UPMC Physician Resources

Pitt Finding Suggests New Heart Disease Screening Target for Middle-Aged Black Women

Middle-aged black women have higher levels of a protein in their blood associated with a predictor of heart disease than their white counterparts, even after other factors, such as obesity, are taken into consideration, according to a study conducted by the University of Pittsburgh Graduate School of Public Health and School of Medicine.

The finding, reported today in the journal Menopause, suggests routine blood testing of black menopausal women may be warranted to determine their heart disease risk and potentially when to start therapies, such as aspirin and statins. The research was funded by the National Institutes of Health (NIH).

“Multiple previous studies have shown that black women are at higher risk for heart disease than white women; however, guidelines for assessing cardiovascular disease risk in asymptomatic adults do not recommend selective race- or ethnic-based risk-assessment,” said lead author Norman C. Wang, MD, MS, assistant professor in Pitt’s School of Medicine. “Our study revealed for the first time that in black, but not white, women going through menopause, higher levels of an easily measured risk factor for heart disease are associated with higher amounts of early atherosclerosis, even after accounting for other risk factors for heart disease. A clinical trial to determine whether routine screening in this population can save lives may be warranted.”

Dr. Wang and his colleagues examined medical records, blood samples and heart CT scans for 372 black and white women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women averaged just over 51 years old, were not on hormone replacement therapy and had no known heart disease when enrolled.

The researchers looked at blood levels of five biomarkers linked to inflammation. All of the biomarkers were associated with coronary artery calcification, a predictor of heart disease that is measured with a heart CT scan. When the researchers then took into account the participants’ body mass index (BMI), a measure of overall body fat, they found that obesity was a key factor linking most of the elevated inflammation biomarkers and coronary artery calcification.

Regardless of BMI, black women with higher levels of one particular biomarker, C-reactive protein, were more likely to have coronary artery calcification than whites. In fact, black women with coronary artery calcification had an average level of C-reactive protein in their blood that was almost double that of their white counterparts.

“We clearly demonstrated that obesity, inflammation biomarkers and coronary artery calcification are linked for both black and white midlife women, further emphasizing the need to promote lifestyle changes to combat obesity at midlife when women are subjected to many physiological and biological changes that could potentially increase their risk for heart disease,” said senior author Samar El Khoudary, PhD, MPH, assistant professor in Pitt Public Health’s Department of Epidemiology. “Future research should build on our findings regarding black women and C-reactive protein by testing similar associations over time, which could potentially yield interventions that can help these women avoid developing heart disease.”

The researchers noted that their study only looked at black and white women, so the results are not generalizable to other racial or ethnic groups.

Additional researchers on the study are Karen A. Matthews, PhD, Emma J.M. Barinas-Mitchell, PhD, and Chung-Chou H. Chang, PhD, all of Pitt.

This work was supported by the NIH through the National Institute on Aging, National Institute of Nursing Research, Office of Research on Women’s Health and National Heart, Lung, and Blood Institute grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, HL065581 and HL065591.

Social Media Use Associated With Depression Among U.S. Young Adults

The more time young adults use social media, the more likely they are to be depressed, according to new research from the University of Pittsburgh School of Medicine.

The findings could guide clinical and public health interventions to tackle depression, forecast to become the leading cause of disability in high-income countries by 2030. The research, funded by the National Institutes of Health, is published online and scheduled for the April 1 issue of the journal Depression and Anxiety.

This was the first large, nationally representative study to examine associations between use of a broad range of social media outlets and depression. Previous studies on the subject have yielded mixed results, been limited by small or localized samples, and focused primarily on one specific social media platform, rather than the broad range often used by young adults.

“Because social media has become such an integrated component of human interaction, it is important for clinicians interacting with young adults to recognize the balance to be struck in encouraging potential positive use, while redirecting from problematic use,” said senior author Brian A. Primack, MD, PhD, director of Pitt’s Center for Research on Media, Technology and Health.

In 2014, Dr. Primack and his colleagues sampled 1,787 U.S. adults ages 19 through 32, using questionnaires to determine social media use and an established depression assessment tool.

The questionnaires asked about the 11 most popular social media platforms at the time: Facebook, YouTube, Twitter, Google Plus, Instagram, Snapchat, Reddit, Tumblr, Pinterest, Vine and LinkedIn.

