UPMC Physician Resources

Life Expectancy for Those With Type 1 Diabetes Improving, Pitt Study Shows

PITTSBURGH, June 24, 2011 – The life expectancy of people diagnosed with type 1 diabetes dramatically increased during the course of a 30-year, long-term prospective study, according to a University of Pittsburgh Graduate School of Public Health study being presented at the 71st Scientific Sessions of the American Diabetes Association.

The life expectancy for participants diagnosed with type 1 diabetes between 1965 and 1980 was 68.8 years – a 15-year improvement, compared to those diagnosed between 1950 and 1964, according to the study. Meanwhile, the life expectancy of the general U.S. population increased less than one year during the same time period.

“The estimated 15-year life expectancy improvement between the two groups persisted regardless of gender or pubertal status at diagnosis,” said Trevor J. Orchard, M.D., lead author of the study and  professor of epidemiology, pediatrics and medicine at the University of Pittsburgh.

The results, found in Abstract Number 0078-OR, are based on participants in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, a long-term prospective study of childhood onset type 1 diabetes, which began in 1986. Participants in the study, who were an average age of 28 when entering the study and 44 at its completion, were diagnosed with type 1 diabetes between 1950 and 1980.

“Type 1 diabetes mortality rates have decreased over time, but formal life expectancy estimates for those diagnosed with type 1 diabetes in the United States are lacking,” Orchard said. “Therefore, we estimated the all-cause mortality experience and life expectancy of the EDC study cohort.”

The 30-year mortality of participants diagnosed with type 1 diabetes from 1965 to 1980 was 11.6 percent – a significant decline from the 35.6 percent 30-year mortality of those diagnosed between 1950 and 1964, according to the study. 

Previously known as juvenile diabetes, type 1 diabetes is usually diagnosed in children and young adults. In type 1 diabetes, the pancreas produces little or no insulin to properly control blood sugar levels. It is typically treated with insulin replacement therapy.

In addition to Dr. Orchard, other authors include Rachel G. Miller, M.S.; Aaron M. Secrest, Ph.D.; Ravi K. Sharma, Ph.D.; and Thomas J. Songer, Ph.D., all of the University of Pittsburgh. The study was funded by the National Institutes of Health.

The University of Pittsburgh Graduate School of Public Health (GSPH), founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. GSPH is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health issues. For more information about GSPH, visit the school’s Web site at http://www.publichealth.pitt.edu.

Linda Siminerio of University of Pittsburgh Diabetes Institute Receives Outstanding Educator in Diabetes Award

PITTSBURGH, June 24, 2011 Linda M. Siminerio, R.N., Ph.D., C.D.E., executive director of the University of Pittsburgh Diabetes Institute, will receive the American Diabetes Association’s (ADA) prestigious Outstanding Educator in Diabetes Award at the association’s 71st Scientific Sessions in San Diego, June 24 to 28.

The award is presented to an individual who demonstrates significant contributions to the understanding of diabetes education, has spent many years of effort in the field, and has benefited recipients of education.

“Diabetes is a condition that requires the person to make informed daily decisions about food, activity and medication in response to blood glucose-monitoring results, all day, everyday. Self-management education provides the necessary foundation for quality self-care. With a diabetes epidemic and accountable care, it becomes critically important that people with diabetes become actively engaged in their self-care,” said Dr. Siminerio.

Dr. Siminerio, who also is associate professor in the School of Medicine and the School of Nursing at the University of Pittsburgh, has been a pioneer in the field of diabetes education. She was one of the first pediatric diabetes educators in the United States and has helped to establish 46 American Diabetes Association-recognized diabetes self-management programs throughout Pennsylvania. She has been a leader in the Pennsylvania Chronic Care Commission, whose efforts are aimed at improving services to people with diabetes. 

“This is the largest diabetes meeting in the world, and candidates for awards are submitted from around the world. Thus, the independent committee that selected Dr. Siminerio as Outstanding Educator rightfully regards her as one of the best diabetes educators,” said Andrew Stewart, M.D., chief, division of endocrinology and metabolism at the University of Pittsburgh School of Medicine, and chair of the scientific planning committee for this year’s ADA Meeting.

