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October 29, 2015

Research Notes

Emergency pediatric CT scanning varies

Emergency departments vary widely when it comes to ordering CT scans for children who come in with injuries, according to a study conducted by the School of Medicine and Children’s Hospital. The findings, published in the Journal of Pediatrics, suggest that improvement in decision making about imaging and establishing best-practice guidelines may help reduce exposure to unnecessary radiation and contain costs.

Concern has grown that patients may be exposed to harmful levels of radiation from CT scans, noted lead investigator and Children’s emergency room physician Jennifer Marin, faculty member in pediatrics and emergency medicine in the School of Medicine.

Said Marin: “Injuries are the leading cause of death in children and CT is the most accurate method we currently have available to diagnose many of these injuries. We wanted to evaluate if and to what degree CT use varied for injured children seen in the emergency department. We found there was no correlation between the severity of injury and when a CT was performed.”

The team looked back at nearly 81,000 cases of injured children treated at 14 emergency departments between November 2010 and February 2013. More than 98 percent had minor injuries and were discharged to home. Doctors were more likely to order CT scans for intracranial injuries and skull and spine fractures, the researchers found. Of those visits in which a CT was performed, 28 percent were associated with more than one CT, 8 percent were associated with more than two CTs and, in some cases, up to 7 CT scans were performed.

“Emergency rooms vary widely in their use of CT scanning with some more likely to perform CT scanning than others,” Marin said. “Additionally, some are more likely to use specific types of CTs, such as cervical spine and chest CTs, which is noteworthy given the radiation dose and radiosensitive areas like the pediatric thyroid and breast being exposed.”

She emphasized the study was not designed to look at patient outcomes or the appropriateness of CT use.

The team included Pitt faculty Li Wang and Daniel G. Winger and a researcher from Boston Children’s Hospital.

The effort was funded by the National Institutes of Health (NIH).


Novel computational method screens nanoparticles

Researchers at the Swanson School of Engineering have developed a novel methodology that can screen nanoparticles of different sizes and shapes as potential industrial catalysts with the use of computers. The study, “Catalyst Design Based on Morphology- and Environment-Dependent Adsorption on Metal Nanoparticles,” will be featured in ACS Catalysis, an American Chemical Society journal.

Giannis Mpourmpakis, chemical and petroleum engineering faculty member, said: “We tested our methodology on a problem that has been troubling researchers for more than three decades now. Although bulk gold does not corrode, which is why we use it as jewelry, gold nanoparticles are exceptionally good oxidation catalysts. Our work demonstrated that the experimentally observed carbon monoxide oxidation activity correlates with the calculated average adsorption strength of CO on the nanoparticle surfaces. Both the CO adsorption and the CO oxidation activity increase with decreasing nanoparticle size.”

Mpourmpakis led the team at the Computer-Aided Nano Energy Lab (CANELA) with graduate student researchers Michael Taylor and Natalie Austin, in collaboration with a chemical engineering professor at Carnegie Mellon University.

Using theory and computation, the researchers at CANELA investigate the physicochemical properties of nanomaterials with potential applications in diverse nanotechnological areas, ranging from green energy and storage to materials engineering and catalysis. Major research areas focus on nanocatalysis, biomass conversion and nanoparticle growth.

The team’s computational results reproduced the CO oxidation activity trends of 45 individual experiments on gold nanoparticles, and the team concluded that despite the changes to nanoparticle surface shape caused by the chemical environment, changes in size have a much greater impact on the overall reactivity of the nanoparticles.

Engineers now will be able to screen the adsorption performance of nanoparticles of different morphologies with the use of computers, which is key to designing nanomaterials used in catalysis, targeted medical imaging, drug delivery and other industrial applications. Computational approaches like this one advance nanomaterials discovery without the use of time-consuming and costly experiments.

In the past, researchers focused on the type of metal being tested as the main variable in catalyst screening, said Mpourmpakis. However, placing metal nanoparticles in a chemical environment has a great effect on their morphology.

