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November 20, 1997


Living-at-Home Program gets research funds The UPMC Health System's Living-at-Home Program has received a $4,000 grant from the Ladies Hospital Aid Society to fund a Pitt graduate researcher who will be assigned to identify ways to measure the program's benefits to its clients and the community, and to investigate possible revenue sources.

The Living-at-Home Program enables adults aged 70 and older to live independently at home as long as possible by making referrals for a range of services, from meals to help with grocery shopping, housekeeping and yard work. As part of the UPMC Health System, the program can draw upon the system's clinical services, including in-hospital care.

The $4,000 grant will pay a research-oriented student from either the Graduate School of Social Work or the Graduate School of Public Health to work 15 hours per week for eight months.

Polymer coating may help prevent thrombosis after angioplasty According to a study by researchers at the UPMC Health System, a thin polymer coating on the inside of coronary arteries may one day prevent blood clot formation called acute thrombosis, following angio-plasty.

"Our study found that the formation of a barrier one molecule thick to prevent platelets from coming in contact with the injured vessel wall cells may lead to a novel and effective treatment of acute thrombosis following angioplasty," said J.E.B. Burchenal, Pitt assistant professor of medicine in the division of cardiology and principal investigator in the study.

Acute thrombosis occurs in 5 percent of patients who undergo angioplasty and can lead to a heart attack.

The study tried to determine if a polymer called polyethylene glycol diisocyanate could protect the damaged vascular wall from platelets in the blood long enough for the inside of the artery to heal and prevent the acute thrombosis process from beginning.

"This technique is unique because we are chemically attaching small polymer chains right onto the damaged tissue. The chains cover the sites the platelets attach to when a clot forms," said study co-investigator William Wagner, assistant professor of surgery and chemical engineering.

In experiments using animals, the researchers found that platelet deposits on arteries treated with the polymer were lower compared with platelet deposits in untreated arteries.

High-dose caffeine may be effective pain reliever High doses of caffeine can be an effective muscle pain reliever, according to a Pitt study in the November issue of the journal Headache.

The study by Daniel E. Myers, an associate professor in the dental medicine school's Department of Oral Medicine and Pathology, measured ischemic muscle contraction pain in seven men and women.

"It has been theorized that the chemical adenosine plays a role in causing muscle pain, especially when blood flow is reduced," Myers said. "Perhaps if adenosine receptors are blocked, muscle pain could be blocked as well. The purpose of this study was to determine the effect of caffeine, which is known to block adenosine receptors, on experimental muscle pain in humans." Study participants who ingested caffeine reported less pain than those given a placebo. "The implication," Myers said, "is that there is a rationale for the use of caffeine in the treatment of muscle pain, especially when blood flow is reduced. Perhaps the blocking of adenosine receptors in muscles explains the value of caffeine in several over-the-counter and prescription pain and headache medicines. On the other hand, withdrawal from habitual caffeine use is known to produce headache. This may be caused in part by rebound activity of adenosine receptors in muscle. Other adenosine receptors found on brain arteries may play a role in caffeine withdrawal headache and migraine." Minimally invasive surgery reduces heart bypass deaths, problems A study by physicians at the UPMC Health System has found that minimally invasive heart bypass surgery greatly reduces the number of deaths and complications in very high-risk cardiac patients who are too ill to undergo traditional bypass.

"We found that the length of hospital stay was greatly reduced and that no patients died or suffered strokes because of the minimally invasive surgery," said Marco Zenati, Pitt assistant professor of surgery and director of UPMC's minimally invasive coronary bypass program. "Additionally, no patient required re-operation and 71 percent of the patients had their breathing tubes removed before leaving the operating room." In minimally invasive surgery, surgeons operate on the heart through a single, three-inch incision rather than cutting through the breastbone. They operate on the blocked artery while the heart continues to beat, unlike standard bypass in which the patient is put on a heart-lung bypass machine, and the heart is stopped.

The study involved 17 very high-risk patients with severe coronary artery disease, 12 of whom were not candidates for traditional bypass surgery.

Study compares quality of life for men and women with congestive heart failure The quality of life for women with congestive heart failure may be greater than for men with the disease, according to a study by UPMC Health System researchers presented Nov. 11 at the annual meeting of the American Heart Association in Orlando.

"In every study evaluating new treatments for heart disease, the majority of patients enrolled are men. So, we make decisions on women's cardiovascular health based on information about men. In this study we wanted to evaluate whether the quality of life was affected differently for men and women with the same degree of impairment of heart function," said Srinivas Murali, Pitt associate professor of medicine and director of transplantation cardiology at UPMC.

An estimated 4.8 million Americans have congestive heart failure, in which the heart cannot maintain adequate circulation of the blood because it fails to pump blood properly. It is the chief cause of about 40,000 deaths in the United States each year and a major factor in 225,000 more deaths.

