UPMC Physician Resources

Heart Failure Care Improving, but Hospitalizations on the Rise

Although hospitalizations have increased in recent years for patients with congestive heart failure, survival rates and length of stay have improved, according to new research from experts at the University of Pittsburgh School of Medicine and UPMC Heart and Vascular Institute. The results, published in the journal Clinical Cardiology and presented Sunday at the American Heart Association Scientific Sessions, were based on more than 15 million US hospital admissions between 1996 and 2009 due to congestive heart failure.

The prevalence of heart failure is increasing in the US due to its aging population and significant advancements in management of associated co-morbidities, such as ischemic heart disease, diabetes, stroke, peripheral vascular disease and hypertension. More than 5 million Americans are living with heart failure, and close to 500,000 patients are newly diagnosed each year.

Heart failure also is a common cause of hospital admissions, leading to significant costs for the nation’s health care system. A recent report from the American Heart Association estimated the annual direct and indirect costs associated with heart failure in the US at more than $30.7 billion. However, until this study, little was known about recent trends involving those admissions, including length of stay and in-hospital mortality.

“There has been significant progress in heart failure management over the past two decades, but more has to be done,” said Muhammad Bilal Munir, MD, clinical instructor of medicine in Pitt’s Division of General Internal Medicine and corresponding author of the study. “The number of hospitalizations has increased, identifying a need to implement heart failure quality measures stringently to reduce these admissions, therefore reducing heart failure-associated health care costs.”

The number of heart failure hospitalizations increased from 1,000,766 in 1996 to about 1,173,832 in 2009, according to study results. The mean length of stay fell from 6.07 days in 1996 to about 5.26 days in 2009, and inpatient mortality rates declined from 4.92 percent in 1996 to 3.41 percent in 2009.

Researchers say the findings likely reflect the changes in the management of heart failure across the country, which include numerous advances in care such as new drug therapies and sophisticated devices. Further efforts are needed to curb the cost of heart failure management, experts agreed, with a focus on reducing heart failure hospital admissions and readmissions, especially for patients with less severe symptoms who could be treated with aggressive outpatient management.

Additional study authors are Michael S. Sharbaugh, MPH; Floyd W. Thoma; Muhammad Umer Nisar, MD; Amir S. Kamran, MD; Andrew D. Althouse, PhD; and Samir Saba, MD, all from the UPMC Heart and Vascular Institute.

Western Psychiatric Institute and Clinic of UPMC Host 33rd Annual Pittsburgh Schizophrenia Conference

On November 18, 2016, join Western Psychiatric Institute and Clinic of UPMC and the University of Pittsburgh Department of Psychiatry for the nation’s longest running scientific meeting devoted to exploring the latest research findings related to schizophrenia and other psychotic disorders.

Held at the Sheraton Station Square, this year’s program features presentations on a wide range of topics including:

  • The relevance of animal models to the prevention and treatment of schizophrenia
  • New findings in the area of genetics 
  • The importance of early detection and intervention 
  • The role of spirituality in recovery from serious mental illness

The conference also welcomes Stephen Marder, MD, Professor of Psychiatry and Biobehavioral Sciences at the UCLA David Geffen School of Medicine, who will be presenting the Gerald E. Hogarty Excellence in Schizophrenia Research Memorial Lecture. Dr. Marder will present on the topic of “New Clinical Targets for Improving Functioning in Schizophrenia.”

Click here to register online and here to download the conference program.

For more information about the conference and how to register, please contact Nancy Mundy at mundynl@upmc.edu.

Click here for more resources and free online CME in psychiatry.

Children’s Hospital of Pittsburgh Experts At the 30th Annual North American Cystic Fibrosis Conference

PrintThe 30th annual North American Cystic Fibrosis Conference was held October 27-29 in Orlando. The event brought scientists, clinicians, and other healthcare professionals from around the world to share the latest ideas and advances in cystic fibrosis research, drug development, and patient care, and included posters and presentations from field-leading experts.

Several Children’s Hospital of Pittsburgh of UPMC faculty and staff presented at the conference on a number of topics including:


Poster: Identification of Novel Inhibitors of Ubiquitination That Improve Rescue of F508DELCFTR by VX-809

Goeckeler-Fried, Jennifer; Estabrooks, Samuel K; Chiang, Annette; Chung, Wook Joon; Ye, Zhaofeng; Denny, Rajiah Aldrin; Weissman, Allan M; Camacho, Carlos J; Sorscher, Eric J; Brodsky, Jeffrey L

Poster: Recognition of CFTR By BCL2 Associated Athnaogene 3 (BAG3): A Pathway meditating Autophagic CFTR Degradation

Mishra, Sanjay K ; Frizzell, Raymond A.