On average the participants used social media a total of 61 minutes per day and visited various social media accounts 30 times per week. More than a quarter of the participants were classified as having “high” indicators of depression.

There were significant and linear associations between social media use and depression whether social media use was measured in terms of total time spent or frequency of visits. For example, compared with those who checked least frequently, participants who reported most frequently checking social media throughout the week had 2.7 times the likelihood of depression. Similarly, compared to peers who spent less time on social media, participants who spent the most total time on social media throughout the day had 1.7 times the risk of depression. The researchers controlled for other factors that may contribute to depression, including age, sex, race, ethnicity, relationship status, living situation, household income and education level.

Lead author Lui yi Lin, BA, who will be graduating from the University of Pittsburgh School of Medicine this spring, emphasized that, because this was a cross-sectional study, it does not disentangle cause and effect.

“It may be that people who already are depressed are turning to social media to fill a void,” she said.

Conversely, Ms. Lin explains that exposure to social media also may cause depression, which could then in turn fuel more use of social media. For example:

• Exposure to highly idealized representations of peers on social media elicits feelings of envy and the distorted belief that others lead happier, more successful lives.

• Engaging in activities of little meaning on social media may give a feeling of “time wasted” that negatively influences mood.

• Social media use could be fueling “Internet addiction,” a proposed psychiatric condition closely associated with depression.

• Spending more time on social media may increase the risk of exposure to cyber-bullying or other similar negative interactions, which can cause feelings of depression.

In addition to encouraging clinicians to ask about social media use among people who are depressed, the findings could be used as a basis for public health interventions leveraging social media. Some social media platforms already have made forays into such preventative measures. For example, when a person searches the blog site Tumblr for tags indicative of a mental health crisis—such as “depressed,” “suicidal” or “hopeless”—they are redirected to a message that begins with “Everything OK?” and provided with links to resources. Similarly, a year ago Facebook tested a feature that allows friends to anonymously report worrisome posts. The posters would then receive pop-up messages voicing concern and encouraging them to speak with a friend or helpline.

“Our hope is that continued research will allow such efforts to be refined so that they better reach those in need,” said Dr. Primack, who also is assistant vice chancellor for health and society in Pitt’s Schools of the Health Sciences and professor of medicine. “All social media exposures are not the same. Future studies should examine whether there may be different risks for depression depending on whether the social media interactions people have tend to be more active vs. passive or whether they tend to be more confrontational vs. supportive. This would help us develop more fine-grained recommendations around social media use.”

Additional authors of the study were Jaime E. Sidani, PhD, Ariel Shensa, MA, Ana Radovic, MD, MSc., Elizabeth Miller, MD, PhD, Jason B. Colditz, MEd, Beth Hoffman, BSc, and Leila M. Giles, BS, all of Pitt.

This research was funded by National Institute of Mental Health grant R25-MH054318 and National Cancer Institute grant R01-CA140150.

UPMC Hamot Receives Magnet Designation for Nursing Excellence

UPMC Hamot has received Magnet designation for excellence in nursing, granted by the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program®. Only seven percent of hospitals nationwide have been granted Magnet status, one of the highest achievements an organization can obtain in professional nursing. UPMC Hamot is the first hospital in Pennsylvania’s northern tier to receive what is widely accepted as the gold standard in nursing excellence.

“Achieving status as a Magnet-recognized institution demonstrates the teamwork and dedication of our entire hospital staff,” said Jim Donnelly, RN, BSN, MBA, chief nursing officer and vice president of patient care services, UPMC Hamot. “We are very proud of UPMC Hamot for achieving this difficult-to-obtain designation and meeting nearly 80 standards of excellence, which indicates our commitment to consistently provide the highest quality care for our patients.”

Candidates must undergo a rigorous and lengthy application and evaluation process that includes extensive interviews and review of all aspects of nursing services. Hospitals must clearly establish a commitment to excellence on all levels of interprofessional nursing practice and adhere to national standards for organization and delivery of nursing services.

