UPMC Physician Resources

Pitt Team Evaluates Tensile Strength of the Human Ureter

PITTSBURGH, Jan. 3, 2015 – Few published studies have examined the mechanical properties of the animal ureter and none have determined the tensile strength of the human ureter, which may help prevent iatrogenic injuries. Researchers at the University of Pittsburgh conducted a trial to determine the tensile strength in the human ureter, and the preliminary results were published in a recent issue of the Journal of Endourology.  

Yaniv Shilo, MD, assistant professor of urology at the University of Pittsburgh and lead author of the study, and colleagues harvested 11 human proximal ureters from patients undergoing nephrectomy, and uniaxially tested tissue strips circumferentially and longitudinally. Corresponding force and displacement were recorded, and stress at failure was noted as the tensile strength of the sample.

The tensile strength of the ureter in circumferential and longitudinal orientations was found to be 457.52±33.74 Ncm(-2) and 902.43±122.08 Ncm(-2), respectively (P<0.001). The circumferential strength in the proximal portion of the ureter was 409.89±35.13 Ncm(-2) in comparison with 502.89±55.85 Ncm(-2) in the distal portion (P=0.08).

The authors found that the “circumferential tensile strength of the ureter was significantly lower than the longitudinal strength” and “circumferential tensile strength was also lower with more proximal parts of the ureter.” The results may be important for the design of “intelligent” devices and simulators to prevent ureteral injuries.

Additional authors included Joseph Pichamuthu, Timothy Averch, MD, and David A. Vorp, PhD, all of the University of Pittsburgh.

To view the full abstract, please visit PubMed.gov.

Pitt Researcher Contributes to Analysis of Inequities in Health Care Needs for Children With Medical Complexity

PITTSBURGH, Jan. 2, 2015 – Amy Houtrow, MD, PhD, MPH, associate professor and vice chair in the Department of Physical Medicine and Rehabilitation for pediatric rehabilitation medicine, was part of a team that analyzed secondary data on children with special health care needs to examine the prevalence, health care service use, and needs of children and youth with special care needs, as reported by their families.

Data from the National Survey of Children with Special Health Care Needs from 2005-06 and 2009-10 was used to examine inequities based on race/ethnicity, primary language in the household, insurance type, and poverty status.

The study, which was published in Health Affairs, found that children with medical complexity were twice as likely as children without medical complexity to have at least one unmet need. Unmet needs were not associated with primary language, income level, or having Medicaid In the children with medical complexity. The authors, led by Dennis Z. Kuo, MD, MHS, associate professor of pediatrics at the University of Arkansas for Medical Sciences, concluded that medical complexity itself can be a primary determinant of unmet needs.

Additional authors on the study were Anthony Goudie, PhD, of the University of Arkansas for Medical Sciences; Eyal Cohen, MD, of the Hospital for Sick Children and University of Toronto; Rishi Agrawal, MD, of Ann and Robert H. Lurie Children’s Hospital and the Northwestern University Feinberg School of Medicine; Adam C. Carle, PhD, of Cincinnati Children’s Hospital Medical Center and the University of Cincinnati; and Nora Wells of Family Voices, Inc.

To view the full abstract, please visit PubMed.gov.

Newly-Identified Genetic Mutations Could Help Explain Early Menopause, Infertility

Pittsburgh, Dec. 31, 2014 –Two newly-identified genetic mutations could increase our understanding of the causes behind premature ovarian failure, which is one cause of infertility, and potentially guide options for treating women with the condition, according to research from Magee-Womens Research Institute (MWRI) recently published online in the Journal of Clinical Investigation and the American Journal of Human Genetics.

The mutations, which occurred in women with premature ovarian failure, a condition that causes a woman’s ovaries to stop working prior to 40 years of age, were found in genes that repair damaged DNA in the cells of the ovary that eventually become egg cells. In the U.S., premature ovarian failure affects about one percent of women during their reproductive years, some as early as their teenage years. Apart from compromising fertility, the condition also puts women at high risk for osteoporosis and heart disease.

Researchers from MWRI, in collaboration with international colleagues, performed genome sequencing on blood and skin samples from three families. Each family had at least one woman with premature ovarian failure.

“Most women with premature ovarian failure don’t know why they can’t reproduce, and it can be devastating for them,” said the senior author of the studies, Aleksandar Rajkovic, M.D., Ph.D., a researcher with MWRI and the Marcus Allen Hogge chair in reproductive sciences at the University of Pittsburgh. “Our findings indicate that genetics may play a strong role in this condition and raise the prospect of one day developing therapies to delay the early onset of menopause.”