“Nanoparticles in a chemical environment exhibit a full range of sizes and shapes,” said Mpourmpakis. “Finding a universal model to describe the chemical behavior of all the surface sites on nanoparticles is a very challenging task. We achieved this by digging into the physics of the adsorbate-nanoparticle interactions and developing models that can capture this multi-site adsorption behavior.”


2 cancer studies presented

Patients with an early-stage, indolent form of lymphoma increasingly are being given no treatment, chemotherapy or targeted drug therapies despite strong clinical evidence that shows radiation therapy can have better outcomes, according to a study by School of Medicine researchers that was presented at the annual meeting of the American Society for Radiation Oncology (ASTRO).

Guidelines from the National Comprehensive Cancer Network and the European Society for Medical Oncology both list radiation therapy as the preferred treatment for low-grade follicular lymphoma, which is a common type of non-Hodgkin lymphoma that grows slowly. It is most likely to occur in people age 60 and older.

Radiation therapy is the use of high-energy X-rays to treat cancer, and was the first curative therapy for lymphoma. Radiation therapy has a long history as the preferred treatment in early-stage follicular lymphoma; however, despite strong supporting evidence, it has been replaced by alternative management strategies including observation without initial treatment and novel systemic therapies.

Said Austin Vargo, a radiation oncology resident at UPMC CancerCenter, partner with the University of Pittsburgh Cancer Institute, and lead author of the study: “Our study highlights the increasing omission of radiation therapy in non-Hodgkin lymphoma and its associated negative effect on overall survival at a national level. This increasing bias toward the omission of radiation therapy is despite proven efficacy and increasing adoption of lower radiation therapy doses and more modern radiation therapy techniques which decrease risk of side effects. More patients should be offered this effective yet underused treatment.”

Researchers analyzed patterns of care and survival outcomes for 35,961 patients diagnosed with early-stage follicular lymphoma as listed in the national cancer data base. The study found that the use of radiation therapy in these patients decreased from 37 percent in 1999 to 24 percent in 2012 while there were increases in the use of single-agent chemotherapy and observation without any initial treatment. Patients who received radiation therapy had five-year and 10-year survival rates of 86 percent and 68 percent, respectively; those who did not have radiation therapy had rates of 74 percent and 54 percent.

Said Dwight E. Heron, faculty member in the Department of Radiation Oncology, Otolaryngology and Head and Neck Surgery and director of radiation services, UPMC CancerCenter: “Survival with radiation therapy in these cases is higher and we think that an evidence-based approach should be used by more oncologists when discussing treatments for their patients.”

Collaborators on the study from Pitt were Beant S. Gill, Goundappa K. Balasubramani and Sushil Beriwal.

Another study presented at ASTRO showed that implementing a clinical pathway to help radiation oncologists determine the right course of palliative care for patients with cancer that has spread to their bones can standardize practice patterns that are based on the latest, evidence-based guidelines.

Cancer spreading to bones, or bone metastases, often are painful, and past studies have suggested that a course of radiation therapy with fewer treatments may be just as effective in relieving that pain as courses with more treatments.

In fact, despite guidelines from ASTRO cautioning against routinely using extended courses, some recent studies have shown the national rate of oncologists using shorter courses was below 5 percent.

But by including the latest scientific evidence in its pathways — which are presented to oncologists electronically at the point of care and guide what treatments patients receive — UPMC CancerCenter showed significant improvements in the rates of physicians following ASTRO guidelines.

Brian Gebhardt, a resident in radiation oncologist and lead author of the study, said: “We wanted to see what impact our clinical pathways had on oncologists and how they were treating bone metastases. Because we have a large cancer network that is designated as a comprehensive cancer center by the National Cancer Institute, we had a large patient base from which to evaluate these pathways.”

UPMC CancerCenter first began using pathways for the management of bone metastases in 2003. In 2014, the pathway was modified based on clinical evidence to encourage radiation therapy courses with single treatments, while those courses with 10 treatments or more were considered off pathway.

