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The Necessity Of Adrenalectomy At The Time Of Radical Nephrectomy: A Systematic Review
UroToday.com - To take the adrenal or not at the time of radical nephrectomy, that is the question. These researchers from New York University School of Medicine performed an extensive literature search to determine the role of adrenalectomy at radical nephrectomy and discovered that the incidence of solitary, synchronous, ipsilateral adrenal involvement, and therefore potentially curable tumor disease with ipsilateral adrenalectomy occurred extremely infrequently - in only 1% to 5% of cases.
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Experts: Big Tobacco Dead By 2047, Possibly Sooner
President Barack Obama"s signature on a bill this week to grant the Food and Drug Administration (FDA) regulatory authority over tobacco was historic, and represents a step in the march to eliminate tobacco use in this country by 2047, two national tobacco experts said recently (June 25).
News of the day
Centrist Dems Say Abortion Issues Must Not Delay Health Reform; Conservatives Step Up Criticism
Five centrist House Democrats, led by antiabortion-rights Rep. Tim Ryan (Ohio), on Tuesday issued a proposal that would neither require nor ban private insurers from covering abortion services as long as federal dollars are not used, the Washington Post"s "Capitol Briefing" reports. In a letter sent to House Speaker Nancy Pelosi (D-Calif.), Ryan and Reps. Dale Kildee (Mich.), James Langevin (R.I.), Artur Davis (Ala.) and Kendrick Meek (Fla.) said that their proposal "maintains the current status quo in the private market" and would not "preempt constitutionally permissible" state restrictions related to abortion, such as parental notification laws. The representatives called their proposal a "common ground solution." Current federal law prohibits the use of federal Medicaid funds for abortion services in nearly all circumstances. The lawmakers said that they are "increasingly concerned about potential roadblocks around the issue of abortion" in the health reform debate in Congress. According to "Capitol Briefing," antiabortion-rights Democrats are concerned that health reform legislation could lead to indirect federal funding of abortion services through private insurers participating in a proposed health insurance exchange (Eggen, "Capitol Briefing," Washington Post, 7/21). In the letter, the representatives said that they would like to include language in the final health reform bill "that makes clear that no insurance company will be required to pay for an abortion except in extraordinary circumstances." In addition, insurance providers would not be prohibited from paying for abortion services "so long as health insurance plans offered in the exchange that choose to provide abortion coverage pay for those services with funds that are separate and distinct from any federal subsidies," the letter said. Ryan said he hopes the proposal will be introduced in committee on Wednesday as an amendment (Smith, Politico, 7/21).House Members Step Up Efforts To Exclude Abortion CoverageMeanwhile, antiabortion-rights House members are intensifying their efforts to exclude abortion coverage from the chamber"s health reform bill (HR 3200), which they said includes a "hidden mandate" that would allow federal money to cover the procedure, the AP/Houston Chronicle reports. Rep. Bart Stupak (D-Mich.) said that he plans to join other antiabortion-rights House members at a news conference on Wednesday to criticize the legislation. Stupak helped draft a June 25 letter to Pelosi saying that he and 19 other Democrats would not support any health reform bill "unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan." The bill does not mention abortion, which supporters say means that the legislation is neutral on the issue (Alonso-Zaldivar, AP/Houston Chronicle, 7/22).Antiabortion-Rights Coalition Launches CampaignA coalition of antiabortion-rights groups this week is launching a three-week campaign aimed at excluding abortion coverage from health reform legislation, Politico reports. The coalition includes James Dobson, founder of Focus on the Family; Tony Perkins, president of the Family Research Council; Richard Land of the Southern Baptist Convention; David Bereit of 40 Days for Life; and Charmaine Yoest, president of Americans United for Life. Yoest said AUL intends to send a letter to President Obama on Thursday citing its "belief that the bills are intended to include abortion."Laurie Rubiner, vice president for public policy and advocacy at the Planned Parenthood Federation of America, said that abortion is "not mandated any more than any other service or procedure in health reform." She added that excluding abortion coverage could result in women losing the coverage they currently have under private plans. The abortion-rights opponents" demand to exclude abortion coverage "violates the first principle of health care reform, which is: Don"t make people worse off under health care reform than they are today," Rubiner said (Smith, Politico, 7/22).
Diagnostics

Knee Injuries May Start With Strain On The Brain, Not The Muscles

New research shows that training your brain may be just as effective as training your muscles in preventing ACL knee injuries, and suggests a shift from performance-based to prevention-based athletic training programs. The ACL, or anterior cruciate ligament, is one of the four major ligaments of the knee, and ACL injuries pose a rising public health problem as well as an economic strain on the medical system. University of Michigan researchers studying ACL injuries had subjects perform one-legged squats to fatigue, then tested the reactions to various jumping and movement commands. Researchers found that both legs - not just the fatigued leg - showed equally dangerous and potentially injurious responses, said Scott McLean, assistant professor with the U-M School of Kinesiology. The fatigued subjects showed significant potentially harmful changes in lower body movements that, when preformed improperly, can cause ACL tears. "These findings suggest that training the central control process - the brain and reflexive responses - may be necessary to counter the fatigue induced ACL injury risk," said McLean, who also has an appointment with the U-M Bone & Joint Injury Prevention Center. McLean says that most research and prevention of ACL injuries focuses below the waist in a controlled lab setting, but the U-M approach looks a bit north and attempts to untangle the brain"s role in movements in a random, realistic and complex sports environments. The findings could have big implications for training programs, McLean said. Mental imagery or virtual reality technology can immerse athletes to very complex athletic scenarios, thus teaching rapid decision making. It might also be possible to train "hard wired" spinal control mechanisms to combat fatigue fallout. In a related paper, McLean"s group again tested the single leg landings of 13 men and 13 women after working the legs to fatigue. While both men and women suffer an epidemic of ACL injuries, women are two to eight times likelier to tear this ligament than men while playing the same sport. However, the study showed that men and women showed significant changes in lower limb mechanics during unanticipated single leg landings. Again, the findings point to the brain, McLean says. During testing, a flashing light cued the subjects to jump in a certain direction, and the more fatigued the subjects became, the less likely they were able to react quickly and safely to the unexpected command. The research suggests that training the brain to respond to unexpected stimuli, thus sharpening their anticipatory skills when faced with unexpected scenarios, may be more beneficial than performing rote training exercises in a controlled lab setting, which is much less random than a true competitive scenario. In this case, expanding the anticipated training to include shorter stimulus-response times could improve reaction time in random sports settings. "If you expose them to more scenarios, and train the brain to respond more rapidly, you can decrease the likelihood of a dangerous response," he said. It"s analogous to how a seasoned stick shift driver versus a novice learner might both respond to a sudden stall. The inexperienced driver might make a slow or even incorrect decision. The paper, "Fatigue Induced ACL Injury Risk Stems from a Degradation in Central Control," will appear in Medicine and Science in Sports and Exercise in August 2009. "Difference between Sexes and Limbs in Hip and Knee Kinematics and Kinetics During Anticipated and Unanticipated Jump Landings: Implications for ACL Injury," appears online at the British Journal of Sports Medicine. Laura Bailey University of Michigan


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