bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Systematic Versus Selective Screening for Methicillin-Resistant Staphylococcus aureus Carriage in a High-Risk Dermatology Ward
Authors: Girou Emmanuelle , Azar Joyce , Wolkenstein Pierre , Cizeau Florence , Brun-Buisson Christian , Roujeau Jean-Claude
Published: February 2006

Objective:

To compare two strategies for screening methicillin-resistant Staphylococcus aureus (MRSA) carriers in a high-risk dermatology ward: systematic screening of all admitted patients versus selective screening of patients at risk.

Design:

The two strategies were applied prospectively during two consecutive periods. In period A (8.5 months), only patients transferred from other wards, or with a history of prior hospitalization, or presenting chronic wounds or disease with denuded skin were considered at high risk of MRSA carriage and sampled. In period B (7.5 months), all admitted patients were systematically screened. End-points were the number of patients having a MRSA-positive screening sample on admission during period B and having none of the risk factors used in period A, the rate of imported MRSA cases, and the rate of acquired cases.

Setting:

A 1,032-bed university hospital with a 19-bed inpatient dermatology ward, a referral center for toxic epidermal necrolysis and severe extensive dermatoses.

Patients:

The study included 729 dermatology inpatients (370 in period A and 359 in period B).

Results:

During period A, screening samples were obtained on admission for 30% of patients (77% of the patients at risk) and identified 25 MRSA carriers. During period B, 90.5% of admitted patients were screened, and 26 MRSA carriers were detected on admission; all of these patients belonged to at least one predefined category at risk for carriage. Overall rates of imported and acquired cases were similar between the two periods (6.8% vs 7.5%, and 2.9% vs 2.4%, respectively).

Conclusions:

A screening strategy targeted to patients at risk of harboring MRSA has similar sensitivity and is more cost-effective than a strategy of systematic screening to identify MRSA carriers on admission.
Surveillance for Nosocomial and Central Line-Related Infections Among Pediatric Hematology-Oncology Patients
Authors: Simon Arne , Fleischhack Gudrun , Hasan Carola , Bode Udo , Engelhart Steffen , Kramer Michael H.
Published: February 2006

Objective:

To determine the incidence of all nosocomial infections (NIs) in pediatric hematology-oncology patients, as well as central venous access device (CVAD)-associated infections acquired during home care.

Design:

Prospective surveillance study.

Setting:

The Pediatric Hematology and Oncology Department at the University Hospital Bonn.

Patients:

All patients admitted from January through October 1998 (surveillance period).

Methods:

Standardized surveillance system based on the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System.

Results:

A total of 143 patients were hospitalized for 3,701 days (776 admissions) during the surveillance period. Of the 40 NIs detected, 26 were CVAD-related, with 21 bloodstream infections (BSIs) and 5 local infections. Four were Clostridium difficile-associated diarrheal illnesses, 3 were pneumonias, and 7 were other infections. The incidence of NIs was 10.8 per 1,000 patient-days (5.2 NIs/100 admissions). The overall CVAD-related BSI rate was 7.4 per 1,000 utilization days, without a significant difference between implanted infusion ports and tunneled catheters. In addition, 7 CVAD-related infections occurred during home care. All 8 BSIs associated with tunneled catheters and 13 (76%) of the 17 BSIs associated with ports were acquired nosocomially. For inpatients and outpatients combined, the exit sites of tunneled catheters were more likely to become locally infected than were the needle entry sites of ports (relative risk, 8.0; P=.007). In 30 (75%) of the 40 NIs, the affected patients had severe neutropenia (<500/mm3) at the time of infection.

Conclusions:

Most NIs in the pediatric hematology-oncology patients were associated with CVAD devices. Although many infections in this high-risk population may not be preventable through infection control measures, the careful evaluation of specific infection rates permits the identification of risk factors that may be targeted by infection control programs. Prospective surveillance for NIs on pediatric oncology units is an indispensable tool for this internal quality control.
Investigation of an Outbreak of Gram-Negative Bacteremia Among Hematology-Oncology Outpatients
Authors: Penzak Scott R. , Gubbins Paul O. , Stratton Shawna L. , Anaissie Elias J.
Published: February 2006

Objective:

To identify risk factors associated with an outbreak of gram-negative bacteremia (GNB).

