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September 12, 1996


UPMC leads the fight against Type II diabetes

UPMC will join 24 other health centers around the country in the Diabetes Prevention Program. The program, the first national study of its kind, will examine different methods to prevent or delay the development of Type II diabetes in people with impaired glucose tolerance (IGT). People who have IGT have elevated blood sugar levels, but not high enough to classify them as having diabetes. Because 30 – 50 percent of those with IGT go on to develop Type II diabetes, it is hoped that early intervention can drastically reduce this percentage. Between 7 million and 7.5 million Americans suffer from Type II diabetes, also known as non-insulin dependent or adult onset diabetes. These people tend to be over 30, and overweight.

The program will examine three interventions that may prevent the development of Type II diabetes in people with IGT. The first, lifestyle intervention, will promote weight loss through diet and exercise programs. The other two interventions will test the effectiveness of two medications and provide participants with recommendations for a healthier lifestyle.

The lifestyle intervention is based upon the research of Rena Wing, director of UPMC's Obesity/Nutrition Research Center. According to Wing, patients who lost 10 pounds and kept it off had a 30 percent decrease in the onset of diabetes.

Individuals who are age 25 and older and believe they may be at risk for IGT or Type II diabetes because they are overweight, have a family history of diabetes, or have had a history of the disease during pregnancy may participate in a free screening by calling 383-1440.


A piece of Pitt blasts into space

Accompanying the space shuttle Columbia in a launch this summer was a little bit of the UPMC. Four members of the seven-member crew were the subjects in the first study to simultaneously examine sleep, circadian rhythms and work performance in space. The study, designed by researchers at UPMC, may help explain how and why shift work and jet lag affect the body's biological clock here on Earth.

The lack of earthly time clues, weightlessness, cramped quarters and intensive work schedules disturb the astronauts' circadian rhythms, the 24-hour cycle of behavior and physiological activity, said Timothy Monk, head researcher and director of UPMC's Human Chronobio-logical Research Program at Western Psychiatric Institute and Clinic. The human biological clock is designed to run on a schedule that is longer than 24 hours, so consequently, each day it must be "reset." Most researchers agree that the daylight/darkness cycle is the main environmental cue that bodies use to do this. Because of the lack of a normal day/night cycle in space, Monk hopes to discover other cues that help humans reset their internal clocks. The four astronauts slept in caps clad with electrodes to objectively measure the quality of their sleep by recording the eye movement, brain waves, and jaw muscle movement. The data collected will be analyzed by UPMC researchers to determine how space flight affected the astronauts' internal clock.

The research has some very down-to-Earth applications, as well. With the advent of late-night work shifts — 20 percent of Americans work nights as part of their schedules — researchers are just currently seeing the effects of pushing biological clocks regularly out of sync. Since most work-related injuries and car accidents occur at night, Monk hopes this research can help to prevent these injuries and deaths.


UPMC battles post-traumatic stress disorder

Western Psychiatric Institute and Clinic is offering free treatment for patients who suffer from post-traumatic stress disorder (PTSD). This debilitating syndrome results from exposure to life-threatening events outside the usual range of human experience.

Patients who suffer from this disorder and are eligible for the study will receive 24 weeks of free treatment in a study designed to test the effectiveness of PTSD medications.

Patients who suffer from PTSD normally will begin to show symptoms such as flashbacks, disassociation from reality, nightmares and sleep problems, avoidance of emotional relationships, and startled reactions to everyday sounds or sights several months or years after a traumatic event. Events such as war, torture, rape and natural disasters can all be triggers for the onset of PTSD.

Those interested in medical treatment for the syndrome should call 624-1000.


WPIC researchers get awards

Several faculty at Western Psychiatric Institute and Clinic (WPIC) have received Young Investigator awards from the National Alliance for Research on Schizophrenia and Depression (NARSAD). These two-year, $60,000 grants are awarded to promising young researchers in psychiatry and neurobiology. WPIC researchers receiving their first year of funding include Wayne C. Drevets, Steven D. Forman, Antonieta Lavin, Holly Moore and William M. Pearlstein.

WPIC faculty receiving second-year funding were Mayada Akil, Deanna M. Barch, Michael D. De Bellis, Janet M. Finlay and Patricia O'Donnell.


Double lung reduction best for emphysema

Lung reduction surgery for emphysema patients provides greater improvements in lung function when performed on both lungs rather than on one lung, according to a study presented by a Pitt researcher at the American Lung Association/American Thoracic Society 1996 international conference.

In lung reduction surgery, diseased portions of lungs are removed. The surgery is not a cure and does not stop the disease, but it offers patients with advanced emphysema an alternative to lung transplantation.

"Short of transplantation, lung reduction surgery provides the most significant benefit yet devised to improve patients with severe emphysema," said Robert Keenan, assistant professor of surgery and principal investigator in the study. "This study emphasizes the need to perform lung reduction on both lungs of a patient to achieve the best clinical result." An estimated 2 million Americans suffer from emphysema. Most cases are caused by smoking.