According to Dr. Rajkovic, this research shows the power of whole genome sequencing. “Now that we understand some of the contributors to premature ovarian failure, we can work toward correcting the condition,” he said.

Radiation Dose Benchmarks During Cardiac Catheterization

Division of Pediatric Cardiology faculty member, Sara Trucco, MD, was part of a team that recently published results of a study that aimed to define age-stratified, procedure-specific benchmark radiation dose levels during interventional catheterization for congenital heart disease. The study found that radiation exposure was lowest in patent ductus arteriosus closure and highest in transcatheter pulmonary valve placement. The full article is available here.

Welcoming New Faculty to Children’s Hospital of Pittsburgh of UPMC

Children’s Hospital of Pittsburgh of UPMC is pleased to welcome three new faculty members.

Marcus Malek, MD, has joined the Division of Pediatric General and Thoracic Surgery as the director of pediatric surgical oncology. He has completed dual-fellowships in pediatric surgery (at Children’s Hospital of Pittsburgh) and pediatric surgical oncology at the Memorial Sloan-Kettering Cancer Center in New York City. Dr. Malek is one of the few dual-fellowship trained pediatric surgical oncologists in the Pennsylvania tri-state area.

Gary Mason, MD, has joined the division as a pediatric neuro-oncologist. He completed his fellowship in the Division of Neuro-Oncology at the Children’s National Medical Center in Washington DC. Dr. Mason will work closely with Ian Pollack, MD, in neurosurgery and will be leading several clinical trials in brain and CNS cancers.

Craig Byersdorfer, MD, PhD, is new to the Division of Pediatric Blood and Marrow Transplantation and Cellular Therapies. He completed his fellowship in pediatric hematology/oncology at the C.S. Mott Children’s Hospital in Ann Arbor, Michigan.

Leaders in Kidney Development Research

Pediatric Division of Nephrology faculty, Carlton Bates, MD, and Jacqueline Ho, MD, have recently been recognized for their work on kidney development research. One of the key missions of the Division of Pediatric Nephrology is to extend the knowledge of pathophysiology of renal disease through basic laboratory and clinical research.

Dr. Bates was elected to the American Society for Clinical Investigation; the medical honor society recognizes physicians who have accomplished meritorious original, creative, and independent investigations in the clinical or allied sciences of medicine. Dr. Bates studies genetic mouse models of kidney and lower urinary tract development. By suppressing or altering the activity of certain genes, he and his team are able to breed mice with structural kidney disease akin to what is seen in affected children, leading to new insights into the causes of congenital kidney and bladder diseases, which are leading causes of pediatric chronic kidney disease.

Dr. Ho was recently awarded a prestigious RO1 research grant by the NIH. She also has received numerous research awards, including the 2014 March of Dimes Basil O’Connor Starter Scholar Research Award and the 2013 International Pediatric Nephrology Association Renée Habib Young Investigator Award.

Pitt Team Discovers New Mechanism That Helps Explain Why Older Patients Develop Lung Fibrosis

PITTSBURGH, Dec. 22, 2014 – When researchers at the University of Pittsburgh School of Medicine took a closer look at certain cells from the scarred lungs of patients with idiopathic pulmonary fibrosis (IPF), they were surprised by what they saw: many misshapen, bloated mitochondria. The unexpected observation led them to conduct a study, published online today, that will be featured on the cover of the February issue of the Journal of Clinical Investigation, that could for the first time help explain why the risk of developing the deadly lung disease increases with age.

Older age is a well-known risk factor for IPF, a disease in which the lung tissue becomes progressively fibrotic, or scarred, leading to breathing difficulties and death within three to five years if a lung transplant isn’t possible, said senior investigator Ana L. Mora, M.D., assistant professor in the Division of Pulmonary, Allergy and Critical Care Medicine and a member of the Heart, Lung, Blood and Vascular Medicine Institute (VMI) at Pitt. The cause of the disease is unknown, or “idiopathic.”

“Other chronic and progressive diseases we see with aging, such as Parkinson’s disease, have been recently associated with mitochondrial abnormalities, so we wondered if that was occurring in IPF,” she said. “It was a simple question, but it hadn’t been asked before, so we examined lung cells from patients with advanced IPF and healthy people. We were so surprised to see dramatic differences in the number, shape and function of the mitochondria.”