Dr. Siminerio is the author of numerous books and scientific publications in her field and is the author of the National Standards for Diabetes Education and the International Diabetes Standards and Curriculum.

She has served as senior vice president for the International Diabetes Federation (IDF) and served as chair of the IDF World Congress in 2009. She was the editor-in-chief of Diabetes Forecast, and a past president of Health Care and Education for the American Diabetes Association.

Nearly 26 million children and adults in the United States have diabetes. Diabetes contributes to the deaths of more than 231,000 Americans each year. The ADA estimates that the total cost of diagnosed diabetes in the United States is more than $174 billion. Published studies suggest that when additional costs for gestational diabetes, pre-diabetes and undiagnosed diabetes are included, the total diabetes-related costs in the United States could exceed $218 billion.

Director Named to the Adult Congenital Heart Disease Center at Children’s Hospital of Pittsburgh of UPMC and UPMC Heart and Vascular Institute

PITTSBURGH, June 22, 2011 Stephen Cook, M.D., has been named director of the Adult Congenital Heart Disease (ACHD) Center at Children’s Hospital of Pittsburgh of UPMC and UPMC Heart and Vascular Institute (HVI).

Dr. Cook comes to Children’s Hospital and the HVI from Nationwide Children’s Hospital in Columbus, Ohio, where he served as assistant professor of pediatrics and internal medicine and director of non-invasive imaging and research for the Adoloescent and Young Adult Congenital Heart Disease Program.

Dr. Cook brings to the center extensive experience in serving adolescents and adults with congenital heart disease as a board-certified physician in four specialties: adult and pediatric cardiology, internal medicine and pediatrics. He is an expert in the transition of care of patients with congenital heart disease from adolescence to adulthood. Other areas of expertise are non-invasive cardiac imaging, including echocardiography, cardiovascular magnetic resonance imaging, and cardiac computed tomography in adults with congenital heart disease.

“Because of advances in medical, transcatheter and surgical care, the survival rates and quality of life for patients with congenital heart disease have improved dramatically,” Dr. Cook said. “Our program provides the expertise, ongoing care and education needed by this complex group of patients who require lifelong follow-up.”

Dr. Cook also serves on many national committees to help define best practices for this unique population of heart patients. He is co-chair for the Adult Congenital Heart Association Research Committee and an active member of the Alliance for Adult Research in Congenital Cardiology, a multicenter collaboration to promote relationships between adult congenital heart disease programs, to support research efforts and to improve outcomes of adults with congenital heart disease.

“In his role as director of the Adult Congenital Heart Disease Center at both Children’s Hospital and the UPMC Heart and Vascular Institute, Dr. Cook will lead a team of specialists dedicated to providing the most advanced care for adults with congenital heart disease,” says Steven A. Webber, M.B.Ch.B., chief, Division of Pediatric Cardiology. “The Heart Center’s success rate for the care of children with congenital heart defects has led to an increase in the number of these patients reaching adulthood. Dr. Cook is exceptionally qualified to serve these patients and to help them lead healthy and active lives.”

For more information about Dr. Cook, the ACHD Center or Children’s Hospital of Pittsburgh of UPMC, please visit www.chp.edu/achd. Follow this hyperlink to download a high-res photo of Dr. Cook.

A successful heart transplant at UPMC allows patient to spend Father’s Day with his family

Pittsburgh, PA, June 17, 2011–As Father’s Day approaches, Tom Meshanko is preparing to spend the day with his family in Moraine State Park. He’ll take a boat onto the lake, fish, and spend time with his five grandchildren.

Meshanko counts himself lucky. The 69-year-old father of two said he doesn’t feel his age. That’s because his heart is 22 years old—literally.

A recipient of a heart transplant at UPMC Presbyterian, Meshanko celebrated the second anniversary of what he considers his “second chance” in life on June 13. The long-time Forest Hills resident and former council member said he struggled with heart problems for more than 20 years before the transplant; his own father died of a heart attack shortly after Meshanko and his wife Donna were married.