Poster: Ubiquitin-Specific Proteases 11(USP11)and 28(USP28)Regulate F508DELCFTRStability Via SUMOConjugation

Gong, Xiaoyan; DaPaula ,AnaCarina; Ahner, Annette; Frizzell, Raymond A

Poster/Workshop Presentation: Predicted Phosphorylation Site in SLC26A9 Modulates CFTR-Dependent Activity

Wang, Xiaohui; Larsen, Mads B; Frizzell, Raymond A.; Bertrand, Carol A.

Poster: Pseudomonas aeruginosa Benefits From Respiratory Viral Infection in Cystic Fibrosis

Jeffrey Melvin

Poster: Viral-Bacterial Interactions in the Paranasal Sinuses in Cystic Fibrosis

Jeffrey Melvin

Abstract: Dynamics of Staphylococcus aureus growth on airway epithelial cells

Megan R Kiedrowski

Presenting: Thursday, Oct. 27 – W06: INF/MIC: Pathogenesis of Airway Infection (speaking 10:20-10:30a)

Poster Session I (11:15a-1:45p), Friday, Oct. 28 – JIB: Junior investigators best abstract session: Basic Science (12:15-1:35p)

Poster: Dysregulation of Nutritional Immunity during Respiratory Viral Infection Promotes Pseudomonas aeruginosa Biofilm Growth

Matthew Hendricks

Poster: SIRT1 Mediates Resveratrol Inhibition of CFTR In Primary Bronchial Epithelium

Agnieszka Swiatecka-Urban, MD, FASN

Poster: TGF-β1 Upregulates Microrna- 145 To Block ∆F508-CFTR Rescue

Agnieszka Swiatecka-Urban, MD, FASN

Poster: Anti-biofilm activity and in vivo efficacy of an engineered peptide antibiotic”

Berthony Deslouches

Workshop III: CLIN: *Emerging Issues in CF Lung Transplantation

A. Faro, J. Pilewski

Poster: Infection and depressed mucociliary clearance in pediatric and adult CF patients

Corcoran TE, Locke LW, Myerburg MM, Weiner DJ, Pilewski JM

Poster: Nitrogen Back Diffusion During Multiple Breath Washout With 100% Oxygen

Weiner DJ, Pederson K, Nielson JG.

Poster: Lung Function Perception in Cystic Fibrosis

Forno E, Weiner DJ

UPMC Heart and Vascular Experts to Present at the American Heart Association’s Annual Scientific Sessions

The UPMC Heart and Vascular Institute will be well-represented at the American Heart Association’s Scientific Sessions in New Orleans on Saturday, Nov. 12 – Wednesday, Nov. 16. Faculty research will be presented in both oral and abstract presentations.

November 13, 2016

511 – The Role Of Exposure To Environmental Pollutants In Racial Disparity In Cardiovascular Risk Factors And Novel Markers

Presented by: Sebhat Erqou, Jane Clougherty, Steven Reis

553 – Population Based Characterization of the Definition, Prevalence and Associated Mortality of Pulmonary Hypertension in the Setting of Left Heart Disease

Presented by: Rebecca R. Vanderpool, Melissa I. Saul, Seyed Mehdi Nouraie, Mark T. Gladwin, Marc A. Simon

 S4127 / 4127 – Trends in Heart Failure Hospitalizations Using Data From National Hospital Discharge Survey

Presented by: Muhammad Bilal Munir, Michael S. Sharbaugh, Floyd W. Thoma, Muhammad Umer Nisar, Amir S. Kamran, Andrew D. Althouse, Samir Saba

Advances in Contrast Echocardiography, Molecular and Myocardial Imaging

S4217 / 4217 – Targeted Delivery of AntimiR-23a Using Ultrasound and Microbubbles Suppresses Cardiac Hypertrophy and Improves Cardiac Function in vivo

Presented by: Jonathan A Kopechek, Charles F. McTiernan, Xucai Chen, Rafey Feroze, Bin Qin, Jissy Cyriac, Linda Lavery, Daniel Whitehurst, Flordeliza S. Villanueva

Clinical Applications of Nuclear Cardiology

S4251 / 4251 – Assessment of Dyssynchrony as an Indicator of Right Ventricular Free Wall Function by Gated Blood Pool SPECT (GBPS) in Patients undergoing LVAD Implantation

Presented by: Aditi Nayak, Christopher B. Link, Andrew D. Althouse, Robert L. Kormos, Marc A. Simon, Jeffrey J. Teuteberg, Luigi G. Lagazzi, Prem Soman

