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Fenestrated Endografts Prove Viable Alternative To Open Surgery
The use of fenestrated endografts to treat juxta-renal and para-renal aneurysms (adjacent to and involving the visceral segment of the aorta) after prior aortic reconstruction, is a viable alternative to open repair. These findings are from a study presented at the 63rd Annual Meeting of the Society for Vascular Surgery®.
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Editorial Calls Supreme Court's Pregnancy Leave Decision 'Not Just'
"The Supreme Court keeps finding ways to deny women equal pay and benefits," a New York Times editorial states in response to the court"s 7-2 ruling on Monday that employers are not required to award women credit toward pension benefits for pregnancy leave taken before Congress passed the 1978 Pregnancy Discrimination Act. According to the Times, the ruling reflects reasoning similar to the court"s 2007 decision in which it denied former Goodyear employee Lilly Ledbetter"s "claim for equal pay because it thought she waited too long to file it." In Monday"s decision, the majority "reasoned mainly that the pregnancy leaves predated the 1978 law, and since the law was not retroactive, the discrepancy in benefits was the product of "past completed events that were entirely lawful at the time they occurred,"" the editorial states. It notes that the majority included "two generally reliable votes for equality, Justices John Paul Stevens and David Souter." The editorial continues, "This may sound logical, but it is not just." The editorial says that Justice Ruth Bader Ginsburg, in writing the dissent, "quite correctly" recognized a company"s "ongoing denial of equal benefits not as past discriminatory behavior that started and ended decades ago, but as a current violation of the act." In a similar way, "Goodyear discriminated against Lilly Ledbetter by maintaining her unequal pay for years, not merely the first time the company underpaid her." The Times calls on Congress to "write corrective legislation" on pregnancy leave (New York Times, 5/21).
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Baltimore Sun Examines Debate Over Howard County, Md., Health Program
About 200 uninsured people have enrolled in the Howard County, Md., Healthy Howard program since it began on Oct. 1, 2008, county health officer Peter Beilenson told a county council budget panel, the Baltimore Sun reports. Healthy Howard is a network of local doctors who charge members between $50 and $115 monthly for comprehensive medical coverage. The program uses health coaches to improve residents" overall health and seeks to lower costs related to emergency care over time. Beilenson had set a goal of enrolling 2,000 people in the program"s first year. According to Beilenson, "The biggest problem with all this is me. I made the definition of success this arbitrary 2,000 number." His new prediction is for 908 enrollees by July 2010. He said, "I think it"s very clear people just don"t know about it." He added that some residents are hesitant to pay even a small monthly charge during the continuing recession. County council member Greg Fox questioned if the enrollment level justifies a second county outlay of $500,000 for the program in fiscal year 2010, adding that he supports cutting county funding in half for the program in that year. Supporters of the program, however, say it needs more time and money in order to succeed, noting that enrollees have been seeing doctors through the program only since January. Commonwealth Fund President Karen Davis said the program "seems like it"s off to a great start" compared with similar local programs nationwide. She added that the program has helped 2,500 county residents, including children, find coverage through state and federal insurance programs, in part thanks to an electronic enrollment system that identifies programs they are eligible for. Howard Health Department Director of Policy and Planning Glenn Schneider said, "None of those applications would have happened without announcing the (Healthy Howard) program" (Carson, Baltimore Sun, 5/18).
Public Health