Hospitals that have achieved Magnet status are recognized for building and supporting a continuous culture of transformational leadership, structural empowerment, exemplary evidence-based practice, advanced training and new knowledge application and innovations— all with measurable outcomes proving quality patient care. The designation is valid for four years, during which time the ANCC monitors the hospital to ensure that high patient-care standards remain intact. The ANCC is the largest and most prominent nursing credentialing organization in the United States.

Other hospitals in the UPMC system that have received Magnet recognition include UPMC St. Margaret, Children’s Hospital of Pittsburgh of UPMC, and UPMC Shadyside.

Magee-Womens Research Institute Awarded $3.7 Million to Study Pregnancy and Heart Disease

Researchers at Magee-Womens Research Institute (MWRI) have been awarded a four-year $3.7 million grant from the American Heart Association (AHA) Go Red for Women Research Network to examine whether certain pregnancy-related blood vessel changes can uncover mechanisms of later-life cardiovascular disease (CVD) in women, identify women at highest risk, and guide new interventions to help them.

The causes of heart disease, which damages the inner walls of the blood vessels and can lead to spasms and decrease blood flow to the heart muscle, known as microvascular dysfunction, are unclear, said principal investigator, Carl Hubel, PhD, associate professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and MWRI investigator. During pregnancy, profound metabolic and cardiovascular changes occur, putting extra stress on a woman’s body and requiring the heart and blood vessels to work harder. Researchers believe that studying these cardiovascular changes may reveal early mechanisms of CVD.

“This grant is an important next step for our research team in the ongoing assessment of using pregnancy as a lens to understand CVD in women throughout the life span,” explained Dr. Hubel. “Microvascular dysfunction is a devastating public health challenge because almost two-thirds of women who die suddenly of coronary heart disease have had no previous symptoms. We hope to build on the research of our previous studies by identifying mechanisms of CVD in women that are unmasked or perhaps affected by adverse pregnancy outcomes. By examining these relationships, we aim to discover early heart disease risks in women as well as the causes.”
 

In addition to Magee, four other centers make up the AHA Go Red for Women Research Network: Johns Hopkins University School of Medicine, Columbia University Medical Center, University of California, San Diego and New York University Medical Center.

Researcher Named UPCI’s 2nd NCI Outstanding Investigator, Awarded $6.4M for Discovering Cancer Viruses

Patrick Moore, MD, MPH, has received the National Cancer Institute (NCI) Outstanding Investigator Award, a top honor given to accomplished cancer researchers, and was awarded $6.4 million to further his work into the link between viruses and cancer. This NCI grant recognizes exceptional past achievements to provide seven years of secured support, giving the investigator freedom from the pressure of ongoing grant competitions.

Dr. Moore’s award makes him the second researcher at the University of Pittsburgh Cancer Institute (UPCI) to receive this highly coveted recognition, given to just 60 people in the country since the grant program was created in 2014. UPCI’s Thomas Kensler, PhD, who studies chemoprevention, or how food can be used to lower the risk of developing cancer caused by unavoidable environmental toxins, was awarded the honor last year.

Dr. Moore is a distinguished professor and leader of the UPCI Cancer Virology Program, holding The Pittsburgh Foundation Chair in Innovative Cancer Research at Pitt. Together with his research partner and wife, Yuan Chang, MD, Dr. Moore identified two different viruses that cause Kaposi sarcoma and Merkel cell carcinoma.

“To have the NCI recognize not just one but two of our faculty really reflects the strength of our research here at UPCI,” said Nancy E. Davidson, MD, director of UPCI, partner with UPMC CancerCenter. “We have a strong bench of talent here, and the work Dr. Moore is doing is making a real difference in our quest to end cancer.”
The award will fund Dr. Moore’s research in three key areas:

1. Understanding the mechanism by which the virus that causes Merkel cell carcinoma turns normal cells into cancer.
2. Investigating unusual ways that the virus causing Kaposi sarcoma makes oncoproteins.
3. Identifying new ways to find viruses that cause cancer in humans.
Recently, the Moore-Chang lab found a new mechanism that cancer viruses use to regulate how cells translate RNA into proteins and developed an assay to discover a class of viruses called polyomaviruses.

“I am hopeful this research will help provide new insights into methods to reliably determine the role of viruses in human cancers and to uncover new common cancer pathways that are at work in both infectious and noninfectious tumors,” Dr. Moore said. “This is an exciting time in cancer research based on past discoveries, and I’m honored that the NCI has chosen to recognize my work with this award.”

