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At least 163 records · Page 9Linked to original sources

Community-acquired Legionella micdadei (Pittsburgh pneumonia agent) infection in Sweden.

The first case of Legionella micdadei (Pittsburgh Pneumonia Agent) infection in Sweden is presented. A previously healthy 68-yr-old man fell ill with diarrhoea, fever, and mental confusion. Subsequently chest roentgenography revealed pneumonic infiltrates and a seroconversion to L. micdadei was shown. No source or transmission of infection was established. The only notable event was that the patient had been drinking rain-water from a barrel 1 day prior to his illness. An alimentary route of infection was considered.

Aged↗

15 years of pediatric heart transplantation at the University of Pittsburgh: lessons learned and future prospects.

Credit for the first pediatric heart transplant is given to Kantrowitz and colleagues who, in 1967, transplanted the heart of an anencephalic infant into a 3-week-old with tricuspid atresia (1). Although the infant only survived a few hours after surgery, this pioneering procedure emphasized the technical feasibility of heart transplantation in childhood. Over the next decade, enthusiasm for heart transplantation declined in both adults and children, as it became apparent that the therapeutic armamentarium for controlling acute allograft rejection was inadequate for achieving graft and patient survival. Towards the end of the 1970s, several advances led to renewed interest in human heart transplantation. These included topical cooling of the donor heart to protect the myocardium from ischemia (and enabling distant procurement), the technique and interpretation of endomyocardial biopsy for the diagnosis of allograft rejection (2) and, most importantly, the introduction of cyclosporine into human clinical trials (3). Cyclosporine was the first oral agent specifically to inhibit T lymphocytes, the principal mediators of allograft rejection. The favorable impact on survival of adult heart transplant recipients was immediately apparent (4) and led to renewed interest in pediatric heart transplantation. The pediatric heart transplant program at the University of Pittsburgh commenced in 1982, drawing on the experience of the adult program which had begun two years earlier. It rapidly became apparent that children present unique problems for the transplant physician and surgeon. This review draws on many of the lessons learned in our program over the last 15 years and reviews some of the prospects for the future of pediatric thoracic organ transplantation.

Child↗

The Pittsburgh Tissue Engineering Initiative.

The Pittsburgh Tissue Engineering Initiative (PTEI) is the prime catalyst for tissue-engineering research and the development of a viable for-profit tissue-engineering industry in southwestern Pennsylvania. PTEI operates targeted programs that support commercializable research; provide professional and community education; and facilitate interactions between academic medical centers, regional government, and industry to support the development of a vibrant tissue-engineering industry. This article discusses the types of research and education programs provided by PTEI and provides a brief summary of some of the tissue-engineering-related research in the region.

Biotechnology↗

The Pittsburgh Sleep Diary.

Increasingly, there is a need in both research and clinical practice to document and quantify sleep and waking behaviors in a comprehensive manner. The Pittsburgh Sleep Diary (PghSD) is an instrument with separate components to be completed at bedtime and waketime. Bedtime components relate to the events of the day preceding the sleep, waketime components to the sleep period just completed. Two-week PghSD data is presented from 234 different subjects, comprising 96 healthy young middle-aged controls, 37 older men, 44 older women, 29 young adult controls and 28 sleep disorders patients in order to demonstrate the usefulness, validity and reliability of various measures from the instrument. Comparisons are made with polysomnographic and actigraphic sleep measures, as well as personality and circadian type questionnaires. The instrument was shown to have sensitivity in detecting differences due to weekends, age, gender, personality and circadian type, and validity in agreeing with actigraphic estimates of sleep timing and quality. Over a 12-31 month delay, PghSD measures of both sleep timing and sleep quality showed correlations between 0.56 and 0.81 (n = 39, P < 0.001).

Journal Article↗

[Experience of orthotopic liver transplantation from non-heart-beating donors at the University of Pittsburgh Medical Center].

Eight cases of orthotopic liver transplantation (OLT) from non-heart-beating donors (NHBDs) were experienced at the University of Pittsburgh Medical Center. Four cases were from donors whose organs were procured following cardiopulmonary resuscitation (uncontrolled NHBD), and the remaining four hepatic allografts were recovered after sustained cardiopulmonary arrest following extubation in an operating room (controlled NHBD). After OLT from uncontrolled NHBDS, two allografts failed due to preservation injury and hepatic arterial thrombosis, and one showed poor allograft function. In contrast, all four grafts from controlled NHBDs survived and functioned well worked postoperatively. Hepatic allografts from controlled NHBDs is considered to be useful in OLT, especially in Japan where there is a serious brain-dead donor shortage.