Read full article:  http://foresthills-regentsquare.patch.com/articles/fatherhood-take-two


New Asthma Research Study at Children’s Hospital of Pittsburgh of UPMC and Pitt to Focus on Wheezing Toddlers and Children

Pittsburgh, PA – June 15, 2011 -A clinical trial at Children’s Hospital of Pittsburgh of UPMC will focus on new treatments for wheezing in young children who may have asthma.
Preschool-aged children often have coughing and/or wheezing that leads to visits to doctor’s offices, urgent care centers, emergency departments or even hospitalization. Researchers at Children’s Hospital and the University of Pittsburgh are studying ways to prevent coughing and wheezing in preschool-aged children and to alleviate symptoms when they do occur.
The study, referred to as APRIL OCELOT, will begin with an initial treatment aimed at preventing wheezing illnesses in children, followed by additional treatment if wheezing does occur. The follow-up treatment will focus on attempting to reduce the wheezing and other respiratory symptoms.
The study is being conducted through Asthmanet, a multicenter network of researchers funded by the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute to study pediatric and adult asthma treatments. Researchers will evaluate the effectiveness of the antibiotic azithromycin at the early signs of a cold in preventing the development of significant breathing symptoms such as frequent coughing, trouble breathing, or wheezing.  The study hopes to show that azithromycin will help to prevent an upper respiratory illness (or cold), from developing into a more severe wheezing illness.
“Frequent wheezing and coughing is something we encounter so often in young children and it is one of the most common causes for visits to the emergency department. Ultimately, we want to find the best treatment plans to decrease it,” said Fernando Holguin, M.D., M.P.H., medical director of the Pediatric Environmental Medicine Center at Children’s Hospital and principal investigator of the study at Pitt. “We believe this study will give us more insight into these particular asthma cases and in turn help give parents the answers they need in this type of care for their children.”
For more information about this study, please call the Asthma Center at 412-692-LUNG (5864).

One son gives the gift of life to his father, a former UPMC heart transplant recipient

Pittsburgh, PA, June 14, 2011–There’s a 30-year-old Bermudian man who goes about his life quietly on the Island. He doesn’t look to seek out praise. He doesn’t want to be in any sort of limelight. He almost wouldn’t talk to me for this article because to his mind what he did was not to be bragged about or even applauded it was “just what families do stick together”.

On January 27, three days before he turned 30, Calvin Ming III gave one of his kidneys to his father heart transplant recipient, Calvin Ming, Jr.

“He needed help to survive. I don’t know anyone that wouldn’t do this for their father,” he said. “That’s what families do stick together.”

The elder Mr Ming is a much loved and well-known community service worker. He’s a Government Probation Officer, member of the Salvation Army and was an Executive Director of NADA, the forerunner to the National Drugs Commission.

Mr Ming had a heart transplant in April 1993 at the age of 46. The surgery was carried out at the University of Pittsburgh Medical Center in Pennsylvania.

Read full article:  http://www.royalgazette.com/article/20110614/ISLAND05/706149989/-1/Island

Building a Better Mouse Model: Pitt Researchers Develop New, Gene-Based Model to Study Depression

PITTSBURGH, May 19, 2010 - Researchers at the University of Pittsburgh School of Medicine have developed a mouse model of major depressive disorder (MDD) that is based on a rare genetic mutation that appears to cause MDD in the majority of people who inherit it. The findings, which were published online today in the American Journal of Medical Genetics Part B: Neuropsychiatric Genetics EarlyView, could help to clarify the brain events that lead to MDD, and contribute to the development of new and better means of treatment and prevention. This report also illustrates an advance in the design of recombinant mouse models that should be applicable to many human diseases.

“Major depressive disorder is a leading cause of suffering, disability and premature death from all causes including suicide. While the cause currently is unknown, twin and adoption studies indicate that genetic factors account for 40 to 70 percent of the risk for developing this common disorder,” explained lead author George Zubenko, M.D., Ph.D., professor of psychiatry, Pitt School of Medicine. 

“In this report, we describe how we constructed a laboratory mouse strain that mimics the brain mechanism that leads to major depression in humans, rather than symptoms,” he said. “Nonetheless, in our initial characterization, the mutant mice exhibited several features that were reminiscent of the human disorder, including alterations of brain anatomy, gene expression, behavior, as well as increased infant mortality.”