After characterizing the oddities of the mitochondria, which provide energy for the cell, the team checked the levels of an enzyme called PTEN-induced putative kinase 1, or PINK1, that plays key roles in mitochondrial function and morphology, or shape. Experiments showed that impairment of mitochondria was associated with a reduction in PINK1 expression, and mice lacking PINK1 had dysfunctional, misshapen mitochondria in lung cells and were susceptible to developing lung fibrosis.

“We found also that low PINK1 is associated with increasing age and cellular stress,” Dr. Mora said. “This might help explain why older people are at greater risk for developing IPF, and it could mean developing drugs that can boost PINK1 levels or improve mitochondrial function will help treat IPF.”

“These findings are remarkable as they identify a similar disease pathway to that seen in other age related brain diseases,” said Mark Gladwin, M.D., professor and chief, Division of Pulmonary, Allergy and Critical Care Medicine, and VMI director, who is not on the research team. “This is the first study to find that the mitochondria themselves, the energy factories of our cells, are altered with lung fibrosis.”

In addition, the team hopes to find biomarkers to identify the disease in earlier stages as well as explore other factors that could increase susceptibility to IPF.

The research team includes Marta Bueno, Ph.D., Yen-Chun Lai, Ph.D, Judith Brands, Ph.D., Claudette St. Croix, PhD., Christelle Kamga, Ph.D., Catherine Corey, John Sembrat, Janet S. Lee, M.D., Steve R. Duncan, M.D., Mauricio Rojas, M.D., Sruti Shiva, Ph.D., and Charleen T. Chu, M.D., Ph.D., all of the University of Pittsburgh; Yair Romero, of Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico; and Jose D. Herazo-Maya, M.D., of Yale University.

The project was funded by National Institutes of Health grants NS065789 and AG026389; the Vascular Medicine Institute at the University of Pittsburgh, the Institute for Transfusion Medicine, and the Hemophilia Center of Western Pennsylvania.

Intervention in School Health Centers is Effective in Counseling Teens About Abusive Relationships, Children’s Hospital of Pittsburgh of UPMC Study Finds

PITTSBURGH, Dec. 22, 2014 – A study by a Children’s Hospital of Pittsburgh of UPMC researcher provides the first evidence of the potential benefits of a brief, provider-delivered universal education and counseling intervention in school-based health centers to address and prevent the major public health problem of adolescent relationship abuse. The study appears online today in Pediatrics.

In collaboration with the California Adolescent Health Collaborative of the Public Health Institute, California School-Based Health Alliance and Futures Without Violence, the study was conducted during the 2012-2013 academic year at eight school-based health centers in California where students receive confidential clinical health services. Researchers surveyed 1,062 teens ages 14 to 19 for exposure to adolescent relationship abuse (including cyber dating abuse), sexual behavior, and care-seeking for sexual and reproductive health at their initial visit and again three months later.

Providers and staff in four school-based health centers received training on how to talk about healthy and unhealthy relationships; received palm-sized brochures about relationship abuse and available resources to hand out to patients; and learned how to refer youth to additional services and supports. No changes were implemented at the other four school-based health centers.

The researchers found students at the intervention sites were more likely than those at the other sites to recognize sexual coercion. Among students who reported relationship abuse at an initial visit  on a confidential survey, students at intervention schools were significantly less likely to report such abuse on the follow-up survey 3 months later.

“This study shows that a universal education and brief counseling approach in health care settings may be a useful way to address relationship abuse among adolescents,” said lead investigator Elizabeth Miller, M.D., Ph.D., chief, Division of Adolescent and Young Adult Medicine. “Clinicians talking about healthy and unhealthy relationships with all of their patients can make a difference.”

Among almost 400 youth who reported experiencing relationship abuse at an initial visit, 65 percent of students in intervention schools reported still experiencing such abuse about three months later, compared to 80 percent of students in the other schools. In addition, youth in the intervention clinics were much more likely to discuss being in an unhealthy relationship with their health care provider. “Embedding prevention messages and information about relevant resources within clinical settings for adolescents may be an effective way to reduce relationship abuse,” said Lisa James, the director of Health at Futures Without Violence and a co-investigator on the study.

“Youth seeking care in adolescent health settings appear to have more exposure to relationship abuse and associated poor health outcomes,” said Dr. Miller, also an associate professor of pediatrics, University of Pittsburgh School of Medicine. “Finding an intervention that may make a difference for these youth who are at higher risk for relationship abuse is encouraging.”

