What are the 5 key medical discoveries from the University of Pittsburgh since the polio vaccine, and how were the discoveries made?
Five key medical discoveries from the University of Pittsburgh since the polio vaccine include the EMT profession, the Gore-Tex heart Masa Valve, the development of the first FDA-approved concussion assessment tool, the development of the hypothermia protocol for trauma victims, and the invention of a mind-powered robotic hand that can also help paralyzed people feel sensations again. A deep dive into each discovery is below.
The EMT Profession
In 1967, social reformer Phil Hallen found that residents of Pittsburgh's Hill District, a mostly black community, did not have adequate access to ambulance services. At that time, "an emergency call to either the police or a private ambulance company might go unanswered, or else the vehicle would arrive only in time to ship the body to the morgue." Hallen had the idea of training Hill District residents to provide "emergency medical response in the community," and teamed up with Freedom House Enterprises, an "empowerment agency focusing on employment and voting rights" to provide a space in which the men could be trained.
However, Hallen did not have the medical expertise necessary to teach others how to save lives. Fortunately, Dr. Peter Safar, an Austrian-born anesthesiologist at Pittsburgh's Presbyterian-University Hospital who had invented cardiopulmonary resuscitation (CPR), was eager to bring life-saving techniques to the streets of Pittsburgh and agreed to train the men. As a result, "Safar ran the recruits through a year-long training program requiring 160 hours of classroom and hands-on instruction, including six weeks of hospital-based training in the emergency department, operating rooms and the intensive care unit. Safar's vision for modern emergency response wasn't to bring the patient to the ICU, but to bring the ICU to the patient." In addition, Safar personally designed the Freedom House ambulances, which were the "first in the nation to include defibrillators, IVs and even drugs like Narcan to revive overdoses."
Eventually, when the city of Pittsburgh established its own EMT service in 1975, the Freedom House lost its funding and the workers had to get retrained before they could join the city service. However, they are still recognized as the first Emergency Medical Technicians in the United States and the "project would never have succeeded without Dr. Peter Safar."
In 2008, Dr. Masahiro Yoshida began implanting his invention, a Gore-Tex heart valve into pediatric patients at the UPMC Children's Hospital. Between October 2008 and September 2009, the Masa Valve (named after its inventor), was implanted into 18 patients with a median age of 1.7 years. At the end of a 6-month follow-up period, all children were still alive and "only three had more than mild pulmonary insufficiency," leading to the conclusion that the valve Dr. Yoshida had invented had "an acceptable early performance." Since then, more than 90 pediatric patients with congenital heart valve defects have received the Masa valve and "patients receiving the valve have shown greater freedom from events and conduit dysfunction than those implanted with homograft valves, biologic valves from human donors."
Dr. Yoshida invented the first iteration of the valve in his native Japan as "an alternative to homograft (human) and allograft (bovine) valves" because the Japanese government did not allow homografts and due to Mad Cow disease, allografts were likewise banned. As an attending surgeon at Kobe Children's Hospital, he noticed that pediatric heart patients had to have repeat surgeries to replace a biologic valve as they grow. In addition, the biologic valves tended to calcify quickly, necessitating replacement sooner than otherwise would be required. When he arrived in Pittsburgh, he began refining the valve, having created several generations, before it underwent the trial in 2008. Dr. Yoshida has instructed surgeons from Mexico, Argentina, and Columbia on how to implant the valves in children in their own countries. He also continues to experiment with other materials and is currently working on a valve that is made from a biodegradable substance that will have "better growth potential, further reducing the number of surgeries children will need.
Mind-powered robotic arm
In 2011, UPMC researchers were researching brain-computer interface (BCI) technology that allowed a quadriplegic man move objects on a computer using his mind. Eventually, he was able to reach out "with a robot arm to touch his girlfriend." A year later, a 53-year-old quadriplegic woman who suffered from spinocerebellar degeneration was able to use UPMC's BCI technology "to intentionally move an arm, turn and bend a wrist, and close a hand for the first time in nine years."
The technology involves implanting "two quarter-inch square electrode grids with 96 tiny contact points each in the regions of Ms. Scheuermann’s brain that would normally control right arm and hand movement." Researchers first used functional imaging tests to determine the exact placement of the grids and then used "imaging technology in the operating room to guide placement of the grids, which have points that penetrate the brain’s surface by about one-sixteenth of an inch." The electrodes are able to pick up signals from the patient's neurons and translate them into computer algorithms that "are used to identify the firing patterns associated with particular observed or imagined movements." The subject was able to perform a variety of movements by just thinking about them. The success of the research suggests that people who have suffered long-term paralysis could "recover natural, intuitive command signals to orient a prosthetic hand and arm to allow meaningful interaction with the environment."
UPMC researchers are also working on BCI grids that do not have to be implanted in the brain, but instead sit on top of the brain, requiring a less-invasive surgical procedure. However, the next step was to "use a two-way electrode system that can not only capture the intention to move, but in addition, will stimulate the brain to generate sensation." Four years later, in 2016, this process became a reality when a paralyzed man was able to "experience the sense of touch in his mind-controlled robotic arm." The patient already had the grids implanted in his brain that allowed him to control the robotic arm with his mind, but then researchers implanted additional electrodes smaller than a grain of sand into the"left hemisphere of his brain, into the sensory cortex area that senses touch in the body's right hand and fingers." While blindfolded, a researcher touched each finger on the robotic hand and the subject was able to correctly identify the location of each touch.