Setting:

A university hospital.

Patients:

Hematology-oncology outpatients.

Design:

Retrospective case-control study.

Results:

Thirty-eight patients developed GNB; 13 patients experienced more than one episode, and eight blood cultures grew more than one gram-negative organism. The most frequently isolated organisms were Stenotrophomonas maltophilia, Klebsiella pneumoniae, Acinetobacter baumannii, and Acinetobacter johnsonii. When the GNB patients (cases) were compared with randomly selected hematology-oncology patients (controls), central venous catheter (CVC) self-care (71% vs 39%; P=.02), and duration of recent hospital stay (median, 15 vs 4 days; P=.01) were identified as risk factors. In a logistic regression model, duration of recent hospital stay was the only risk factor significantly associated with GNB (odds ratio, 1.05; 95% confidence interval, 1.01-1.08; P<.02).

Conclusions:

Hematology-oncology patients providing their own CVC care who have recently been hospitalized for more than 2 weeks may be at increased risk of GNB. CVCs should be protected from possible environmental contamination in hematology-oncology patients. Patients providing their own CVC care should undergo continued rigorous education regarding proper CVC care.
Nosocomial Ringworm in a Neonatal Intensive Care Unit: A Nurse and Her Cat
Authors: Drusin Lewis M. , Ross Barbara G. , Rhodes Karen Helton , Krauss Alfred N. , Scott Rachelle A.
Published: February 2006

An outbreak of nosocomial ringworm involved five infants in a neonatal intensive care unit. The index case was a nurse infected with Microsporum canis by her cat. After standard infection control measures were initiated, the outbreak was resolved successfully by an interdisciplinary professional collaboration of physician and veterinary dermatologists and infection control personnel.
A Pilot Study of Antibiotic Cycling in a Hematology-Oncology Unit
Authors: Dominguez Edward A. , Smith Theresa L. , Reed Elizabeth , Sanders Christine C. , Sanders W. Eugene
Published: February 2006

Objective:

To determine the safety and treatment efficacy of cycling antibiotic regimens for prophylaxis or treatment of patients with profound neutropenia.

Design:

A prospective, nonrandomized, observational trial.

Setting:

A 20-bed adult hematology-oncology inpatient unit at a university referral hospital.

Patients:

Hospitalized adult patients with chemotherapy-or radiation-induced neutropenia (absolute neutrophil count less than 500 cells/mm3).

Intervention:

Between July 1994 and January 1996, 295 hospitalized patients were evaluated on an intent-to-treat basis for the cycling protocol. Of these, 271 were eligible and assigned to one of four antibiotic regimens being used at the time of enrollment: (1) ceftazidime+vancomycin; (2) imipenem; (3) aztreonam+cefazolin; (4) ciprofloxacin+clindamycin. Data on infection rates and types, and antibiotic resistance patterns, toxicity, and effectiveness were collected.

Results:

Twenty-four patients were excluded. Of the 271 evaluable patients, 123 (42%) were able to complete treatment on the assigned regimen. Of the 148 patients (50%) unable to do so, the reasons for failure included persistent fever (79%), breakthrough bacteremia (14%), and drug toxicity (7%). The antibiotic susceptibility profiles over the study period showed no increase in resistance. However, there was a marked increase in enterococcal infections.

Conclusions:

Our data show no significant increase in side effects or decrease in efficacy while cycling antibiotics among neutropenic patients and thus support further study of its role.
Pharmacodynamic Modeling of Risk Factors for Ciprofloxacin Resistance in Pseudomonas aeruginosa
Authors: Hyatt Judith M. , Schentag Jerome J.
Published: February 2006

Objective:

To determine risk factors for ciprofloxacin resistance in Pseudomonas aeruginosa.

