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Obstructive Sleep Apnea Prevalent In Nonobese Patients
There is a high probability of obstructive sleep apnea (OSA) in non-obese, middle-aged patients, according to a research abstract presented at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies.
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Senate GOP Could Use Procedural Tactics To Delay Sotomayor Hearings
Senate Minority Whip Jon Kyl (R-Ariz.), a member of the Senate Judiciary Committee, on Thursday said that the GOP has not ruled out the use of procedural tactics, such as a Republican boycott, to attempt to delay Supreme Court nominee Sonia Sotomayor"s confirmation hearing, Roll Call reports. Republicans have complained that the scheduled July 13 start date for the hearing does not give them enough time to review Sotomayor"s record. Kyl said that Republicans will try to negotiate with Senate Judiciary Committee Chair Patrick Leahy (D-Vt.) for more time if they feel they cannot meet the July 13 deadline (Stanton, Roll Call, 6/11). Leahy said that Sotomayor is entitled to be confirmed on the same timetable as Chief Justice John Roberts, who appeared before the Judiciary Committee less than two months after his nomination (Kivlan, CongressDaily, 6/11).Republican Senate aides say Judiciary Committee ranking member Jeff Sessions (R-Ala.) is not likely to make a final decision for several weeks on whether the GOP will try to delay the nomination. According to Roll Call, Sessions has sought to approach the issue "in a careful, measured way," though he has been critical of some of Sotomayor"s public statements. Roll Call reports that Republicans are apt to display an impartial stance on Sotomayor until the hearing starts, meaning that they likely will delay a decision on whether to stall the nomination until the last minute (Roll Call, 6/11).Sen. Dianne Feinstein (D-Calif.) said that Republican senators are stalling to give conservative groups more time to organize a campaign against Sotomayor that they hope will taint her nomination. Feinstein said that there are "groups out there who need more time for attacks and sound bites." She added, "This is a woman who is qualified, who is brilliant, and who worked her way up" (CongressDaily, 6/11).
News of the day
Washington Post Examines Focus On Abortions Later In Pregnancy After Tiller Murder
The Washington Post on Friday examined the renewed attention on abortion procedures performed later in pregnancy following Kansas provider George Tiller"s shooting death on Sunday. Tiller was one of the few physicians in the U.S. who performed late abortions. The Post reports that these abortions make up a small portion of the 1.2 million abortions performed each year -- more than 88% of abortions are performed in the first trimester and less than 1% are performed after 21 weeks" gestation. Data published in 2001 from 15 states and New York City show that as many as 2,400 abortions after 24 weeks" gestation were performed in the U.S. that year, according to Stanley Henshaw, a senior fellow at the Guttmacher Institute. He added that most of those abortions likely were performed in the 25th or 26th week.Henshaw said that little is known about the circumstances surrounding third trimester abortion procedures and that "information just isn"t available." The government does not collect detailed data regarding the number of such procedures, who is performing them and under what circumstances. In addition, abortion providers who perform the procedure later in pregnancy supply very little published information, the Post reports. According to the Post, most abortion providers will not perform the procedure after 22 or 24 weeks" gestation because of legal and other concerns, social stigma, or inadequate training and lack of experience. A 2001 survey of 1,819 abortion providers indicated that 18 clinics and 12 hospitals performed abortions at 26 weeks" gestation. However, the Post reports that the number of providers offering abortions later in pregnancy likely has declined in correlation with the decreasing number of overall providers. Henshaw said the number of providers offering the procedure later in pregnancy also likely has declined.Abortion-rights supporters say that third-trimester abortions are performed only when medically necessary, such as when a fatal abnormality is detected in the fetus or a life-threatening complication in the woman is discovered. Other circumstances include cases when the woman suffers serious emotional issues or is undergoing cancer treatment, the Post reports. Vicki Saporta, president of the National Abortion Federation, said that women who experience such pregnancies have "no good choice" and "nee[d] to terminate their pregnancies to protect their own health." Tiller "provided both the emotional and physical care for women in that situation," she said (Stein, Washington Post, 6/5).Los Angeles Times Profiles Abortion Provider Hern The Los Angeles Times on Friday profiled Warren Hern, a Colorado-based abortion provider who performs the procedure later in pregnancy and was a close friend of Tiller"s. Hern has provided abortions since 1973 when the Supreme Court legalized the procedure with Roe v. Wade. He said he "felt doing abortions was the most important thing I could do with my life." Hern opened the Boulder Abortion Clinic in 1975, and in the 1980s authored and self-published a textbook, Abortion Practice. He said that he eventually began to focus on abortion procedures later in pregnancy, which currently make up the majority of his practice. Such abortions usually are performed because of medical complications in the woman or abnormalities in the fetus. Patients at Hern"s clinic receive counseling to explain the procedure and to ensure the woman wants it, although he said many women have already made their decision with their own physician. Hern said that although Tiller"s death has been an emotional situation, his clinic is "pretty busy taking care of people who said they couldn"t find anyone else" to perform abortions later in pregnancy (Correll, Los Angeles Times, 6/5).Bond Set for Tiller Shooting Suspect Sedgwick County, Kan., District Judge Warren Wilbert on Thursday set a $5 million bond for Scott Roeder, the man charged with shooting and killing Tiller, the AP/Yahoo! News reports. A preliminary hearing for Roeder is scheduled for June 16. If convicted, Roeder face
Mental Health