Researchers found that 12,678 unique courses of radiation therapy were delivered from 2003 to 2014. During that time, the rate for a course with a single treatment rose from 7.6 percent to 15.8 percent. The rate for using courses with multiple treatments decreased from 18.6 percent to 9.7 percent during the same time. By 2014, the study found that more than 90 percent of courses were delivered with fewer than 10 treatments.

“This study really shows how having a clinical pathway can have a transformative effect on care,” said Heron.

Other Pitt collaborators on the study were Malolan S. Rajagopalan, Beant S. Gill, Susan M. Rakfal, John C. Flickinger and Sushil Beriwal.


Partnership formed with Korean medical device group

Pitt and the Korea Medical Devices Industrial Cooperative Association entered an agreement that each entity expects will lead to advances in research and innovation.

Rebecca Bagley, the University’s vice chancellor for economic partnerships, along with her Korean counterpart, Chairman Jai-Wha Lee, signed the agreement in Washington, D.C.

Said Bagley: “We feel that our collaboration could further strengthen Pitt’s excellent biotech programs and stands as just one of what we hope to be many external partnerships for Pitt.”

Over the next three years, Pitt and KMDICA will explore opportunities for collaboration in research, technical consultation, technical assistance, manufacturing and the application of medical-device technologies as well as jointly host seminars in Korea and the United States to advance research and the development of medical products.

KMDICA represents 450 member companies.


Healthy aging with HIV studied

The U.S. reaches an important milestone this year in the fight against HIV, with more than half the people living with the virus older than age 50. The Graduate School of Public Health is launching a study to determine ways to promote health among gay and bisexual men, who make up about two-thirds of the people aging with HIV.

In an effort to create strategies for use in public health outreach nationwide, the research team will be looking for protective factors — called “resiliencies” — that are helping keep some men with HIV healthy and could be extended to other men, rather than simply fixing health problems as they arise.

This research is funded with a three-year, $2.1 million grant from NIH.

Said study principal investigator Ron Stall, director of the Center for LGBT Health Research as well as faculty member and director of both behavioral and community health sciences and infectious diseases and microbiology: “We celebrate that medications now exist to enable people with HIV to live well into old age. But we also need to recognize that the health complications that come with aging — both mental and physical — are compounded when you’re living with HIV. It is critical that we develop research-based programs to support HIV-positive people as they age.”

The project will regularly survey 1,850 HIV-positive and -negative men participating in the multicenter AIDS cohort study, an ongoing research study that has enrolled thousands of men in Baltimore, Chicago, Pittsburgh and Los Angeles over the past 30 years to participate in research on HIV/AIDS.

The study aims to tease out why some gay and bisexual men remain healthy well into later life, even with multiple risk factors for conditions such as depression and substance abuse. The research team then will determine strategies that could help all gay and bisexual men adopt resiliencies — whether it’s strong friendships, positive family ties, good coping skills or something else — that will give them a better shot at healthy aging, particularly when living with HIV.

The research team also will look at whether changing rates of resiliencies over time are associated with changes in substance use and other psychosocial health problems, as well as HIV-related health outcomes and medication adherence.

“Aging can be hard even when you have very few health risks,” said Stall. “A gay man who came of age in a much less accepting era and is positive for HIV has the odds stacked against him. He’s at greater risk for depression and substance abuse; he might not have prepared for retirement because he didn’t expect to live to reach it; and he may eventually need long-term care because he’s at greater risk for complications from diabetes and heart disease. And yet there are men facing all these risks who are defying the odds and leading healthy, happy lives. We could — and should — all learn from them.”
Additional Pitt investigators on this project are James Egan, Mack Friedman and Dan Siconofli. A researcher from Georgetown University also is participating.

—Compiled by Marty Levine


The University Times Research Notes column reports on funding awarded to Pitt researchers as well as findings arising from University research.

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