Methods:

Patients with cultures (any site) positive for P aeruginosa, susceptible to ciprofloxacin, between January 1993 and December 1996 were identified using a computerized database. Factors predictive of emergence of ciprofloxacin resistance in P aeruginosa strains isolated from the same cultured site, within 21 days of the initial culture, were determined. Factors considered included length of stay prior to initial P aeruginosa culture, isolation site, initial minimum inhibitory concentration (MIC), antibiotic area under the 24-hour concentration curve (AUC24), total area under the 24-hour inhibitory concentration curve ([AUIC24] AUC24/MIC summed for all active drugs), antibiotic(s) used as dichotomous variables (yes/no), and use of monotherapy or combination therapy.

Results:

Of 635 patients, 43 (7%) subsequently had ciprofloxacin-resistant P aeruginosa isolated. Four significantly differing patient groups were identified: group 1, P aeruginosa isolates from all sites other than the respiratory tract, treated with any drugs; group 2, respiratory tract isolates treated with drugs other than ciprofloxacin; group 3, respiratory tract isolates treated with ciprofloxacin at AUIC24 > 110 (μg·h/mL)/μg/mL; and group 4, respiratory tract isolates treated with ciprofloxacin at AUIC24 ≤110 (μg·h/mL)/μg/mL. The observed percentage resistant was a continuous function of prior length of stay in all four groups. Respiratory tract isolates had higher rates of ciprofloxacin resistance (12%) than isolates from other infection sites (4%). Respiratory tract isolates exposed to ciprofloxacin at AUIC24 ≤110 (μg·h/mL)/μg/mL had the highest resistance (17%). At AUIC24 >110 (μg·h/mL)/μg/mL, resistance was decreased to 11%, a rate similar to that seen in respiratory isolates not exposed to ciprofloxacin (7%).

Conclusions:

Application of pharmacokinetic and pharmacodynamic principles to dosing of ciprofloxacin may reduce the risk of ciprofloxacin resistance to the level seen in isolates exposed to other agents.
Antimicrobial Cycling: Lessons Learned From the Aminoglycoside Experience
Authors: Gerding Dale N.
Published: February 2006

Several discrete strategies have been suggested to prevent or reduce microbial resistance to antimicrobials, including optimal use of the agents (also known as good stewardship); control, removal, or restriction of antimicrobials; use of antimicrobials in combination; and rotational or cyclic use of antimicrobials. The latter strategy is attractive because it periodically removes from the institutional environment certain classes or specific agents that could induce or select resistance. Hospitalwide studies of aminoglycoside substitution employed from the late 1970s through the early 1990s, although not originally intended to test cycling or rotation of aminoglycosides, serendipitously provided data that may be useful in designing future studies. In particular, one 10-year study at the Minneapolis Veterans' Affairs Medical Center (MVAMC) rotated amikacin and gentamicin use over cycles of 12 to 51 months' duration. Significantly reduced resistance to gentamicin was found when amikacin was used, but resistance to gentamicin returned with the first gentamicin recycle. This was followed by reintroduction of amikacin a second time with decreased resistance to gentamicin and, finally, a second reintroduction of gentamicin without resistance to it recurring. Thus, some evidence of proof of principal can be garnered, albeit subject to considerable criticism. Critical examination of the design of the aminoglycoside rotation study and the unforeseen pitfalls is provided as a 13-element guidance list for design of future rotational studies. Rotational usage practices are likely to be most appropriate for drugs active against gram-negative bacilli because of the wide choices available for rotation. Future availability of new agents active against resistant gram-positive organisms will present the opportunity to cycle these agents as vancomycin substitutes. Careful monitoring of clinical outcomes and resistance will be required. Multicenter controlled trials that follow carefully designed protocols are most likely to produce statistically significant and clinically meaningful results.
Potential Role of Pharmacokinetics, Pharmacodynamics, and Computerized Databases in Controlling Bacterial Resistance
Authors: Hyatt Judith M. , Schentag Jerome J.
Published: February 2006

Bacterial resistance to antibiotics continues to be a problem, in spite of increased knowledge of resistance mechanisms. Due to the multifactorial nature of bacterial resistance, studies that evaluate the association between antimicrobial exposure and emergence of resistance may fail to find a relationship unless other factors, in particular the association between patient-pathogen pharmacokinetics (PK) and pharmacodynamics (PD) and the emergence of bacterial resistance, are evaluated as well. It has been hypothesized that, in conjunction with good infection control practices, cycling of antimicrobial agents may prove to be effective in reducing resistance emergence.