November 14, 2016

Metabolic Disease and Pulmonary Hypertension

670 – Development of a Mouse Model of Metabolic Syndrome, Pulmonary Hypertension, and Heart Failure With Preserved Ejection Fraction (PH-HFpEF)

Presented by: Yen-Chun Lai, Qingqing Meng, Neil Kelly, Marta Bueno, Jeffery Baust, Timothy Bachman, Rebecca Vanderpool, Josiah Radder, Jian Hu, Alison Morris, Ana Mora, Mark T. Gladwin

Imaging the Mitral Valve and Strain Imaging

M5020 / 5020 – Vector Flow Mapping Quantification of Left Ventricular Energy Loss Occurring in Normal Subjects

Presented by: Masataka Sugahara, Zhi Qi, Tijmen Koopsen, Marc A. Simon, John Gorcsan lll

Imaging the Right Heart and the Left Ventricle in Mitral Regurgitation

M5027 / 5027 – Three Dimensional Echocardiographic Wall Motion Tracking Assessment of Right Ventricular Remodeling and Effects on Left Ventricular Function as Prognostic Predictors in Patients With Pulmonary Hypertension

Presented by: Masataka Sugahara, Zhi Qi, Marc A. Simon, Michael A. Mathier, John Gorcsan lll

 Percutaneous Non-Coronary Cardiac Intervention (including Percutaneous Valves) III

M5078 / 5078 – Predictors of Mortality in Patients With Persistent Pulmonary Hypertension Following Transcatheter Aortic Valve Replacement

Presented by: Ahmad Masri, Michael S. Sharbaugh, Andrew D. Althouse, Islam Abdelkarim, Wei Han, William E. Katz, Frederick Crock, Mathew Harinstein, Dustin E. Kliner, Forozan Navid, Thomas G. Gleason, Joon S. Lee, John T. Schindler, João L. Cavalcante

Percutaneous Non-Coronary Cardiac Intervention (including Percutaneous Valves) III

M5081 / 5081 – Prognostic Value of Baseline Right Ventricular Dysfunction in Patients Undergoing Transcatheter Aortic Valve Replacement

Presented by: Islam Abdelkarim, Wei Han, Floyd Thoma, Andrew D Althouse, William E Katz, Frederick W Crock, Matthew E Harinstein, Dustin E Kliner, Forozan Navid, Thomas G Gleason, Joon S Lee, John T Schindler, João L Cavalcante

 Arrhythmia: Clinical Electrophysiology, Diagnosis and Risk Stratification V

M5186 / 5186 – Depression and 5-Year Stroke Risk in Patients With Atrial Fibrillation

Presented by: Bruno B. Lima, Andrew D. Althouse, Muhammad B. Munir, Michael S. Sharbaugh, Bruce L. Rollman, Samir Saba


Treatment of Arrhythmias: ICD/Pacemaker – excluding CRT II

M5276 / 5276 – Reversible Cause of Sudden Cardiac Arrest and Rates of Defibrillator Implantation

Presented by: Adetola Ladejobi, Deepak Kumar Pasupula, Shantanu Patil, Shasank Rijal, Bilal Munir, Asad Durrani, Awais Javed, Max Wayne, Oluremi Ajala, Natasha A. Kassim, Shubash Adhikari, Samir Saba


Ventricular Function/Hemodynamics and Biomarkers III

M4257 / 4257 – Myocardial Fibrosis is Associated With Pulmonary Artery Pressure and Adverse Outcomes in Patients With Preserved Left Ventricular Systolic Function

Presented by: George Cater, Erik Schelbert, Marc A. Simon, Peter Kellman, Timothy Wong


November 15, 2016

Echocardiography in Clinical Syndromes: CAD, Stress Echo, Vascular Disease

Echocardiographic Radial and Circumferential Strain Follow-up Analysis of Neurocardiac Injury in Patients With Subarachnoid Hemorrhage

Presented by: Zhi Qi, Masataka Sugahara, Elizabeth A. Crago, Yugang Chang, Theodore F. Lagattuta, Khalil Yousef, Robert M. Friedlander, Marilyn T. Hravnak, John Gorcsan III


Medical Aspects End Stage Heart Failure: Transplantation and Device Therapies IV

T4071 / 4071 – Critical Preoperative Factors and Specific Postoperative Adverse Events Drive Left Ventricular Assist Device Implant Hospitalization Costs

Presented by: Christine V. Nikas, Jennifer O. Larsen, Jeffrey J. Teuteberg, Luigi G. Lagazzi, Andrew D. Althouse, Michael S. Sharbaugh, Michael A. Shullo, Kathleen L. Lockard, Elizabeth M. Dunn, Nicole M. Kunz, Robert L. Kormos