The UPMC study surveyed 26 men and 26 women with the disease, and used standardized measurements to determine their feelings about the quality of their lives. While both groups had scores indicating a lower quality of life than the reported norm in the United States, women scored higher in physical functioning, bodily pain, general health and vitality.

Nora Olds, clinical transplant coordinator in the UPMC cardiology division, said: "Women scored significantly higher for social functioning, indicating that emotional and physical problems did not interfere with social activities as much as for men." Women also reported significantly higher mental health scores and felt less depressed and more peaceful than did the men. "These gender differences may in part explain the failure of some heart failure drugs to improve the already heightened quality of life in some women," Olds said.

Brain's serotonin system declines with age, UPMC research shows The serotonin system, an aspect of the brain's neurochemical structure associated with behavior and mood, has been shown to substantially decline with age, according to research at the UPMC Health System.

The study results have implications for research on the delicate balance of brain serotonin and its possible role in the development of depression in people and/or those with Alzheimer's disease. Understanding this chemical system may pave the way for developing better treatments to control these and other debilitating conditions.

Serotonin's importance is widely recognized, particularly with the success of Prozac and other medications that treat depression by leveling swings in serotonin levels. UPMC researchers examined the serotonin system by focusing on one of the most important of the 14 types of receptors (binding sites) for serotonin. A radioactive form of a drug called altanserin was given to young and older healthy people before PET scanning was used to take pictures of the distribution and number of serotonin receptors in the brain.

The UPMC study found a 55 percent decline in these receptors in several areas of the older participants' brains. The decline persisted even after normal aging changes on the brain's anatomy were taken into account.

Carolyn Cidis Meltzer, Pitt assistant professor of radiology and psychiatry and acting medical director of UPMC's Positron Emission Tomography Facility, and her colleagues reported on the study results at the annual meeting of the Society for Neuroscience last month. New Pitt study questions role of homocysteine in heart disease Previous research has suggested that homocysteine, a byproduct of dairy and meat foods, is a risk factor for heart disease. But evidence from a new study by Pitt researchers counters this premise.

Results from the Multiple Risk Factor Intervention Trial suggest that homocysteine more likely indicates the extent of atherosclerosis or inflammation rather than promoting the processes that lead to stroke or heart attack. The trial enrolled 12,866 healthy men between 1973 and 1976. Blood samples were taken and stored and the men were monitored for up to 17 years for heart disease. Researchers analyzed the blood samples and found no difference in homocysteine levels between men who later suffered heart attacks and those who did not.

Study findings were reported in the October issue of the American Heart Association's journal, Arteriosclerosis Thrombosis and Vascular Biology.

Abnormally high metabolism in brain area may account for many depression symptoms Using positron emission tomography (PET) and magnetic resonance imaging (MRI), researchers at the UPMC Health System have found evidence that many emotional symptoms of depression may be caused by abnormally high metabolism in an almond-sized area in the brain called the amygdala.

UPMC researchers said the finding, reported at the Society for Neuroscience annual meeting last month, may lead to greater understanding of how antidepressant and mood stabilizing treatments work and eventually to more effective treatments for depression and bipolar disorder.

Wayne Drevets, Pitt associate professor of psychiatry and radiology, explained that by superimposing PET images, which tend to be blurry, over crisp pictures obtained through MRI, he and his colleagues could further study the amygdala. The technology also enabled them to show for the first time that depressed people with bipolar disorder, also known as manic-depressive illness, also have abnormally high glucose metabolism in this area of the brain.

Study findings may lead to earlier diagnosis, treatment of atherosclerosis Earlier diagnosis and treatment of atherosclerosis may be possible using specially engineered, gas-filled microbubbles, according to a study by UPMC Health System researchers.

Microbubbles, gas-filled microspheres the size of red blood cells are used in contrast echocardiography, an ultrasound technique used to detect blood flow to the heart muscle in conditions such as angina and heart attack.

One of the first processes leading to atherosclerosis involves the inflammation of endothelial cells that line blood vessels. To simulate this inflammation, cultured endothelial cells were experimentally stimulated to produce a protein on their surface called ICAM-1.

ICAM-1 is thought to be centrally involved in the development of atherosclerosis. UPMC Health System researchers cultured human coronary artery endothelial cells on lab coverslips. Some of the endothelial cells were stimulated by interleukin-1 while others were not. Both groups were then exposed to one of three microbubble preparations.

After this, researchers counted the number of microbubbles that bound to the endothelial cells. Binding to normal endothelial cells was minimal. However, there was a 40-fold increase in adherence of the microbubbles containing anti-ICAM-1.

UPMC researchers reported the study results at the annual scientific session of the American Heart Association meeting in Orlando, Fla. last month.

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