There is some indication that there may be a relationship between the level of antibiotic exposure and the probability of emergence of bacterial resistance. As shown in our companion article in this supplement, factors associated with ciprofloxacin resistance in Pseudomonas aeruginosa included increased length of stay prior to isolation, exposure to ciprofloxacin, and respiratory tract site of bacterial isolation. However, in patients who received ciprofloxacin therapy, when exposure was at an area under the 24-hour inhibitory concentration curve (AUIC24)>110 (μg·h/mL)/μg/mL, resistance was decreased to 11%, a rate similar to that seen in respiratory isolates not exposed to ciprofloxacin (7%).

While the length of time the patient spends in the hospital and the site of infection cannot be controlled, by using PK and PD principles for dosing of ciprofloxacin, the emergence of ciprofloxacin resistance in P aeruginosa may be reduced. Prospective antibiotic-cycling studies may help to determine not only the impact of antibiotic cycling on the institution's antibiogram but also, through the use of PK and PD principles, may help to determine appropriate dosing schedules for antibiotics in order to reduce the probability of emergence of bacterial resistance.
Evidence‐Based Research in Complementary and Alternative Medicine II: The Process of Evidence‐Based Research
Authors: Chiappelli Francesco , Prolo Paolo , Rosenblum Monica , Edgerton Myeshia , Cajulis Olivia S.
Published: February 2006

It is a common practice in contemporary medicine to follow stringently the scientific method in the process of validating efficacy and effectiveness of new or improved modes of treatment intervention. It follows that these complementary or alternative interventions must be validated by stringent research before they can be reliably integrated into Western medicine. The next decades will witness an increasing number of evidence‐based research directed at establishing the best available evidence in complementary and alternative medicine (CAM). This second paper in this lecture series examines the process of evidence‐based research (EBR) in the context of CAM. We outline the fundamental principles, process and relevance of EBR, and its implication to CAM. We underscore areas of future development in EBR. We note that the main problem of applying EBR to CAM at present has to do with the fact that the contribution of EBR can be significant only to the extent to which studies used in the process of EBR are of good quality. All too often CAM research is not of sufficient quality to warrant the generation of a consensus statement. EBR, nevertheless, can contribute to CAM by identifying current weaknesses of CAM research. We present a revised instrument to assess quality of the literature.
Osteoprotegrin Knockout Mice Demonstrate Abnormal Remodeling of the Otic Capsule and Progressive Hearing Loss
Authors: Zehnder Andreas F. , Kristiansen Arthur G. , Adams Joe C. , Kujawa Sharon G. , Merchant Saumil N. , McKenna Michael J.
Published: February 2006

Objectives: The otic capsule, when compared with other bones in the body, is unique in that it undergoes no significant remodeling of bone after development. We previously demonstrated that osteoprotegerin (OPG), which inhibits formation and function of osteoclasts, is produced at high levels in the inner ear of normal mice and secreted into the perilymph from where it diffuses into the surrounding otic capsule bone through a lacunocanalicular system. To test our hypothesis that the high level of OPG may be important in the inhibition of otic capsule remodeling, we studied the light microscopic histology of the otic capsule in OPG knockout mice for evidence of abnormal remodeling of bone. We also tested the hearing in OPG knockout mice to determine whether OPG and its influence on surrounding bone is important for auditory function.

Methods: Temporal bone histopathology and pathophysiology were compared in homozygous OPG knockout mice and C57BL/6 (B6) mice, the background strain for the knockouts. Auditory function in age‐matched animals from each group was evaluated at approximately 4‐week intervals from 8 to 21 weeks using frequency‐specific auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE). After each of the last three evaluations, the cochleae from one mouse of each group were harvested, processed, and examined by light microscopy.