770 – Heart Failure Admissions Under Observation versus Short Inpatient Stay: A Cohort Study

Presented by: Ahmad Masri, Andrew D. Althouse, Jeffrey McKibben, Floyd Thoma, Michael A. Mathier, Ravi Ramani, Jeffrey J. Teuteberg, Oscar C. Marroquin, Joon S. Lee, Suresh R. Mulukutla


VA.RFO.14 – Novel Insights into the Clinical Spectrum of PH and PAH

819 – Identification of a Pro-Hypertrophic Pathway With Chamber Specificity for the Right Ventricle; Implications for Right-Heart Dysfunction in Pulmonary Arterial Hypertension

Presented by: Imad Al Ghouleh, Daniel Meijles, John Sembrat, Mauricio Rojas, Rebecca R. Vanderpool, Jeffrey Baust, Asma Naqvi, Patrick J. Pagano,


Determinants of Clinical Outcome in Pulmonary Artery Hypertension

T4261 / 4261 – Nitric Oxide Synthase (NOS3) Asp298Glu Polymorphism and Survival in Pulmonary Arterial Hypertension

Presented by: Andrew Klein, David Ishizawar, Karen Hanley-Yanez, Dennis M. McNamara


For more information, visit the event website.

Topical Therapy for Radiation-Induced Skin Damage Shows Promising Results

A team of University of Pittsburgh researchers has demonstrated that a newly developed topical therapy applied before or after radiation exposure prevents skin damage in both animal and human models.

The results, published online in the Journal of Investigative Dermatology, are expected to accelerate efforts that will lead to clinical studies and licensing of the technology, said Louis Falo, MD, chairman of the Department of Dermatology at the Pitt School of Medicine and corresponding author for the study.

The skin is the largest human organ and protects the body from physical, chemical and environmental exposures. Radiation-induced skin damage ranges from photo-aging and ultraviolet sun exposure to radiation dermatitis, a treatment-limiting condition caused by radiation therapy; and skin radiation syndrome, a frequently fatal consequence of exposures from nuclear accidents.

Dr. Falo teamed with Joel Greenberger, MD, professor and chair of the Department of Radiation Oncology, and Peter Wipf, PhD, Distinguished University Professor of Chemistry, in 2008. Drs. Greenberger and Wipf were exploring treatments to mitigate radiation poisoning caused by an accident at a nuclear power facility or from a so-called “dirty bomb” device. Together, they determined that the approaches being developed and investigated at Pitt could potentially benefit the approximately 1 million people annually in the U.S. who undergo radiation therapy to the skin for breast, head and neck, and other cancers.

“During the course of radiation therapy, patients can develop irritating and painful skin burns that can lead to dangerous infections and diminished quality of life,” Dr. Falo said. “Sometimes the burns are so severe that patients must stop their treatment regimen. Our results show that topical treatment with this therapeutic agent prevents skin damage at the source.”

Dr. Wipf’s lab developed the molecule that targets the formation of oxidative free radicals in the cell’s mitochondria, thereby preventing inflammation and cell death.

“This provides for potentially improved treatment options for patients undergoing radiation therapy with the prospect for more simplified treatment regimens and reduced concern about quality of life post-treatment,” he said. Dr. Wipf’s former student, Joshua Pierce, PhD, who now operates his own lab at North Carolina State University, is credited with synthesizing the molecule, named JP4-039.

Dr. Falo said he is optimistic about the therapy’s performance in clinical trials because the treatment appears to be effective in a model that uses human skin obtained from cosmetic procedures.

Looking beyond treating radiation therapy, he and his team are pursuing further studies of the molecule’s ability to reduce skin damage from sun exposure, including sunburns and the molecular changes that lead to skin cancer, as well as cosmetic applications to prevent skin changes caused by the oxidative stress that is associated with normal skin aging.

Additional authors on this study are Rhonda M. Brand, PhD, Michael W. Epperly, PhD, J. Mark Stottlemyer, BS, Xiang Gao, PhD, Erin M. Skoda, PhD, Song Li, MD, PhD, Saiful Huq, PhD, and Valerian E. Kagan, PhD, D.Sc, all of Pitt.

This research was funded by National Institute of General Medical Sciences grants P50 GM067082 and U19-A1068021, and National Institute of Allergy and Infectious Diseases grant 1RC1AI081284, and the Coulter Foundation.