The NCI Outstanding Investigator Award provides funding to investigators with outstanding records of productivity in cancer research to continue or embark upon new projects of unusual potential in cancer research over an extended period of seven years. The award was developed to provide investigators with substantial time to break new ground or extend previous discoveries to advance biomedical, behavioral or clinical cancer research.

“The NCI Outstanding Investigator Award addresses a problem that many cancer researchers experience: finding a balance between focusing on their science while ensuring that they will have funds to continue their research in the future,” said Dinah Singer, Ph.D., director of NCI’s Division of Cancer Biology. “With seven years of uninterrupted funding, NCI is providing investigators the opportunity to fully develop exceptional and ambitious cancer research programs.”

Burning More Calories Associated with Greater Gray Matter Volume in Brain, Reduced Alzheimer’s Risk

Whether they jog, swim, garden or dance, physically active older persons  have larger gray matter volume in key brain areas responsible for memory and cognition, according to a new study by researchers at the University of Pittsburgh School of Medicine and UCLA.

The findings, published today in the Journal of Alzheimer’s Disease, showed also that people who had Alzheimer’s disease or mild cognitive impairment experienced less gray matter volume reduction over time if their exercise-associated calorie burn was high.

A growing number of studies indicate physical activity can help protect the brain from cognitive decline, said investigator James T. Becker, PhD, professor of psychiatry, Pitt School of Medicine. But typically people are more sedentary as they get older, which also is when the risk for developing Alzheimer’s disease and other dementias increases.

“Our current treatments for dementia are limited in their effectiveness, so developing approaches to prevent or slow these disorders is crucial,” Dr. Becker said. “Our study is one of the largest to examine the relationship between physical activity and cognitive decline, and the results strongly support the notion that staying active maintains brain health.”

Led by Cyrus Raji, MD, PhD, formerly a student at Pitt School of Medicine and now a senior radiology resident at UCLA, the team examined data obtained over five years from nearly 876 people 65 or older participating in the multicenter Cardiovascular Health Study. All participants had brain scans and periodic cognitive assessments. They also were surveyed about how frequently they engaged in physical activities, such as walking, tennis, dancing and golfing, to assess their calorie expenditure or energy output per week.

Using mathematical modeling, the researchers found that the individuals who burned the most calories had larger gray matter volumes in the frontal, temporal and parietal lobes of the brain, areas that are associated with memory, learning and performing complex cognitive tasks. In a subset of more than 300 participants at the Pitt site, those with the highest energy expenditure had larger gray matter volumes in key areas on initial brain scans and were half as likely to have developed Alzheimer’s disease five years later.

“Gray matter houses all of the neurons in your brain, so its volume can reflect neuronal health,” Dr. Raji explained. “We also noted that these volumes increased if people became more active over five years leading up to their brain MRI.”

He added that advancements in technology might soon make it feasible to conduct baseline neuroimaging studies of people who already have mild cognitive impairment or who are at risk for a dementia disorder, with the aim of prescribing lifestyle approaches such as physical activity to prevent further memory deterioration.

“Rather than wait for memory loss, we might consider putting the patient on an exercise program and then rescan later to see if there are any changes in the brain,” Dr. Raji said.

In a journal press release, George Perry, PhD, Dean of Sciences at the University of Texas at San Antonio and Editor in Chief of the Journal of Alzheimer’s Disease, called the research “a landmark study that links exercise to increases in gray matter and opens the field of lifestyle intervention to objective biological measurement.”

Other members of the research team include Kirk I. Erickson, PhD, Oscar L. Lopez, MD, H. Michael Gachi, PhD, and Lewis Kuller, MD, DrPH, all of the University of Pittsburgh; David A. Merrill, MD, PhD., Harris Eyre, MD, Sravya Mallam, BS, Nare Torosyan, BS, and Paul M. Thompson, PhD, all of UCLA; Owen T. Carmichael, PhD, of University of California, Davis; and W.T. Longstreth, Jr., MD, of the University of Washington.

The research was supported in part by funds from contract numbers N01-HC-80007, N01-HC-85079 through N01-540 HC-85086, N01-HC-35129, N01-HC-15103, N01-541 HC-55222, N01-HC-75150, N01-HC-45133 and grant HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke.