“These findings support the role of the genetic variant in the development of MDD, and affirm the mutant mouse strain as a model of MDD worthy of further study,” Dr. Zubenko said. Hugh B. Hughes, III, M.S., served as the co-author of this report.

Previous studies of families with a severe and strongly familial form of MDD revealed a mutation in the control region of CREB1, a gene that orchestrates the expression of many other genes that play important roles in normal brain functioning. Mice have a CREB1 gene that is very similar to the human version and, with the aid of genetic engineering techniques, the researchers were able to establish a mutant mouse strain that bore the same genetic error. Since the control regions of corresponding human and mouse genes often have regions of high similarity, the methods described in this report may be useful in creating mouse models of other human diseases.

“Treatments that are the most effective and produce the fewest side effects typically address the root causes of the disease,” Dr. Zubenko noted. “Animal models that recapitulate those root causes should better inform us about the brain mechanisms that lead to MDD, and have the best chance of leading to advances in treatment and prevention.”

This work was supported by grants from the National Institute of Mental Health; and the Provost’s Fund for Research Development and the Shane Richard Brown Fund, both of the University of Pittsburgh. MRI data were collected at the Pittsburgh NMR Center for Biomedical Research at Carnegie Mellon University and were analyzed with support from the Office of the Senior Vice Chancellor for the Health Sciences, University of Pittsburgh, and the National Center for Research Resources, a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research.

New UPMC Heart and Vascular Institute Will Deliver World-Class Care, Promote Cardiovascular Innovations

PITTSBURGH, May 3, 2011 – UPMC has combined the operations of its departments of cardiac surgery, vascular surgery and cardiology to create the Heart and Vascular Institute (HVI), which will deliver world-class and compassionate care to patients while furthering the hospital system’s commitment to cardiovascular innovations.

The new HVI will be led by co-directors Victor Morell, M.D., chief, pediatric cardiothoracic surgery, Children’s Hospital of Pittsburgh (CHP) of UPMC; Joon Lee, M.D., clinical director, UPMC Cardiovascular Institute; and Michel Makaroun, M.D., chief, UPMC division of vascular surgery.

UPMC is ranked among America’s best hospitals by U.S. News & World Report for heart care and heart surgery, and has one of the largest cardiac catheterization programs in the country. Its physicians have been leaders in implanting ventricular-assist devices and in developing minimally invasive techniques for vascular procedures.

The HVI will consist of UPP physicians from the Cardiovascular Institute (CVI) and from the Division of CT surgery. The areas will merge on July 1, after which the CVI will no longer exist. Mark Sevco, vice president of operations, UPMC Presbyterian Shadyside, and the designated president of UPMC East, will provide administrative direction for the HVI.

Dr. Morell, who will head cardiac surgery in the HVI, also will serve as vice-chair and director of cardiovascular services for the Department of Cardiothoracic Surgery. Dr. Morell was chosen after a national search to fill the position. Dr. Morell has been chief of cardiothoracic surgery at CHP since 2004 and the associate program director of the thoracic surgery residency at the University of Pittsburgh since 2005.

Dr. Joon Lee, who will head cardiology at the HVI, had been with the UPP CVI since 1996. Dr. Lee has been the CVI’s clinical director since 2003.

Dr. Michel Makaroun will oversee vascular surgery at the HVI. He was appointed UPMC’s chief of vascular surgery in 1999. In addition to his new role at the HVI, Dr. Makaroun will continue to be the division chief of vascular surgery.

Tinnitus Caused by Too Little Inhibition of Brain Auditory Circuits, Pitt-led Study Says

PITTSBURGH, April 18, 2011 - Tinnitus, a relentless and often life-changing ringing in the ears known to disable soldiers exposed to blasts, unwary listeners of too-loud music and millions of others, is the result of under-inhibition of key neural pathways in the brain’s auditory center, according to scientists at the University of Pittsburgh School of Medicine in this week’s early online edition of the Proceedings of the National Academy of Sciences. The discovery, which used a new technique to image auditory circuits using slices of brain tissue in the lab, points the way to drug development and effective treatment for a condition that currently has no cure.