UPMC Partners with Bon Secours to Open Advanced Radiation Treatment Center in Ireland

UPMC and Bon Secours Health System Ltd. today announced that they have formed a joint venture in Cork, Ireland, to own and operate one of the nation’s most advanced radiation therapy centers for the treatment of cancer patients. The new center will combine the expertise of Ireland’s largest independent health care provider with UPMC’s world-renowned model of cancer care that brings innovative and personalized treatments close to where patients live.

“This partnership builds upon the world-class medical and surgical oncology services that we already offer to patients in Cork,” said Bill Maher, chief executive officer of Bon Secours Health System. “With the help of UPMC, we will soon enhance our cancer services by providing access to leading-edge radiation technology and clinical protocols.”

The radiotherapy center will be built on the Bon Secours campus in Cork as part of a new, six-story expansion currently under construction. The joint venture, to be managed by UPMC and owned equally by both partners, will lease space from Bon Secours. Starting in 2019, it expects to treat patients with two advanced Varian TrueBeam Radiotherapy System linear accelerators, providing image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT). Used for a variety of cancers, these approaches are designed to improve patient outcomes while minimizing side effects.

“We’re excited to work with such a highly regarded clinical partner as Bon Secours to reach more patients in Ireland with world-class care close to home,” said Charles Bogosta, president of UPMC International and UPMC CancerCenter. “This new facility will share in the learning and best practices at the UPMC Whitfield Cancer Centre in Waterford, now celebrating 10 years of providing state-of-the-art radiotherapy and personalized care in Ireland.”

The center in Cork also will benefit from access to the entire UPMC CancerCenter network, comprising more than 40 sites in the US and around the world. As part of that powerful network, patients have access to cutting-edge treatments, protocols and technologies guided by the latest scientific evidence. UPMC CancerCenter partners with the University of Pittsburgh Cancer Institute, western Pennsylvania’s only National Cancer Institute-designated Comprehensive Cancer Center.

In 2006, UPMC CancerCenter opened its first international cancer center, UPMC Whitfield, based on UPMC’s “hub-and-spoke” model in which a wide range of oncology services are offered in local communities with support from UPMC’s academic and clinical hub at the Hillman Cancer Center in Pittsburgh. Based on its high quality standards and patient safety, UPMC Whitfield was accredited by the Joint Commission International in 2008. UPMC also operates a radiation center in Rome and works with partners in Kazakhstan, Lithuania, Colombia, Russia, Myanmar and other nations to improve cancer care worldwide.

“With Bon Secours, we look forward to continuing to grow the number of patients that we can help in Ireland,” said Mr. Bogosta. “This investment underscores UPMC’s commitment to improving cancer care in Ireland, while giving us access to knowledge and resources that will strengthen our medical and research mission in Pittsburgh and around the world.”

Completion of the agreement is contingent on the approval of the Competition and Consumer Protection Commission of Ireland.

UPMC Senior Services Honors Resnick as 2016 Grand Champion

UPMC Senior Services will honor Neil Resnick, MD, Thomas Detre Professor and chief of the Division of Geriatric Medicine and Gerontology as its 2016 Grand Champion for demonstrating exceptional leadership in improving the lives of seniors in western Pennsylvania and nationally. It is the highest honor awarded by UPMC Senior Services.

“Dr. Resnick’s research has fundamentally changed the clinical care of older patients around the world. Through innovation and collaboration, he’s created specialized centers to evaluate the most difficult problems, trained others to do the same, and has investigated geriatric conditions that had fallen through the cracks,” said Deborah Brodine, president of UPMC Community Provider Services. “UPMC Senior Services is exceptionally proud to recognize him for such exemplary work on behalf of the seniors in western Pennsylvania.”

The awards will be presented October 26 at the annual UPMC Senior Services “Celebrating Senior Champions” Dinner and Auction at the Omni William Penn hotel.

Dr. Resnick founded the Aging Institute of UPMC Senior Services at the University of Pittsburgh, which is now one of the country’s top-funded aging research programs. His research led to a discovery of a new cause of incontinence, a syndrome that leads to significant disability, and helped develop new approaches to its diagnosis and treatment. These approaches also led to federal guidelines that have since been adopted by many other countries.

Additionally, Dr. Resnick has made major research contributions to other geriatric conditions, including osteoporosis, falls and delirium. Lessons from his research also enabled him to develop geriatric modules for primary care providers and help national urological and gynecological organizations develop training programs in geriatrics.

“This award is such a wonderful testament to the importance of geriatric care, as well as to the research we need to offer still better care tomorrow,” said Dr. Resnick. “It’s been an incredible privilege to have been able to do both and it is a real honor to receive this award.”