Adolescent↗

Simultaneous pancreas-kidney transplantation at the University of Pittsburgh.

Analysis of the SPK program at the University of Pittsburgh has led to a number of observations: 1. Under tacrolimus-based immunosuppression, without antibody induction, it has been possible to achieve (a) One- and 3-year actuarial patient survival rates of 98% and 95% (b) One- and 3-year actuarial kidney survival rates of 95% and 87% (c) One- and 3-year actuarial pancreas survival rates of 86% and 80% 2. Steroid withdrawal has been achieved in over half of the successfully transplanted recipients, with excellent outcomes and a low rate (4.7%) of subsequent rejection. 3. Bone marrow augmentation has been associated with (a) less rejection (b) less pancreatic graft loss to rejection (c) an increased ability to withdraw steroids 4. Rejection has been associated with a rising serum lipase. 5. Renal allograft rejection in SPK patients with elevated serum lipase levels has been seen in the setting of normal renal function. 6. Enteric drainage has been associated with a reasonably low complication rate. 7. SPK transplantation is a successful therapeutic option in selected type I diabetics with end-stage renal disease.

Adult↗

MFG-IRAP University of Pittsburgh.

The University of Pittsburgh is developing MFG-IRAP gene therapy for the potential treatment of arthritis. Phase II studies have commenced, including one trial in arthritis patients [225365]. A retrovirus (MFG-IRAP) is used in the ex vivo transfer of a cDNA encoding the human interleukin-1 receptor antagonist (IL-1Ra). The therapy is being tested in post-menopausal women, and involves the removal of some of their synovium, which is then transfected with the IRAP gene and reimplanted into the joint [188197]. A phase I rheumatoid arthritis trial of a therapy using the IL-1 antagonist gene therapy in synergy with soluble TNF alpha receptors was reported in March 1999 and was considered to be effective in producing an anti-arthritic effect [318398].

Animals↗

Technology evaluation: MFG-IRAP, University of Pittsburgh.

The University of Pittsburgh is developing MFG-IRAP, a retroviral vector carrying the human interleukin-1 receptor antagonist protein (IRAP) cDNA for potential treatment of arthritis. MFG-IRAP gene therapy was effective in local gene delivery to synovial lining of joints and systemically to hematopoietic stem cells, in preclinical studies. Intra-articular expression of IRAP, although transient (4 to 6 weeks), was efficacious in several animal models of arthritis. On the other hand, systemic transgene expression was prolonged (15 months), but was relatively less efficacious. Clinical data on the safety of MFG-IRAP therapy per se are limited, however, recombinant IRAP studies in humans have not resulted in any serious adverse effects. Phase II studies, including a trial in arthritis patients should provide the much anticipated MFG-IRAP efficacy data.

Animals↗

Simulation-based training at the University of Pittsburgh.

The following article reviews the experience of using human simulators for medical education at the University of Pittsburgh in the Department of Anesthesiology and Critical Care Medicine. The intent of the authors is to provide the reader with an overview of 1) what human simulators can do, 2) the components of a simulation training facility, 3) some of the economic considerations in operating a simulation training facility, and 4) how this centre is made use of.

Academic Medical Centers↗

The Pittsburgh Sleep Diary.

Increasingly, there is a need in both research and clinical practice to document and quantify sleep and waking behaviors in a comprehensive manner. The Pittsburgh Sleep Diary (PghSD) is an instrument with separate components to be completed at bedtime and waketime. Bedtime components relate to the events of the day preceding the sleep, waketime components to the sleep period just completed. Two-week PghSD data is presented from 234 different subjects, comprising 96 healthy young middle-aged controls, 37 older men, 44 older women, 29 young adult controls and 28 sleep disorders patients in order to demonstrate the usefulness, validity and reliability of various measures from the instrument. Comparisons are made with polysomnographic and actigraphic sleep measures, as well as personality and circadian type questionnaires. The instrument was shown to have sensitivity in detecting differences due to weekends, age, gender, personality and circadian type, and validity in agreeing with actigraphic estimates of sleep timing and quality. Over a 12-31 month delay, PghSD measures of both sleep timing and sleep quality showed correlations between 0.56 and 0.81 (n = 39, P < 0.001).

