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Democrat Bill, FTC Examine Ways To Drive Down Health Care Costs
A bill introduced Wednesday in the House would create an artificial joints database to root out bad practices and unnecessary surgeries, The New York Times reports. "The bill, co-sponsored by (Democrats) Bill Pascrell Jr. of New Jersey and Lloyd Doggett of Texas, would establish a government-backed registry to track patients" results over time and help detect ineffective surgical practices and faulty devices. Patient registries, in areas like orthopedics, are expected to play an important role in "comparative effectiveness" reviews that the Obama administration hopes will help identify which medical procedures and products work best."

Fate Of Tiller's Clinic Expected To Be Decided This Week
The family of murdered Kansas abortion provider George Tiller is expected to decide this week whether his Wichita clinic will reopen, NPR"s "Morning Edition" reports. Tiller"s clinic is one of the few in the U.S. that performs abortions later in pregnancy, and many abortion-rights advocates are concerned whether women in need of abortions in the second and third trimester would be able to obtain care if it were not reopened. LeRoy Carhart, a Nebraska abortion provider who worked with Tiller at his clinic for four years, said that although it is a difficult time for abortion providers, he hopes that the family will reopen the clinic. "This is a job that we took, and we were well-aware of the risks when we started, as was Dr. Tiller," he said. Providing abortion services in the second and third trimester is "a service that"s so needed that it"s worth the risks," he added (Lohr, "Morning Edition," NPR, 6/9). Carhart also said that although no decision on Tiller"s clinic has been made, he "want[s] to assure the press and the women of America ... that we will somehow, somewhere continue to provide abortions later in gestation" (Duin, Washington Times, 6/9).According to Carhart, there are only about 10 providers in the U.S. who perform abortions in the second and third trimesters, including a few hospitals that do not advertise the services. "Morning Edition" reports that most women"s health care providers either are not trained or do not want to receive training to perform the procedure later in pregnancy. Providers who do tend to be older and face extreme pressure from antiabortion-rights advocates. Data from the Guttmacher Institute show that about 1% of all abortions performed in the U.S. occur after 21 weeks" gestation. Elizabeth Nash of Guttmacher said that 37 states have laws that limit access to abortion after a certain point in pregnancy, "usually around 24 weeks, which is at the end of the second trimester." She added that most of those states only allow abortions to save the life of the woman or if her physical health is in jeopardy. Pratima Gupta, an ob-gyn in California, said that she is concerned about what will happen to Tiller"s patients. Gupta said Tiller "had patients that were scheduled for Monday morning. What happened to those patients for the rest of the week, the rest of the month? Those patients are the ones who need us" ("Morning Edition," NPR, 6/9).
News of the day
Profiling Genes In Acutely Ill Idiopathic Pulmonary Fibrosis Patients, A Pitt Team First
The first findings from a one-of-a-kind, patient-driven effort to provide lung tissue for research might help doctors predict when patients with idiopathic pulmonary fibrosis (IPF) are becoming dangerously ill and also could point the way to interventions that could sustain them until life-saving transplants can be performed.
Diagnostics

During Pregnancy Uterine Cells Produce Their Own Estrogen

For decades, scientists assumed that the ovary alone produced steroid hormones during pregnancy. In a new study in mice, however, researchers demonstrate that once an embryo attaches to the uterine wall, the uterus itself actually synthesizes the estrogen needed to sustain the pregnancy. This is the first time that the uterus has been identified as an endocrine organ, said University of Illinois veterinary biosciences professor Indrani Bagchi, who led the study with doctoral student Amrita Das. Their findings appear this week in the Proceedings of the National Academy of Sciences. "It"s the local estrogen that"s critical in maintaining the growth of blood vessels within the uterus," Das said. After an embryo implants, the researchers found, this locally produced estrogen acts in concert with progesterone secreted from the ovaries to spur the differentiation of uterine stromal cells, a process called decidualization, and promotes the growth of blood vessels that support the development of the embryo. The researchers discovered that during decidualization, mouse uterine stromal cells increase their expression of P450 aromatase, a key enzyme that acts with other enzymes to convert androgens to estrogen. Even in pregnant mice that have had their ovaries removed, the production of uterine estrogen is able to support the growth and differentiation of the tissue and blood vessels needed to sustain the pregnancy. Progesterone supplementation is required, however, indicating that local estrogen alone is not sufficient to maintain pregnancy. Blocking the activity of the aromatase with an inhibitor also blocked decidualization, the researchers found, another indication that a successful pregnancy relies on estrogen production in uterine cells. There are advantages to producing the appropriate amount of estrogen right where it is needed, rather than relying on the ovaries, Bagchi said. "During pregnancy, the ovaries would need to secrete a high level of estrogen to ensure that the right amount of estrogen is present in the uterus to support decidualization," she said. "You can imagine that if the estrogen level goes high systemically, it could have a deleterious effect on pregnancy itself by antagonizing the progesterone action." The findings may also be helpful to the study of endometriosis, said molecular and integrative physiology professor Milan Bagchi, an author on the study. This disorder involves the growth of endometrial tissue, which is normally shed during menstruation, at sites outside the uterus, such as the peritoneal cavity and ovaries, producing painful lesions. Endometriosis is spurred, in part, by unusually high levels of estrogen secreted from endometrial tissue growing at these extrauterine sites, he said. Except during pregnancy, "a normal cycling uterus does not make estrogen," he said. High estrogen levels block the activity of progesterone and can cause the non-cancerous growth of tissue seen in endometriosis. This study was supported by the National Institutes of Health (NIH) and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the NIH as part of the Specialized Cooperative Centers Program in Reproduction and Infertility Research. Diana Yates University of Illinois at Urbana-Champaign


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