Hydrogen Peroxide In The Immune System

When you were a kid your mom poured it on your scraped finger to stave off infection. When you got older you might have even used it to bleach your hair. Now there"s another possible function for this over-the-counter colorless liquid: your body might be using hydrogen peroxide as an envoy that marshals troops of healing cells to wounded tissue. Using the zebrafish as an animal model, researchers in the lab of Harvard Medical School professor of systems biology Timothy Mitchison and Dana Farber Cancer Institute professor Thomas Look have discovered that when the tail fins of these creatures are injured, a burst of hydrogen peroxide is released from the wound and into the surrounding tissue. Teams of rescue-working white blood cells respond to this chemical herald, crawl to the site of damage, and get to work. "We"ve known for quite some time that when the body is wounded, white blood cells show up, and it"s really a spectacular piece of biology because these cells detect the wound at some distance," says Mitchison. "But we haven"t known what they"re responding to. We do know something about what summons white blood cells to areas that are chronically inflamed, but in the case of an isolated physical wound, we haven"t really known what the signal is." These findings are reported in the June 4 issue of the journal Nature. Philipp Niethammer, a postdoc in Mitchison"s lab, and Clemmens Grabber, a postdoc in Look"s lab, initiated this research project with no interest in wound healing. Rather, they were studying a groups of molecules called reactive oxygen species, or ROS. These small oxygen-derived molecules, of which hydrogen peroxide is one, have the potential to be both helpful and hurtful. Niethammer and Grabber were simply curious to find ways to detect ROS molecules in an organism. To do this, they took a gene engineered to change color in the presence of hydrogen peroxide and inserted it into zebrafish embryos. Once the embryos entered the larvae stage after a few days, this synthetic gene spread throughout the entire body, essentially "wiring" the fish so that any discreet location in which hydrogen peroxide appears would glow. But how do you coax the fish to produce a reactive chemical like hydrogen peroxide in the first place? Since white blood cells have long been known to produce hydrogen peroxide, one obvious way to initiate chemical production would be to inflict a small wound onto the fish, and then, using microscopy, observe patterns of this chemical as white blood cells gathered around the wound. But much to the researchers surprise, they found that hydrogen peroxide immediately appeared at the wound site, prior to the arrival of any white blood cell, and quickly disseminated into neighboring tissue. They repeated the experiment, this time in zebrafish where they"d disabled a protein that was previously discovered to produce hydrogen peroxide in the human thyroid gland. Not only did hydrogen peroxide not appear at the wound site, but white blood cells failed to respond to the injury. "This was our real eureka! moment," says Niethammer. "We weren"t too surprised that we could block hydrogen peroxide production through this technique, but what we didn"t expect at all was that white blood cells wouldn"t respond. This proved that the white blood cells needed hydrogen peroxide to sense the wound, and move towards it." Of course, zebrafish are not people, and while our genomes share many similarities with these tiny fish, it isn"t yet clear that natural selection has conserved this process throughout the evolutionary family tree. Still, these findings offer something of a conceptual shift in how to view human conditions where hydrogen peroxide plays a role. "When we look at how hydrogen peroxide works in people, this really starts getting intriguing," says Mitchison. In the human body, hydrogen peroxide is produced primarily in three places: lung, gut, and thyroid gland. Because hydrogen peroxide, and the proteins responsible for producing other ROS molecules, are especially present in lung and gut, the researchers hypothesize that human diseases relevant to these findings would include any in the lung and gut that involve disproportionate levels of white blood cells, like asthma, chronic pulmonary obstruction, and some inflammatory gut diseases. "Our lungs are supposed to be sterile; our guts are anything but," says Mitchison. "It"s very logical that both those tissues produce hydrogen peroxide all the time. Perhaps in conditions like asthma, the lung epithelia is producing too much hydrogen peroxide because it"s chronically irritated, which, if our findings translate to humans, would explain inappropriate levels of white blood cells. This is certainly a question worth pursuing." Mitchison is currently laying the groundwork for investigating this hypothesis. This research was funded by the National Institutes of Health. Full Citation: Nature, June 3, 2009; 459 (7247) "A tissue-scale gradient of hydrogen peroxide mediates rapid wound detection in zebrafish" Philipp Niethammer(1), Clemens Grabher(2, 3), A. Thomas Look(2, 4), Timothy J. Mitchison(1) * Departement of Systems Biology, Harvard Medical School, Boston MA * Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA * Current address: Karlsruhe Institute of Technology, Forschungszentrum Karlsruhe GmbH, 76344 Eggenstein-Leopoldshafen, Germany * Division of Hematology/Oncology, Department of Pediatrics, Children"s Hospital, Harvard Medical School, Boston, MA David Cameron Harvard Medical School


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