Results: Osteoprotegerin knockout mice demonstrated abnormal remodeling of bone within the otic capsule with multiple foci showing osteoclastic bone resorption and formation of new bone. Such changes were not seen in the age‐matched B6 controls. The active bone remodeling process in the knockout animals showed many similarities to otosclerosis seen in human temporal bones. Over the time period that we monitored, auditory function was significantly and progressively compromised in the knockout animals relative to B6 controls. At the earliest age of test (8 wk), the loss was apparent as a mild, high‐frequency reduction in sensitivity by ABR. In contrast, DPOAE losses in the knockouts were substantial even at 8 weeks, and by 21 weeks, these losses exceeded our equipment limits. Results of ABR testing showed hearing sensitivity changes in the animals of the background strain were confined largely to the high frequencies, whereas OPG knockouts demonstrated substantial low‐frequency shifts in addition to those at high frequencies.

Conclusions: The histopathological and pathophysiological findings in OPG knockout mice support the hypothesis that OPG is important in the inhibition of bone remodeling within the otic capsule and the maintenance of normal auditory function. This mouse may provide a valuable animal model of human otosclerosis.
Long‐Term Result of the New Endoscopic Vocal Fold Medialization Surgical Technique for Laryngeal Palsy
Authors: Nishiyama Koichiro , Hirose Hajime , Masaki Takashi , Nagai Hiromi , Hashimoto Daimon , Usui Daisuke , Yao Kazuo , Tsunoda Koichi , Okamoto Makito
Published: February 2006

Objective: The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap.

Study Design and Methods: In the present study, we modified the method of medialization using the ATFV technique to obtain effective closure of a large glottal gap. To overcome this difficulty, an attempt was made to extend the site of transplantation more posteriorly so as to adduct the vocal process of the arytenoid cartilage in the body of the vocal fold.

Results: This new technique was applied to eight cases of patients with unilateral laryngeal paralysis with severe dysphonia. None of the patients showed any evidence of falling off of the graft. Elongation of the maximum phonation time and a decrease in airflow rate during phonation were obtained with improvement in voice quality in all patients 1 year after the surgery.

Conclusions: This method, with its less invasive approach, proved to be useful for the treatment of large glottal gap due to unilateral laryngeal nerve paralysis.
The Histone Deacetylase Inhibitor Sodium Butyrate Protects Against Cisplatin‐Induced Hearing Loss in Guinea Pigs
Authors: Drottar Marie , Liberman M Charles , Ratan Rajiv R. , Roberson David W.
Published: February 2006

Objective: There is a need for otoprotective agents that can be administered systemically without compromising cancer treatment. Histone deacetylase inhibitors are anticancer agents that act by upregulating the expression of cell‐cycle control genes. They are also neuroprotective, leading us to hypothesize that they might be otoprotective. The goal of this study was to determine if the antitumor agent sodium butyrate (a histone deacetylase inhibitor) protects against cisplatin ototoxicity when administered systemically.

Study Design: This was an animal study.

Methods: Cisplatin was administered to guinea pigs who received either 12 days of sodium butyrate (7 d before and 5 d after cisplatin) or equivolume saline injections. Hearing was tested with distortion product otoacoustic emission (DPOAE) analysis before the start of the study and 2 weeks after cisplatin treatment.

Results: Guinea pigs given a single intraperitoneal injection of 14 mg/kg cisplatin experience a mean hearing loss of 8 dB across the frequencies of 3.5, 5, 7, 10, 14, and 20 kHz. Intraperitoneal injection of 1.2 mg/kg sodium butyrate per day for 7 days before and 5 days after cisplatin almost completely eliminates this threshold shift (P = .0011).

Conclusions: The histone deacetylase inhibitor sodium butyrate gives almost complete protection in a single‐dose model of cisplatin ototoxicity in guinea pigs. Because histone deacetylase inhibitors are anticancer agents with very few side effects, they may be candidates for clinical use during cisplatin chemotherapy.
Fluorodeoxyglucose‐Positron Emission Tomography/Computed Tomography Imaging in Patients with Carcinoma of the Larynx: Diagnostic Accuracy and Impact on Clinical Management
Authors: Gordin Arie , Daitzchman Marcello , Doweck Ilana , Yefremov Nikolay , Golz Avishay , Keidar Zohar , Bar‐Shalom Rachel , Kuten Abraham , Israel Ora
Published: February 2006

Objectives: The objectives of this study were to assess the value of 18F‐fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with carcinoma of the larynx as compared with PET and CT alone and to assess the impact of PET/CT on further clinical management.