Searching for genes that cause anorexia

The unyielding obsession that drives people with anorexia nervosa to starve themselves may originate in their genes, researchers say. University of Pittsburgh Medical Center scientists have joined researchers at 10 sites in North America and Europe in an attempt to find genes that may predispose people to eating disorders.

According to Walter H. Kaye, a Pitt psychiatry professor who is lead investigator at the Pittsburgh site, results from the international, two-year study may help researchers and clinicians identify people who are at the greatest risk of developing eating disorders and may some day allow health care professionals to provide preventive treatment.

In the study, researchers are seeking to enroll approximately 200 families in which at least two members have anorexia nervosa or related eating disorders. Studies of twins and other family members hint at a genetic root to the disorders. Research has shown that individuals with anorexia nervosa have more relatives with eating disorders than people without the condition. Moreover, identical twins are more likely to have anorexia than fraternal twins.

The Price Foundation of Switzerland is sponsoring the study. For more information, call 1-800-895-3886.


Transplantation Institute receives four NIH grants

The National Institutes of Health have awarded the Pitt-affiliated Thomas E. Starzl Transplantation Institute four grants totaling more than $6.2 million.

The grants were awarded to institute director Thomas Starzl; John Fung, chief of the Division of Transplantation Surgery, and his co-investigator Abdul Rao, director of cell transplantation and associate director of research at the institute; Angus Thomson, research professor of surgery and of molecular genetics and biochemistry; and Anthony Demetris, director of the Division of Transplant Pathology.

Starzl is studying why and how organs are accepted after transplantation. Fund and Rao's research will determine if bone marrow augmentation will improve organ function, patient survival, allowing for reduction or elimination of transplant patients' needs for immunosuppressive drugs.

Thomson is investigating the role of the dendritic cell in the acceptance of transplanted organs, particularly the liver. Demetris is studying how interleukin-6 affects the proliferation of biliary epithelial cells, seen in certain types of liver diseases.


Pitt engineering faculty win grants, honors

Professor Badie Morsi and Ph.D. candidate Juan Inga of the Department of Chemical and Petroleum Engineering have been honored by the American Chemical Society's Division of Fuel Chemistry with the Richard A. Glenn Award in recognition of their paper and presentation, "A Novel Approach for the Assessment of the Rate Limiting Step in the Fischer-Tropsch Process." Electrical engineering professors Hong Koo Kim and Dietrich Langer were awarded a two-year, $204,421 Office of Naval Research grant to develop optical amplifiers and light-emitters for integrated opto-electronics. The study is expected to generate applications in such areas as optical communication and optical information processing.

The Materials Research Center recently awarded six one-year seed grants of $30,000 each to engineering faculty members Eric Beckman, Jean Blachere, Ilan Grave and Robert Stoehr and chemistry professors David Beratan and Rob Coalson.


Bypass better than angioplasty for diabetics, both equally effective in non-diabetics, study shows

Severe coronary heart disease can be treated with either heart bypass surgery or angioplasty with similar survival rates, according to findings of a five-year, international study published in the July 25 issue of the New England Journal of Medicine.

However, in patients who were also treated for diabetes (20 percent of the study's 1,829 participants), bypass surgery provided significantly better survival than angioplasty, the study showed.

The multi-center Bypass Angioplasty Revascularization Investigation was coordinated at Pitt and was the largest clinical trial comparing the two surgical procedures.

Among non-diabetics, patients who underwent bypass surgery had a survival rate of 89.3 percent. For those who underwent angioplasty, the rate was 86.3 percent. However, in a subgroup of 353 drug-treated diabetics, those who had bypass surgery had an 80.6 percent survival rate; those who underwent angioplasty had a 65.5 percent survival rate.

Some 362,000 angioplasties and 309,000 bypass surgeries are performed annually in the United States.

The typical cost of angioplasty is about $15,000, while the typical cost of a bypass is $30,000.


Interaction with children benefits Alzheimer's disease patients

A Pitt research project indicates a link between young children's interaction with Alzheimer's disease patients and patients' responsiveness.

Researchers at Generations Together, an intergenerational studies program within the University Center for Social and Urban Research, conducted their study at Brooklyn's Shorefront Jewish Geriatric Center.

Two groups of 12 children from a nearby daycare center interacted with two groups of up to 12 Alzheimer's patients 30 minutes a week for six months. Therapists led the adult groups in music and movement activities, first without the children, then with them. Observations and analysis of videotape showed the adults' smiles, touching, verbal expression and hand extensions increased significantly in the children's presence.

Nursing assistants who cared for the dementia patients were interviewed. Analysis of 536 observations by the nursing assistants revealed the patients' overall agitation levels were lessened on days they were visited by the children.

"What's significant about this is you're talking about people who are typically non-responders," said Sally Newman, Generations Together executive director. "Apart from the fact they don't remember, they're at a stage in their illness where they frequently have very little affect and communication is every limited. If we can provide a small amount of pleasure for them, I think we're onto something." A paper on the Generations Together study has been accepted for publication in the gerontological journal Activities, Adaption and Aging.