UPMC CancerCenter Re-Accredited By American College of Radiation Oncology

UPMC CancerCenter has received re-accreditation by the American College of Radiation Oncology (ACRO), maintaining its position as the largest comprehensive cancer network in the country to be accredited in radiation oncology. Two of UPMC CancerCenter’s newer network sites, UPMC Altoona and Butler Radiation Oncology centers, each received accreditation for the first time.

“This three-year accreditation recognizes the high-quality radiation oncology care that our facilities provide to the patients in our communities each day,” said Dwight E. Heron, MD, director of radiation oncology services at UPMC CancerCenter, partner with the University of Pittsburgh Cancer Institute. “This accreditation exemplifies our ongoing commitment and the focused effort of our staff to exceed national quality standards set forth by our professional peers. I am extremely proud of our outcomes.”

ACRO is the premier national organization dedicated to radiation oncology, and its validation confirms that UPMC CancerCenter delivers the highest-quality care to its patients. The lengthy and in-depth accreditation process included a thorough review of patient charts, technology, staff certifications and documentation of processes for each radiation oncology site, among other factors, followed by ACRO’s visits to each site to survey day-to-day operations.

At its treatment locations in western Pennsylvania, UPMC CancerCenter uses a variety of cutting-edge techniques to provide care for the approximately 7,000 cancer patients undergoing radiation at UPMC every year. These include external beam radiotherapy, such as intensity-modulated radiation therapy (IMRT) and 3-D conformal radiation therapy; stereotactic radiosurgery using the GammaKnife, CyberKnife and TrueBeam technologies, among others; and brachytherapy.

ACRO developed its voluntary accreditation program to help promote the highest standards for radiation oncology.

New Placenta Model Could Reveal How Birth Defect-Causing Infectious Agents Cross From Mother to Baby

Researchers at the University of Pittsburgh and Magee-Womens Research Institute (MWRI) have devised a cell-based model of the human placenta that could help explain how pathogens that cause birth defects, such as Zika virus, cross from mother to unborn child. The findings were published today in Science Advances.

The placenta is a complex and poorly understood organ that anchors the developing fetus to the uterus, nourishes the baby, and provides a barrier to the spread of microorganisms from an infected mother to the fetus, explained senior investigator Carolyn Coyne, PhD, associate professor of microbiology and molecular genetics at Pitt School of Medicine and a member of the MWRI.

“The human placenta is unique and unlike that of other many other placental mammals,” she said. “With our new model in the research toolkit, we and other scientists hope to advance our knowledge of the placenta, examine its function , and learn how it can prevent most, but not all, maternal infections from causing problems for the baby.

Researchers currently can obtain and study placental cell lines, but such cells do not fuse spontaneously to form the characteristic structure of the human organ. Some scientists study cells, called primary human trophoblasts, that are isolated from placentas obtained after childbirth, but such cells do not divide, can be more difficult to obtain, and are more difficult to genetically manipulate to learn about biochemical pathways that have a role in placental function, Dr. Coyne said.

Dr. Coyne’s team took a different approach: They cultured a human placental trophoblast cell line in a microgravity bioreactor system developed by NASA. The trophoblasts along with blood vessel cells were added to small dextran beads that were then spun around in a container filled with cell culture fluid, creating shear stress and rotational forces to better mimic the environment at the maternal-fetal interface than static cell-culture systems.

As a result, the cells fused to form syncytiotrophoblasts, and thus more closely resemble the primary cells lining the outermost layer of the tree-like or villous structure of the human placental tissue. Next, the researchers tested the functional properties of their model by exposing it to a virus and to Toxoplasma gondii, a parasite found in cat feces that can lead to fetal infection, causing miscarriage, congenital disease and/or disability later in life.

“We found that the syncytiotrophoblasts formed in our system recapitulated the barrier properties of the naturally occurring cells and they resisted infection by a model virus and three genetically different strains of Toxoplasma,” said co-investigator Jon P. Boyle, PhD, associate professor of biological sciences at Pitt. “With this model, we can experiment with different biological factors to see what might allow an infectious agent to get through the placental barrier to the fetus.”