Prior research has shown that auditory circuits in the brain are more excitable in tinnitus sufferers, but until now it has not been clear whether that is due to hyperactivity of excitatory neural pathways, reduced activity of inhibitory ones, or a bit of both, explained senior investigator Thanos Tzounopoulos, Ph.D., assistant professor of otolaryngology and neurobiology, Pitt School of Medicine.

“This auditory imbalance leaves the patient hearing a constant ringing, buzzing or other irritating noise even when there is no actual sound,” he said. “Tinnitus drowns out music, television, co-workers, friends and family, and it profoundly changes how the patient perceives and interacts with the world.”

According to the American Tinnitus Association, tinnitus is the most common service-connected disability among veterans of the Iraq and Afghanistan conflicts. Of the 50 million who have experienced it, 16 million have symptoms severe enough to seek medical attention and 2 million tinnitus sufferers are unable to carry out day-to-day activities.

To identify what goes wrong in the brain’s auditory circuits, Dr. Tzounopoulos’ team created tinnitus in a mouse model. While the rodent was sedated, one ear was exposed to 45 minutes of 116 decibel (dB)-sound, equivalent to an ambulance siren. Intense noise exposure is thought to lead to damage in the cochlea, an inner ear structure critical to the neural transmission of sound waves, and clinically undetectable hearing loss.

Several weeks later, the scientists confirmed the exposed mice had tinnitus by conducting startle experiments in which a continuous, 70dB tone was played for a period, then stopped briefly and then resumed before being interrupted with a much louder pulse.

Mice with normal hearing could perceive the gap and, because they were aware something had changed, were less startled than mice with tinnitus, whose ear ringing masked the moment of silence in between the background tones.

The scientists then sought to determine what had gone wrong in the balance of excitation and inhibition of the auditory circuits in the affected mice. They established that an imaging technique called flavoprotein autofluorescence (FA) could be used to reveal tinnitus-related hyperactivity in slices of the brain. Experiments were performed in the dorsal cochlear nucleus (DCN), a specialized auditory brain center that is crucial in the triggering of tinnitus. FA imaging showed that the tinnitus group had, as expected, a greater response than the control group to electrical stimulation. Most importantly, despite local stimulation, DCN responses spread farther in the affected mice.

Dr. Tzounopoulos’ new experimental approach has resolved why tinnitus-affected auditory centers show increased responsiveness. After administering a variety of agents that block specific excitatory and inhibitory receptors and seeing how the brain center responded, his team determined that blocking an inhibitory pathway that produces GABA, an inhibitory neurotransmitter, enhanced the response in the region surrounding the DCN in the control brain slices more so than it did in the tinnitus slices.

“That means the DCN circuits are already ‘disinhibited,’ or blocked, in tinnitus,” Dr. Tzounopoulos explained. “We couldn’t block inhibition anymore to elevate the evoked response, like we could in the normal brain. And, when we blocked another inhibitory circuit mediated by the neurotransmitter glycine, or when we blocked excitatory pathways, there was no difference in the responses between the groups.”

This means that agents that increase GABA-mediated inhibition might be effective treatments for tinnitus, he added. Dr. Tzounopoulos’ team is now trying to identify such drugs.

Co-authors of the paper include Jason W. Middleton, Ph.D., and Courtney Pedersen, of the University of Pittsburgh; Taro Kiritani and Gordon M.G. Shepherd, M.D., Ph.D., of Northwestern University; and Jeremy Turner, Ph.D., of Southern Illinois University.

The research was funded by the National Institutes of Health, the U.S. Department of Defense, the American Tinnitus Association, and the Albert and Ellen Grass Faculty Award.

Transplant Guardian Angels at UPMC provide comfort and patient- and family-centered care

Pittsburgh, PA, April 18, 2011–The first time Holly Rute was called in to UPMC Presbyterian for a possible double-lung transplant she was put in a room and, when her family needed food or a drink, she was left nervous and alone.

The second time, on April 11, when her husband and 11-year-old daughter went out to dinner, Mrs. Rute had the company of Kate Fitzpatrick, 21, a junior nursing student at the University of Pittsburgh and one of UPMC’s new Transplant Guardian Angels.

Read full article: http://www.post-gazette.com/pg/11108/1139826-114-0.stm?cmpid=healthscience.xml

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