“This study effectively combined school-based clinical interventions with youth-led promotion of healthy adolescent relationships,” said co-investigator Samantha Blackburn, formerly with the California School-Based Health Alliance, and now an assistant professor of nursing at California State University Sacramento. “Not only did students receive needed services, they were also empowered to help their peers be healthy and safe.”

“Prevention of relationship abuse among adolescents requires a range of strategies from educating youth and adults about the extent of the problem; connecting youth to relevant supports and services; and engaging schools, parents, and other influential adults to talk about healthy relationships,” said co-investigator Alison Chopel from the Public Health Institute’s California Adolescent Health Collaborative.  “This intervention is a part of the prevention solution.”

Dr. Miller and her collaborators are hopeful that these findings will encourage schools and adolescent health care providers to implement this program.  For parents and educators, she adds, “This study suggests that creating spaces for young people to learn about healthy and unhealthy relationships and how to help their friends can really help to reduce adolescent relationship abuse.”

Collaborators with Dr. Miller on the study were: Heather L. McCauley, Sc.D., Kelley Jones, MPH, Rebecca Dick, MS, all with Children’s Hospital of Pittsburgh of UPMC; Sandi Goldstein, MPH, Johanna Jetton, California Adolescent Health Collaborative, Public Health Institute; Jay G. Silverman, Ph.D., Division of Global Public Health, University of California, San Diego School of Medicine; Samantha Blackburn, RN, MSN, PNP, California School-Based Health Alliance and California State University Sacramento School of Nursing; Erica Monasterio, RN, MN, FNP-BC, University of California San Francisco School of Nursing; Lisa James, Futures Without Violence; and Daniel J. Tancredi, Ph.D., University of California Davis School of Medicine.

The study was supported by Award No. 2011-MU-MU-0023 of the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.

For more information on Dr. Miller and the Division of Adolescent and Young Adult Medicine, visit www.chp.edu/CHP/am. To learn more about how to implement this intervention, visit http://www.futureswithoutviolence.org/hanging-out-or-hooking-up-clinical-guidelines-on-responding-to-adolescent-relationship-abuse-an-integrated-approach-to-prevention-and-intervention/.

Save the Date: Breast Symposium 2015

PITTSBURGH, Dec. 19, 2014 – Breast Symposium 2015: Updates in the Management of Breast Cancer/Breast Disease will be held at the Herberman Conference Center in Pittsburgh, Pa. on Friday, April 24, 2015.

This course is designed to cover the most recent advances in breast health screening and diagnosis including methods of detection, application of new technology, and benign disease and cancer management. Upon completion of the activity, participants should be able to:

  • Discuss the latest breast cancer methods of detection, treatment, surveillance, and research
  • Describe how these advances can be applied to their practice

Who Should Attend
This course is designed for physicians, nurses and other health care professionals practicing in the areas of Primary Care, Gynecology, Radiology, and General Surgery; recommended for any practitioner caring for women.

UPMC Shadyside
Herberman Conference Center
5230 Centre Avenue
Pittsburgh, PA 15232

Course Co-Directors
Marguerite A. Bonaventura, MD
Associate Professor of Surgery
University of Pittsburgh School of Medicine

Gretchen M. Ahrendt, MD
Associate Professor of Surgery
University of Pittsburgh School of Medicine

This activity has been approved for AMA PRA Category 1 Credit.TM

Online registration will be available on the Upcoming Events page at the Center for Continuing Education in the Health Sciences.

Register for the 23rd Annual Clinical Update in Geriatric Medicine

PITTSBURGH, Dec. 19, 2014 – Registration is now open for the 23rd Annual Clinical Update in Geriatric Medicine, March 26–28, 2015.

This award-winning CME conference is designed to help clinicians provide exceptional care for their older patients. Its structure, speakers, and content have been specifically chosen to provide state-of-the-art yet pragmatic approaches to the most common and confounding conditions clinicians face. The conference attracts more than 500 attendees annually.

Who Should Attend
This course is designed for family practitioners, internists, geriatricians, and other health care professionals who provide care to older adults. Previous attendees also will be interested because of the conference’s continually changing topics, speakers, and approach.

Marriott City Center
112 Washington Place
Pittsburgh, PA 15219

To register online, please visit the Upcoming Events page at the Center for Continuing Education in the Health Sciences and click the ‘23rd Annual Clinical Update in Geriatric Medicine′ link.

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