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Democrats Promote Sotomayor's 'Mainstream Record'; GOP Senators Seek More Documents
Senate Democratic leaders on Thursday circulated talking points stating that Supreme Court nominee Sonia Sotomayor has a "mainstream record of judicial modesty," the AP/Miami Herald reports. The document includes a quote from Sotomayor expressing her belief in basing judicial decisions on the Constitution rather than on politics.Meanwhile, Senate Judiciary Committee Chair Patrick Leahy (D-Vt.) and ranking member Jeff Sessions (R-Ala.) also wrote to the president of LatinoJustice PRLDEF, formerly known as the Puerto Rican Legal Defense and Educational Fund, requesting the quick disclosure of documents Sotomayor has requested in relation to her work with the group (Hirschfeld Davis, AP/Miami Herald, 6/19). Sotomayor worked with the group from 1980 to 1992, assisting in a number of legal briefs and helping the group develop stances on public policy matters (Stanton, Roll Call, 6/18). According to the AP/Herald, interest groups and members of both political parties are "competing to define" Sotomayor ahead of her confirmation hearing, which is scheduled to begin July 13. Conservative groups have focused on labeling her an "activist" and singled out her involvement with PRLDEF as evidence of her support for abortion rights. The group sided with abortion-rights supporters in several major Supreme Court cases during Sotomayor"s time on its board (AP/Miami Herald, 6/19).
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NMC Responds To RCN Decision On Assisted Suicide, UK
The Nursing & Midwifery Council (NMC) has responded to the decision by the Royal College of Nursing (RCN) to move to a neutral position on assisted suicide.
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Heat Shock Proteins Provide Protection Against Cataracts
The human eye lens consists of a highly concentrated mix of several proteins. Protective proteins prevent these proteins from aggregating and clumping. If this protective function fails, the lens blurs and the patient develops cataracts. Two research groups at the Department of Chemistry of the Technische Universitaet Muenchen (TUM) have succeeded in explaining the molecular architecture of this kind of protective protein. Their findings, which are published online in the current early edition of PNAS (Proceedings of the National Academy of Sciences), shed new light on the work of these proteins and may be able to help in the development of new treatments.
Endocrinology

Repair Of Heart Defect Discovered Incidentally During Surgery May Not Have Clear Benefit

Patients who have a heart defect known as patent foramen ovale incidentally discovered and repaired during surgery for a different condition may have an increased odds of postoperative stroke, along with no clear benefit on short-term outcomes or long-term survival, according to a study in the July 15 issue of JAMA. Patent foramen ovale (PFO) is an opening in the upper chambers of the heart that failed to close naturally shortly after birth. The role that PFO plays in cryptogenic (of unknown cause) stroke remains controversial. "The debate over an association has existed for more than a century, but causal data linking PFO and cryptogenic stroke remain anecdotal. Epidemiological evidence is consistent with an increased risk of stroke associated with PFO but data are not conclusive. The paucity of evidence supporting PFO as the mechanism for cryptogenic stroke has left many questions in the field unanswered, including when PFO repair is appropriate," the authors write. A recent survey suggested that cardiothoracic (heart and chest) surgeons may alter planned procedures to repair a newly discovered PFO. How frequently this occurs and the impact on outcomes has been unknown, according to background information in the article. Richard A. Krasuski, M.D., of the Cleveland Clinic, and colleagues examined the prevalence of PFO incidentally discovered during cardiothoracic surgery and investigated the relationship of repair (closure of the opening) on outcomes and long-term survival. The researchers reviewed the intraoperative transesophageal (through the esophagus) echocardiograms of 13,092 patients without prior diagnosis of PFO or atrial septal defect (an abnormal opening between the left and right atria of the heart) undergoing surgery at the Cleveland Clinic from 1995 through 2006. Postoperative outcomes were collected until discharge. The authors found that PFO was intraoperatively discovered in 2,277 patients (17 percent). Of patients with newly discovered PFO, 639 (28 percent) underwent surgical repair, nearly all of which were suture closures (97 percent). Patients undergoing repair were more likely to be women, be younger, have a history of stroke or atrial fibrillation. Further analysis indicated that patients with intraoperatively diagnosed PFO had similar rates of in-hospital stroke and hospital death. Length of hospital stay and days spent in the ICU were also similar between those with intraoperatively diagnosed PFO and those without. Regarding outcomes for patients who underwent PFO repair compared with those who did not, the primary difference noted between the 2 groups was the rate of in-hospital stroke, which was 2.8 percent in the repaired group vs. 1.2 percent in the unrepaired group, representing a nearly 2.5 times greater odds of having in-hospital stroke. The rate of hospital deaths, hospital length of stay, ICU length of stay and time on cardiopulmonary bypass were all similar. Long-term analysis demonstrated that PFO repair was associated with no survival difference. "In summary, PFO is commonly detected during intraoperative imaging at the time of cardiothoracic surgery. When incidentally discovered, it appears to have a benign short-term and long-term clinical course. While the number of events is small, there was no clear benefit of closure on short-term perioperative outcomes or longer-term mortality. The finding that repair may increase postoperative stroke risk should discourage routine surgical closure and foster further investigation to delineate whether there is any benefit in terms of long-term stroke prevention and which patients might benefit from this intervention," the authors conclude. JAMA 2009;302[3]:290-297. Journal of the American Medical Association


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