Activities of Daily Living↗

Aging and space flight: findings from the University of Pittsburgh.

For more than a decade, the Sleep and Chronobiology Center (SCC) at the University of Pittsburgh has received funding from the National Institute on Aging (NIA), the National Institute of Mental Health (NIMH) and the National Aeronautics and Space Administration (NASA) in order to study the sleep and circadian rhythms of healthy older people, as well as the sleep and circadian rhythms of astronauts and cosmonauts. We have always been struck by the strong synergism between the two endeavors. What happens to the sleep and circadian rhythms of people removed from the terrestrial time cues of Earth is in many ways similar to what happens to people who are advancing in years. Most obviously, sleep is shorter and sleep depth is reduced, but there are also more subtle similarities between the two situations, both in circadian rhythms and in sleep, and in the adaptive strategies needed to enhance 24h zeitgebers.

Adult↗

Pittsburgh Regional Healthcare Initiative puts new spin on improving healthcare quality.

For nearly 4 years, the Pittsburgh Regional Healthcare Initiative (PRHI) has been working to improve the way healthcare is delivered in southwestern Pennsylvania by combining the voices and resources of hospitals, providers, the business community, insurers, health plans, and federal agencies. As one example of borrowing from business, the PRHI has created a new learning and management system, called Perfecting Patient Care, which is based on the Toyota Production System model and is now being used successfully in hospitals.

Health Care Coalitions↗

Lung and heart-lung transplantation at the University of Pittsburgh: 1982-2002.

The University of Pittsburgh lung transplantation program began in 1982 and through 2002 we have performed 576 lung and 101 heart-lung transplants. One-, 3- and 5-year survival rates over the past decade have been 77%, 62% and 55%, respectively, comparing favorably to ISHLT registry outcomes of 73%, 57% and 46%. We continue to utilize a very thorough evaluation process but have been flexible and aggressive with potential recipients with regard to age, coronary artery disease and disease state (eg., scleroderma). Despite worldwide progress in the field of lung transplantation, many difficulties remain. The limited number of lungs deemed acceptable for transplantation continues to hinder application to a greater number of patients. Our efforts in this regard have focused on cooperation with our OPO in education and detailed donor management protocols. Chronic rejection also remains a major difficulty frequently leading to death. Recent work utilizing aerosol cyclosporine in patients with established chronic rejection suggests that this therapy may prolong life. We are also hopeful that recently initiated therapies utilizing T-cell induction strategies may contribute to further improvement in outcomes.

Brain Death↗

[Colombian validation of the Pittsburgh Sleep Quality Index].

INTRODUCTION: Many studies establish an elevated frequency of sleep disorders. The prevalence during life is of 35%. This situation has lead to develop a great number of instruments with the intention to evaluate better these alterations. Nevertheless, the majority lacks a suitable and national validation. Buysse et al designed the Pittsburgh Sleep Quality Index (PSQI) considered the most able instrument to establish the quality of the sleep. This has been used and validated widely. Nor it exists a version validated to the Castilian for Colombia, nor similar instruments that allow making studies in sleep. AIM: Validation of the Pittsburg Sleep Quality Index in Colombia (ICSP-VC). SUBJECTS AND METHODS: Experts consensus for face validity, pilots studies for evaluating understanding of the questionnaire, with double interview method. Evaluation of internal consistency. RESULTS. Internal consistency was Cronbach's alpha = 0.78. There were different scores between subjects that mentioned some subjective sleep disturbance (U Mann Whitney z = -5.635, p = 0.000), between them that qualify as 'so bad' or not their sleep quality (U Mann Whitney z = -2.90, p = 0.0037), between they that were consuming or not, habitually hypnotics (U Mann Whitney z = -4.289, p = 0.0000) and between they that referred conciliation insomnia or not (U Mann Whitney z = -4.769, p = 0.0000). There were clinical differences in ICSP-VC scores between adult older and younger (U Mann Whitney z = -1.926, p = 0.0542). There were not differences by gender. Subjects with extreme values scores had clinical differences with others. CONCLUSIONS: ICSP-VC is a valid version of PQSI useful for studying sleep disorders.