The UPMC Senior Services also will honor Operation Safety Net as its 2016 Community Champion. James S. Withers, MD, founder and CEO of Pittsburgh Mercy’s Operation Safety Net, will accept the award on behalf of the organization. Operation Safety Net supports the homeless of Pittsburgh, a growing segment of which are seniors, by delivering health care, case management, housing follow up, and other vital health and human services.

Elaine H. Berkowitz, DMD, will receive the 2016 Caregiver Champion award. Dr. Berkowitz practices geriatric and special needs dentistry in private homes, nursing homes, personal care homes, rehabilitation hospitals and general hospitals, bringing essential oral care to the home-bound, including residents at UPMC Canterbury Place.

World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition 2016

PrintThe 5th World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition (WCPGHAN) was held October 5-8, 2016 in Montreal. This event showcased state of the art science and technology in the field of pediatric gastroenterology, hepatology, and nutrition, as well as presentations and keynote speeches from experts who are leaders in their field.

The conference encompassed nine themes including:

  • IBD
  • Celiac and other GI disorders
  • Neurogastroenterology and motility
  • Endoscopy
  • Hepatology
  • Pancreatology
  • Global health
  • Nutrition and intestinal rehabilitation
  • Transplantation

Several Children’s Hospital of Pittsburgh of UPMC faculty and staff spoke at the conference on a number topics including:

Immune Tolerance and Rejection
Pharmacology (pharmaco-genetics) and immunosuppression: Past, present and future
Patrick McKiernan, MD

Steatorrhea: What if it’s not Cystic Fibrosis
Mark Lowe, MD, PhD

Acute Liver Failure – Pathogenesis and Management
Rob Squires, MD and Anil Dhawan, MD

Mark Lowe, MD PhD


Inflammatory Responses/ Healing in Pancreatic Injury
Sohail Husain, MD

Poster Presentations

Sterile Cerebrosprinal Fluid Ascites: A Rare Complication After Ventriculoperitoneal Shunting
James Squires, MD, and  Kristen Critelli, MD (fellow)

Clinical Variability Following Partial External Biliary Diversion In Familial Intrahepatic Cholestasis 1 Deficiency
James Squires, MD,  Robert Squires, MD, and Amy Morris, RN, CCPC

Concussions are Treatable, More Research Needed, say Leading U.S. Experts in Published Paper

Concussions, often viewed by the public as dire and perplexing, can be effectively treated despite their complexity, according to experts from around the US in a Statement of Agreement available online and published in the December issue of the journal Neurosurgery.

In October, 2015, leading concussion clinicians and researchers gathered at UPMC in Pittsburgh for the “Targeted Evaluation and Active Management” (TEAM) symposium, an unprecedented meeting and white paper designed to propose and share nationally the participants’ agreement on the best practices, protocols and active therapies for treating concussions.

The conference discussions, led by chair Micky Collins, PhD, director of the UPMC Sports Medicine Concussion Program, along with co-directors Anthony Kontos, PhD, and David Okonkwo, MD, PhD, of UPMC and the University of Pittsburgh, resulted in the Statement of Agreement publication. The two-day meeting was fully funded by a grant from the NFL Foundation.

“This conference was remarkable because it brought together a diverse group of leading experts in cutting-edge research and clinical treatment to approach this injury in ways that will help move concussion treatment forward,” said Anthony Kontos, PhD, research director for the UPMC Concussion Program, associate professor in the University of Pittsburgh Department of Orthopaedic Surgery.

The US Center for Disease Control (CDC) estimates that as many as 4 million concussions occur each year in the US, and sport- and recreation-related concussions in particular have increasing incidence. Symptoms, which can be subtle and last days or weeks, include but are not limited to headache, confusion and nausea.

“There has been only limited evidence-based guidance, particularly for primary care providers, about the active treatment of concussion,” Dr. Collins said. “This makes it difficult for clinicians to determine how best to treat patients with this injury. Many are treating patients with concussion using a uniform, rest-based approach today much the same way they did a decade ago.”

Doctors typically advise patients to rest—both the brain and body—until symptoms abate, which might require accommodations at school or work. If the injury was sustained during sports, the patient is instructed not to return to play on the same day and to gradually increase aerobic, exertion-based activity while symptoms are carefully monitored.

But, as described at the symposium and in the published Statement of Agreement, research is beginning to show active rehabilitation can help people recover more quickly and safely than simply resting.

“More research in large, multicenter trials is needed to figure out what kinds of treatments are most effective for a set of symptoms and for individual patients,” Dr. Collins said. Most importantly, we believe concussions are treatable and patients can and do get better.”