This medical breakthrough represented the first time a paralyzed person has been able to experience the sensation of touch using a robotic limb. It gives researchers and patients hope that the technology can restore "a critical function in people with paralyzed limbs: the ability not just to move those limbs, but to feel them." The next goal of the researchers is to make the movement and touch sensation more seamless so that "when [a paralyzed person] reaches out to grasp an object, he can feel it. … He can pick something up that’s soft and not squash it or drop it."
The UPMC Sports Medicine Concussion Program began in 2000 and quickly became a "global leader in testing, treating, and researching sports-related concussion." Researchers and physicians in the program have published nearly 200 "peer-reviewed concussion research studies" that have led to the establishment of a standard of care that is now used in medical centers throughout the United States. The program's concussion protocol has been implemented by nearly all major sports leagues, as well as amateur, college, and youth programs across the country.
The singular focus of the UPMC Sports Medicine Concussion Program led to the development of the first FDA-approved "neurocognitive testing tool to assess concussion, helping to refine return-to-play guidelines, and creating personalized treatment plans that cross a variety of clinical specialties." This tool, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and its youth-oriented version, ImPACT Pediatric, "are the first medical devices permitted for marketing that are intended to assess cognitive function following a possible concussion. They are intended as part of the medical evaluation that doctors perform to assess signs and symptoms of a head injury." It was approved by the FDA in August 2016 and was considered "a very important step in [the] testing and treatment of concussions." ImPACT Pediatric now allows sports medical personnel to "test the millions of kids between 5 and 12 heretofore who had no test for baseline concussions."
The FDA based its approval on the more than 100 "independently conducted clinical research studies" by UPMC that "analyzed the scientific value of the ImPACT devices including the devices’ validity, reliability and ability to detect evidence of cognitive dysfunction that might be associated with a concussive head injury." The device tests several aspects of a player's neurocognitive state, including "verbal and visual memory, brain processing speed, and reaction time." As of 2017, the "NFL, NHL, and more than 8,400 high schools and colleges across the country have mandated ImPACT."
In 2014 the University of Pittsburgh Medical Center began a trial that induced hypothermia in and slowed the metabolism of dying patients who had suffered severe trauma, including gunshot wounds. The protocol, known as Emergency Preservation and Resuscitation or EPR, had never before been performed on a human, although it had "long been proved successful in animal experiments." Dr. Samuel A. Tisherman, the lead researcher on the trial, began thinking about a procedure that would buy doctors "valuable time in which to mend [a] victim's wounds" when he was training as a trauma surgeon more than 20 years earlier. A 23-year-old patient came into the emergency room with a severe stab wound. The young man died, but Tisherman believes they would have saved him had they been able to keep his heart going.
Over the next nearly 30 years, Dr. Tisherman worked to develop a procedure that would lower a patient's body temperature to 50 degrees Fahrenheit with the use of a cold saline solution that would be pumped throughout the body and would provide the doctors approximately one hour of extra time to "repair the injuries before brain damage occurs." In the 1980s, Tisherman met Dr. Peter Safar (who invented CPR) at the UPMC and together they began "to explore therapeutic hypothermia as a way of protecting patients’ brains over longer periods of time." After Tisherman's graduation from medical school, he returned to UPMC to work with Safar on "whether hypothermia might offer a way 'to preserve and protect' a pulseless patient for two hours, which was Safar’s estimate of the time required to evacuate a wounded soldier from the battlefield and to conduct basic wound repair." He and Dr. Safar conducted trials on animals for the next 10 years, publishing their first results in 1990, which showed "dogs that had effectively died from blood loss and then been rapidly cooled to 59 degrees could be brought back to life an hour later with no brain damage."
Over the next few years, UPMC researchers "gradually managed to extend the interval between death and resuscitation to three hours." Other medical facilities began to expand on Tisherman's work, eventually bringing pigs back from clinical death with no brain damage. Tisherman and Safar began preparing for human trials in 2002, but it would take a dozen more years before they would receive the approvals and funding they needed for the first trial. In addition, UPMC had to be proactive in educating the community on the procedure because the nature of traumatic injuries means patients wouldn't be able to consent to the protocol. The hospital handed out free bracelets to people who did not want to participate in the trial should they arrive at UPMC with a traumatic injury.
Although the trial was set to occur in Pittsburgh, the relative lack of gunshot victims in the city caused Tisherman to move the trial to Shock Trauma in Baltimore, Maryland. The move occurred in 2016 and "citing the preliminary nature of the research, Dr. Tisherman declined to say whether he and his colleagues had already operated on a patient." The initial plan was to "try the technique on 10 subjects, then review the data, consider changes in their approach, and enroll another 10," and if the procedure was successful, Tisherman planned to use it on patients who experience other types of traumatic injuries such as those sustained in car accidents. As of November 2017, the initial 20-patient trial had been completed, but according to the abstract of the study, Tisherman is still reviewing the data and will publish the results at some point in 2018. If the results are as expected, it will likely be a major medical discovery that can help reduce the number of deaths that occur from trauma, which is currently the "leading cause of death in people up to age 44."
Many medical advances and discoveries have come out of the University of Pittsburgh. Five of the most important medical breakthroughs that have occurred at UPMC since the polio vaccine are those that can help people survive severe trauma, can decrease the number of surgeries pediatric heart patients have to endure, can lower the incidence of brain injuries from sports-related concussions, and can help paralyzed people regain some mobility, feeling, and independence.