Understanding the placenta might one day lead to ways to prevent fetal damage from the so-called TORCH infections: toxoplasmosis, rubella, cytomegalovirus, herpes and HIV, he added.

The researchers are beginning to use their model to test whether Zika virus, and other pathogens associated with congenital disease, can infect placental cells and/or cross the placental barrier.

Research team members include Cameron McConkey, BS, Elizabeth Delorme-Axford, PhD, and Yoel Sadovsky, MD, all of the University of Pittsburgh; Cheryl A. Nickerson, PhD, of Arizona State University; and Kwang Sik Kim, MD, of Johns Hopkins University.

The project was funded by National Institutes of Health grants AI081759 and HD075665 and the Burroughs Wellcome Fund.

UPMC Partners with medCPU to Rapidly Expand Innovative Clinical Decision-Support Technology

UPMC and medCPU Inc. today announced a far-reaching strategic partnership in which UPMC, one of the nation’s leading integrated health systems, will take a majority interest in this technology innovator, become a customer of medCPU’s real-time decision support solutions and co-develop additional products with the goal of improving patient outcomes.

As part of this transaction, UPMC has commenced a tender offer to purchase stock from existing non-employee medCPU shareholders and expects to hold majority ownership in the privately held company when the offer is completed in the second quarter of this year. In addition to the stock purchase, UPMC will lead an investment round of $35 million in new capital to accelerate the expansion of New York-based medCPU. Existing medCPU shareholder Merck Global Health Innovation Fund also is participating in this round.

“Our partnership with medCPU will provide UPMC with technology and solutions that will be immediately valuable to our clinicians and patients. Longer term, this powerful technology will enable the development of other data-dependent applications in such critical areas as care management, population health and consumer engagement,” said Tal Heppenstall, president of UPMC Enterprises, the commercialization arm of UPMC which led this investment. “medCPU is a perfect example of the kind of technological innovation nurtured by UPMC Enterprises to help us transform the delivery of care, not only at UPMC but around the world.”

medCPU, which already counts more than 60 hospital facilities among its clients, is opening a Pittsburgh office, where it will hire more than 20 engineers and other staff to work with UPMC to co-develop additional products and to enhance its existing solutions.

“We are excited to have UPMC as a majority partner and investor,” said Sonia Ben-Yehuda, president and co-founder, medCPU. “Having access to the clinical, technological and operational expertise of one of the country’s leading integrated health care providers and insurance systems will enable medCPU to rapidly expand our current capabilities and leverage our technology to greatly impact an industry that is moving quickly to value-based care.”

Through its revolutionary, seamless technology, medCPU’s solution addresses the health care IT challenges of interoperability, capturing all relevant patient data, and understanding free text, dictation and structured data from electronic medical records and ancillary systems.

According to Eyal Ephrat, MD, chief executive officer and co-founder of medCPU, “Our solution provides precise, real-time decision support prompts to clinicians without interrupting their workflow.”

This novel technology overcomes many of the obstacles that currently make it difficult to aggregate and normalize information across siloed data systems. medCPU’s solution makes it possible to combine rich, highly accurate information with extensive clinical best-practice content and services—resulting in reduced “alert fatigue” and improved response rates, thus avoiding clinical errors and reducing costs.

“Our vision at UPMC is to enable care providers to deliver the right care to our patients every time. Our partnership with medCPU will help drive the clinical pathways developed by our leading clinicians to the point of care, where it matters most,” said Steven Shapiro, MD, chief medical and scientific officer of UPMC.

Nephrotic Syndrome Symposium

Nephrotic Syndrome: Clinical Challenges and Evidence-based Management
May 12, 2016 – 9:00 a.m. to 6 p.m.
Children’s Hospital of Pittsburgh of UPMC
4401 Penn Ave.
Pittsburgh, PA 15224

Please join us for this one day event will engage glomerular kidney disease researchers, clinicians, other healthcare professionals and patient families. This event promises to foster new collaborations, close the gaps between research and clinical care and form common research agendas.

Course Directors
Agnieszka Swiatecka-Urban, MD
Children’s Hospital of Pittsburgh of UPMC,
University of Pittsburgh School of Medicine

Hoda Kaldas, MD
University of Pittsburgh

To view the Save the Date flyer, click here.
For more information or to register, click here.

 

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