National vaccine study for melanoma begins under UPCI researcher's leadership

A unique vaccine against melanoma that could save many lives is being tested in a nationwide study directed by John Kirkwood, director of the University of Pittsburgh Cancer Institute's (UPCI) Melanoma Center.

The study involves the first-ever large-scale use of a cancer vaccine targeted against a specific substance found on melanoma cells. This anti-melanoma vaccine already has shown a potential to prevent recurrence of melanoma in a smaller study of patients with high-risk melanoma — melanoma that is likely to relapse after surgery.

In the current study, researchers are offering this therapy to patients with similar high-risk melanoma. "If this vaccine works in patients with high-risk disease, it may be added to Interferon alpha 2b, the only FDA-approved effective treatment and the one that we have developed over the last 10 years," Kirkwood said.


Sleep disturbances shown to affect health, UPMC study concludes

Intrusive thoughts caused by stress can make it difficult to fall asleep. They also may affect the quality and consistency of sleep, resulting in poorer overall health, according to research at the University of Pittsburgh Medical Center.

Results of two UPMC studies that looked at stress-related intrusive thoughts, one involving rescue workers of a fatal plane crash, were presented this month at the 104th annual conference of the American Psychological Association in Toronto.

Intrusive thoughts — ideas that pop into one's mind — are common after experiencing a stressful event. The more these thoughts occur, the more likely they will disrupt sleep, which in turn may lead to anxiety, depression and even the common cold, reported UPMC research fellow Martica Hall.

In one of the studies, 64 healthy men and women spent the night in a sleep lab where their sleep patterns were monitored. Before going to bed, half were told they would be reading a magazine after they woke up the next morning. The other half were told they would have to deliver a 15-minute speech that would be judged for content by one of the researchers. Participants experiencing more intrusive thoughts about making a speech took 10 minutes longer to fall asleep than participants with fewer speech-related intrusive thoughts.

A second study assessed the impact of stress-related thoughts in 155 volunteer workers involved in the rescue and clean-up operations following the crash of USAir Flight 427 on Sept. 8, 1994. "Results of this study showed a chain reaction effect. The more intrusive thoughts that occurred, the poorer the sleep. This led to worsening overall health and greater feelings of distress over the course of the two-, six-, nine- and 12-month assessment taken following the accident," Hall said.


WPIC study shows spirituality has strong impact on heart transplant patients' well-being

Religious faith and spirituality have a strong impact on the physical and emotional well-being of heart transplant patients and their loved ones, according to results of a Western Psychiatric Institute and Clinic (WPIC) study presented at the 10th annual conference of the American Psychological Association this month in Toronto.

WPIC researchers Ronna Casar Harris and Mary Amanda Dew interviewed and evaluated 275 pairs of adult heart transplant recipients and their family caregivers (mostly spouses) in a long-term study of mental health and health care compliance. As part of the National Institutes of Health-funded study, which began in 1989, respondents were asked many questions, including ones concerning the role of religion in their lives.

"Results of the study show that religion has a positive impact on the lives of patients who have faith that a higher power is watching over them not only during their recovery but in the long-term as well," said Dew, director of the study and associate professor of psychiatry, psychology and epidemiology.

According to the study, patients who felt that their beliefs exerted greater influence over their lives, and who consulted God to make important decisions, were more likely to feel positive about their health status one year after transplantation, even if they were experiencing medical complications.

Harris said: "Health care professionals who work with seriously ill patients and their families often refuse to identify religious supports and to build on patients' belief systems. There has been little consideration of the role that religion may play in patients' health, well-being and continued survival."


New treatment shrinks tumors in transplant patients with cancer

Transplant patients who develop cancers that don't respond to standard treatment may benefit from an infusion of cells from their own immune system that have been activated to kill tumors, UPMC researchers reported last month (AUGUST) at the XVI International Congress of the Transplantation Society in Barcelona, Spain.

The complication of developing tumors following organ transplantation is called post-transplant lymphoproliferative disease (PTLD). Certain cells of the patient's own immune system, some of which may be associated with the Epstein-Barr virus, proliferate and tumors result. About 2 percent of transplant patients will eventually develop PTLD.

Standard treatment involves temporarily reducing or eliminating the doses of drugs taken to suppress the immune system and prevent organ rejection. However, in only 30 to 50 percent of patients do tumors respond to this therapy. PTLD can be fatal in as many as 80 percent of its victims, according to some reports.

Of the seven patients in the UPMC study — individuals whose tumors did not respond to reduced immunosuppression or in whom it was not a clinical option — four had complete remission of their tumors after single infusions of their own, manipulated immune cells.

The remaining three patients did not have complete regression of their tumors. The patients also had aggressive cancers that also tested negative for the Epstein-Barr virus. UPMC researchers say that further study in at least 20 more patients will help them determine if the presence of Epstein-Barr or the type and stage of cancer more strongly contributes to a patients' success or failure with the promising treatment.

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