A 2015 Harris Poll of more than 2,000 US adults found that 71 percent did not recognize that concussions are treatable. In the same report, 1 in 3 patients who had been diagnosed with a concussion reported receiving no prescribed treatment.

“The purpose of the UPMC symposium was to engage leading clinicians and scientists in a discussion of what we know about concussion and its treatment,” Dr. Okonkwo said. “We hope to build on this effort to share the best available information to improve public understanding and guide future research.”

The authors feel the Statement of Agreement is a step forward in the field and will lead to a collaborative era.

“Over the past decade, many of us individually have accumulated quite a bit of experience about which treatments work for specific symptoms and deficits caused by concussion. We are looking forward to working together to rigorously test these treatments,” said David Brody, MD, PhD, co-author and professor of neurology, Washington University School of Medicine in St Louis.

The Neurosurgery paper was co-written by 37 experts representing 32 clinical and academic institutions, including:

• Jon Almquist, ATC, VATL, ITAT, Fairfax Concussion Center
• Julian Bailes, MD, University Health System, University of Chicago Pritzker School of Medicine
• Mark Barisa, PhD, Baylor Institute for Rehabilitation
• Jeffrey Bazarian, MD, MPH, University of Rochester
• Joshua Bloom, MD, Carolina Sports Concussion Clinic
• David Brody, MD, PhD, Washington University St. Louis
• Robert Cantu, MD, Emerson Hospital, Boston University
• Javier Cardenas, MD, Barrow Neurological Institute
• Jay Clugston, MD, University of Florida
• Randy Cohen, DPT, ATC, University of Arizona
• Ruben Echemendia, PhD, Psychological and Neurobehavioral Associates
• R.J. Elbin, PhD, University of Arkansas Office for Sports Concussion Research
• Richard Ellenbogen, MD, University of Washington
• Janna Fonseca, ATC, Carolina Sports Concussion Clinic
• Gerry Gioia, PhD, Children’s National Health System
• Kevin Guskiewicz, PhD, ATC, University of North Carolina Chapel Hill
• Robert Heyer, MD, Carolinas Medical Center
• Gillian Hotz, PhD, University of Miami
• Grant L. Iverson, PhD, and Ross Zafonte, DO, Harvard Medical School
• Barry Jordan, MD, MPH, Burke Rehabilitation and Research
• Geoffrey Manley, MD, University of California San Francisco
• Joseph Maroon, MD, University of Pittsburgh
• Thomas McAllister, MD, and Daniel Thomas, MD, Indiana University
• Michael McCrea, PhD, Medical College of Wisconsin
• Anne Mucha, DPT, UPMC Centers for Rehabilitation Services
• Beth Pieroth, PhD, North Shore University Health System
• Ken Podell, PhD, Methodist Concussion Center at Houston Hospital
• Matt Pombo, MD, Emory University Healthcare
• Teena Shetty, MD, Hospital for Special Surgery, Weill Cornell Medical College
• Allen Sills, MD, and Gary Soloman, PhD, Vanderbilt University Sports Concussion Center
• Tamara C. Valovich-McLeod, PhD, ATC, FNATA, AT, Still University
• Tony Yates, MD, Pittsburgh Steelers

For more information on concussion research at UPMC, please visit rethinkconcussions.com.

In a First, Pitt-UPMC Team Help Paralyzed Man Feel Again Through a Mind-Controlled Robotic Arm

