD, professor of pediatrics and obstetrics, gynecology, and reproductive sciences, was the first author of a paper entitled, “Bilirubin-Induced Neurologic Damage — Mechanisms and Management Approaches.” The paper was recently published in the New England Journal of Medicine.

Approximately 85 percent of newborns are affected by neonatal unconjugated hyperbilirubinemia and the resultant clinical jaundice. In most cases this condition is generally benign and transitional, but in some newborns, unconjugated bilirubin levels can cause serious brain injury.

Dr. Watchko’s paper gives an overview of the mechanisms involved in this progression, as well as treatment interventions for the management of hyperbilirubinemia. Claudio Tiribelli, MD, PhD, from the University of Trieste in Trieste, Italy was co-author on the paper.

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