Adult↗

Pittsburgh hospital increases OR utilization by 60%.

By setting some stricter ground rules for scheduling surgical cases, St. Clair Hospital in Pittsburgh, PA has been able to increase the utilization rate of its 11 operating rooms from 45% to 72%.

Appointments and Schedules↗

Simplified quantification of Pittsburgh Compound B amyloid imaging PET studies: a comparative analysis.

UNLABELLED: PET studies have been performed using the amyloid binding radiotracer Pittsburgh Compound B (PIB). Previous quantitative analyses using arterial blood showed that the Logan graphical analysis using 90 min of emission data (ART90) provided a reliable measure of PIB retention. This work reports on simplified methods of analysis for human PIB imaging. METHODS: PIB PET scans were conducted in 24 subjects (6 Alzheimer's disease [AD], 10 mild cognitive impairment [MCI], 8 controls) with arterial blood sampling. Retest scans were performed on 8 subjects (3 AD, 1 MCI, 4 controls) within 28 d. Data were analyzed over 60 and 90 min using the Logan analysis and (a) metabolite-corrected input functions based on arterial plasma (ART60, ART90), (b) carotid artery time-activity data with a population average metabolite correction (CAR60, CAR90); and (c) cerebellar reference tissue (CER60, CER90). Data also were analyzed using the simplified reference tissue method (SRTM60, SRTM90) and a single-scan method based on late-scan ratios of standardized uptake values (SUVR60, SUVR90). RESULTS: All methods of analysis examined effectively discerned regional differences between AD and control subjects in amyloid-laden cortical regions, although the performance of the simplified methods varied in terms of bias, test-retest variability, intersubject variability, and effect size. CAR90 best agreed with ART90 distribution volume ratio (DVR) measures across brain regions and subject groups and demonstrated satisfactory test-retest variability (+/-7.1% across regions). CER90 and CER60 showed negative biases relative to ART90 in high-DVR subjects but had the lowest test-retest variability. The single-scan SUV-based methods showed the largest effect sizes for AD and control group differences and performed well in terms of intersubject and test-retest variability. CONCLUSION: Of the simplified methods for PIB analysis examined, CAR90 provided DVR measures that were most comparable to ART90; CER90 was the most reproducible and SUVR90 produced the largest effect size. All simplified methods were effective at distinguishing AD and control differences and may be effectively used in the analysis of PIB. SUVR60 data can be obtained with as little as 20 min of PET emission data collection. The relative strengths and limitations of each method must be considered for each experimental design.

Alzheimer Disease↗

Premorbid characterization in schizophrenia: the Pittsburgh High Risk Study.

Prospective studies of young relatives at risk for schizophrenia can shed light on the possible premorbid precursors of the disease. Ongoing studies in Pittsburgh suggest that young non-psychotic high risk relatives have neurobehavioral, brain structural, physiological, and neurochemical deficits that may date back to childhood or earlier. We summarize these data, review the relevant literature in this emerging field, and provide some new data suggesting alterations in sleep architecture in young relatives at risk for schizophrenia. Collectively, such data are likely to help us to predict the eventual emergence of schizophrenia, schizophrenia spectrum or non-spectrum psychopathology.

Journal Article↗

Design and implementation of a library-based information service in molecular biology and genetics at the University of Pittsburgh.

SETTING: In summer 2002, the Health Sciences Library System (HSLS) at the University of Pittsburgh initiated an information service in molecular biology and genetics to assist researchers with identifying and utilizing bioinformatics tools. PROGRAM COMPONENTS: This novel information service comprises hands-on training workshops and consultation on the use of bioinformatics tools. The HSLS also provides an electronic portal and networked access to public and commercial molecular biology databases and software packages. EVALUATION MECHANISMS: Researcher feedback gathered during the first three years of workshops and individual consultation indicate that the information service is meeting user needs. NEXT STEPS/FUTURE DIRECTIONS: The service's workshop offerings will expand to include emerging bioinformatics topics. A frequently asked questions database is also being developed to reuse advice on complex bioinformatics questions.

Computational Biology↗