PITTSBURGH, Oct. 13, 2016 – Imagine being in an accident that leaves you unable to feel any sensation in your arms and fingers. Now imagine regaining that sensation, a decade later, through a mind-controlled robotic arm that is directly connected to your brain.
That is what 28-year-old Nathan Copeland experienced after he came out of brain surgery and was connected to the Brain Computer Interface (BCI), developed by researchers at the University of Pittsburgh and UPMC. In a study published online today in Science Translational Medicine, a team of experts led by Robert Gaunt, Ph.D., assistant professor of physical medicine and rehabilitation at Pitt, demonstrated for the first time ever in humans a technology that allows Mr. Copeland to experience the sensation of touch through a robotic arm that he controls with his brain.
“The most important result in this study is that microstimulation of sensory cortex can elicit natural sensation instead of tingling,” said study co-author Andrew B. Schwartz, Ph.D., distinguished professor of neurobiology and chair in systems neuroscience, Pitt School of Medicine, and a member of the University of Pittsburgh Brain Institute. “This stimulation is safe, and the evoked sensations are stable over months.  There is still a lot of research that needs to be carried out to better understand the stimulation patterns needed to help patients make better movements.”
This is not the Pitt-UPMC team’s first attempt at a BCI. Four years ago, study co-author Jennifer Collinger, Ph.D., assistant professor, Pitt’s Department of Physical Medicine and Rehabilitation, and research scientist for the VA Pittsburgh Healthcare System, and the team demonstrated a BCI that helped Jan Scheuermann, who has quadriplegia caused by a degenerative disease. The video of Scheuermann feeding herself chocolate using the mind-controlled robotic arm was seen around the world. Before that, Tim Hemmes, paralyzed in a motorcycle accident, reached out to touch hands with his girlfriend.
But the way our arms naturally move and interact with the environment around us is due to more than just thinking and moving the right muscles. We are able to differentiate between a piece of cake and a soda can through touch, picking up the cake more gently than the can. The constant feedback we receive from the sense of touch is of paramount importance as it tells the brain where to move and by how much.
For Dr. Gaunt and the rest of the research team, that was the next step for the BCI. As they were looking for the right candidate, they developed and refined their system such that inputs from the robotic arm are transmitted through a microelectrode array implanted in the brain where the neurons that control hand movement and touch are located. The microelectrode array and its control system, which were developed by Blackrock Microsystems, along with the robotic arm, which was built by Johns Hopkins University’s Applied Physics Lab, formed all the pieces of the puzzle.
In the winter of 2004, Mr. Copeland, who lives in western Pennsylvania, was driving at night in rainy weather when he was in a car accident that snapped his neck and injured his spinal cord, leaving him with quadriplegia from the upper chest down, unable to feel or move his lower arms and legs, and needing assistance with all his daily activities. He was 18 and in his freshman year of college pursuing a degree in nanofabrication, following a high school spent in advanced science courses.
He tried to continue his studies, but health problems forced him to put his degree on hold. He kept busy by going to concerts and volunteering for the Pittsburgh Japanese Culture Society, a nonprofit that holds conventions around the Japanese cartoon art of anime, something Mr. Copeland became interested in after his accident.
Right after the accident he had enrolled himself on Pitt’s registry of patients willing to participate in clinical trials. Nearly a decade later, the Pitt research team asked if he was interested in participating in the experimental study.
After he passed the screening tests, Nathan was wheeled into the operating room last spring. Study co-investigator and UPMC neurosurgeon Elizabeth Tyler-Kabara, M.D., Ph.D., assistant professor, Department of Neurological Surgery, Pitt School of Medicine, implanted four tiny microelectrode arrays each about half the size of a shirt button in Nathan’s brain. Prior to the surgery, imaging techniques were used to identify the exact regions in Mr. Copeland’s brain corresponding to feelings in each of his fingers and his palm.
“I can feel just about every finger—it’s a really weird sensation,” Mr. Copeland said about a month after surgery. “Sometimes it feels electrical and sometimes its pressure, but for the most part, I can tell most of the fingers with definite precision. It feels like my fingers are getting touched or pushed.”
At this time, Mr. Copeland can feel pressure and distinguish its intensity to some extent, though he cannot identify whether a substance is hot or cold, explains Dr. Tyler-Kabara.
Michael Boninger, M.D., professor of physical medicine and rehabilitation at Pitt, and senior medical director of post-acute care for the Health Services Division of UPMC, recounted how the Pitt team has achieved milestone after milestone, from a basic understanding of how the brain processes sensory and motor signals to applying it in patients
“Slowly but surely, we have been moving this research forward. Four years ago we demonstrated control of movement. Now Dr. Gaunt and his team took what we learned in our tests with Tim and Jan—for whom we have deep gratitude—and showed us how to make the robotic arm allow its user to feel through Nathan’s dedicated work,” said Dr. Boninger, also a co-author on the research paper.
Dr. Gaunt explained that everything about the work is meant to make use of the brain’s natural, existing abilities to give people back what was lost but not forgotten.
“The ultimate goal is to create a system which moves and feels just like a natural arm would,” says Dr. Gaunt. “We have a long way to go to get there, but this is a great start.”
The lead author on the research publication is Sharlene N. Flesher, of Pitt. Additional authors on this research are Stephen T. Foldes, Ph.D., Jeffrey M. Weiss and John E. Downey, all of Pitt; and Sliman J. Bensmaia, Ph.D., of the University of Chicago.
Primary support for the study was provided by the Defense Advanced Research Projects Agency’s (DARPA) Revolutionizing Prosthetics program through contract N66001-10-C-4056. Additional support was provided by the Office of Research and Development, Rehabilitation Research and Development Service, U.S. Department of Veterans Affairs, grant numbers B6789C, B7143R, and RX720 and the National Science Foundation Graduate Research Fellowship grant DGE-1247842.
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