Scientists Out A Gene For Gout

Having partnered last year with an international team that surveyed the genomes of 12,000 individuals to find a genetic cause for gout, Johns Hopkins scientists now have shown that the malfunctioning gene they helped uncover can lead to high concentrations of blood urate that forms crystals in joint tissue, causing inflammation and pain the hallmark of this disease. The ABCG2 gene, they found, makes a protein that normally transports urate out of the kidney and into urine before the waste product does any harm. In studies using frog egg cells genetically engineered with human DNA, the Hopkins researchers established the role of the ABCG2 gene as a cause of gout, lending credence to suspicions that metabolic deficiencies, in addition to too much rich food and alcohol, are mostly to blame for this painful type of arthritis that affects 3 million Americans. The gene, they believe, may be responsible for some 10 percent of gout in Caucasians. A report on the research, funded by the National Institutes of Health, was published June 8 in the online Early Edition PNAS. The research began with a "genome-wide association study" that involved participants of the Artherosclerosis Risk in Communities Study, originally initiated two decades ago to examine the roots of heart disease. Over the course of that research, blood was collected from the study participants and analyzed for a variety of chemical elements, including uric acid. Subjects also reported whether they had ever been diagnosed with gout, enabling researchers to link information from DNA, uric acid levels and gout. By analyzing associations between blood uric acid levels and genotypes, the researchers identified the gene known as ABCG2 and specifically a certain mutation as a candidate for causing the joint inflammation and pain that are symptoms of gout. Because animal models for gout are not representative of humans all mammals except for higher primates have an enzyme that efficiently breaks down uric acid the researchers turned to genetic engineering to figure out just how the human ABCG2 gene might work to regulate uric acid levels, and how its mutation may lead to gout. First, the team injected both normal and the mutant versions of the human ABCG2 gene into frog eggs which served as the live "factories" for producing the protein made by the gene. A couple of days later, after the egg cells produced lots of ABCG2 protein, the researchers bathed them in a radioactive-tagged uric acid bath. Using the tag to identify and measure how much urate accumulated in the cells, the investigators then measured how quickly the urate left the cell. Comparing these so-called "efflux rates" to rates in control cells injected with the normal ABCG2, the scientists found that the cells with the mutant ABCG2 protein excreted uric acid at a rate just half of normal. "We were able to show for what we believe is the first time that the ABCG2 protein is vital for transporting urate out of cells,"says Owen Woodward, Ph.D., a postdoctoral fellow in physiology in the Johns Hopkins University School of Medicine. The researchers further showed that the ABCG2 protein is located in the kidney at a location where urate exretion takes place. They suggest that a lack of efficiency in removing urate from the blood leads to its increased concentration and crystallization. In humans, these crystals get caught in joint tissues, leading to painful inflammation. "As the first major gene identified to cause gout, we believe that ABCG2 also represents an attractive new drug target," says Michael Kottgen, M.D., a biological chemistry research associate in the Johns Hopkins University School of Medicine. One strategy is to identify a drug that makes excretion faster and more efficient by activating the "urate transporter" protein. "Instead of trying to limit urate production the major current approach to gout treatment newer treatments could focus on getting urate out of the bloodstream," Kottgen says. "We anticipate that activation of ABCG2 with a drug may help to promote excretion of urate." "It"s exciting that a finding from genome-wide association studies has been directly translated into better understanding physiology and perhaps will help us find better clinical therapies", says Anna Kottgen, M.D., M.P.H., an epidemiologist in the Johns Hopkins University Bloomberg School of Public Health. Authors of the paper, in addition to Michael Kottgen, Owen Woodward and Anna Kottgen are Josef Coresh and William Guggino, also of Johns Hopkins University, and Eric Boerwinkle of the University of Texas. Johns Hopkins Medicine


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