Study Design: This was a prospective, nonrandomized study.

Materials and Methods: Forty‐two patients with laryngeal cancer had 51 PET/CT examinations. There were 34 men and eight women, aged 39 to 80 years. All studies were interpreted prospectively with knowledge of the clinical history and results of previous imaging tests. The performance of different imaging modalities was compared on both a study‐ and lesion‐based analysis for sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and accuracy. Changes in patient care resulting from the PET/CT studies were recorded.

Results: The study analysis showed that PET/CT had a sensitivity of 92%, specificity 96%, PPV 96%, NPV 92%, and accuracy of 94% as compared with 92%, 73%, 76%, 91%, and 82% for PET, and 88%, 8%, 48%, 40%, and 51% for CT, respectively. There were 112 suspicious sites evaluated in the 51 studies. PET/CT altered management in 25 patients (59%) by sparing previously planned diagnostic procedures (n = 13), by changing the planned therapeutic approach (n = 9), and by guiding a biopsy to a metabolically active laryngeal area (n = 3).

Conclusions: The performance of PET/CT is better than standalone PET or CT in patients with cancer of the larynx. PET/CT had a major impact on management of 59% of patients.
The Effect of Erythropoietin on Gentamicin‐Induced Auditory Hair Cell Loss
Authors: Monge Arianne , Nagy Ivana , Bonabi Sharouz , Schmid Stephan , Gassmann Max , Bodmer Daniel
Published: February 2006

Objective/Hypothesis: Mammalian auditory hair cells that are unable to regenerate and various agents, including gentamicin, can irreversibly damage the hair cells. Erythropoietin, known as the primary regulator of erythropoiesis, exerts also neuroprotective effects by binding to its receptor. We tested whether erythropoietin can protect the hair cells from gentamicin‐induced damage.

Study Design: This study localized the erythropoietin receptor in the cochlea and analyzed the effect of erythropoietin on gentamicin‐damaged hair cells in vitro.

Methods: Expression of erythropoietin receptor in the rat cochlea was analyzed by reverse transcriptase–polymerase chain reaction (RT‐PCR) and immunohistochemistry. Protection of auditory hair cells from gentamicin was tested in vitro by exposing cultured rat organs of Corti with increasing concentrations of erythropoietin (0.1 U/mL, 1 U/mL, and 10 U/mL).

Results: We detected erythropoietin and erythropoietin receptor mRNA expression in the organ of Corti, spiral ganglion, and stria vascularis by RT‐PCR. Immunohistochemistry revealed that the erythropoietin receptor localizes to the outer and inner hair cells and supporting cells of the organ of Corti, as well as to the spiral ganglion cells and the stria vascularis. Significantly less hair cell loss occurred in the organs of Corti that were pretreated with 0.1 U/mL erythropoietin as compared with samples treated with gentamicin only.

Conclusion: Decreased hair cell loss in erythropoietin‐treated organs of Corti that had been exposed to gentamicin provides evidence for a protective effect of erythropoietin in aminoglycoside‐induced hair cell death.
Exiting TANF: Individual and Local Factors and Their Differential Influence Across Racial Groups*
Authors: Parisi Domenico , McLaughlin Diane K. , Grice Steven Michael , Taquino Michael
Published: February 2006

Objective. We ask whether individual and local factors known to influence reliance on welfare continue to be important under the TANF program, and if such factors differentially affect exit from TANF for African Americans and whites.

Methods. We use monthly administrative data on TANF recipients from October 1996 to July 2004 from the Mississippi Department of Human Services. These data are linked to local economic, social, and spatial characteristics to estimate discrete time hazard models of TANF exit.

Results. Personal barriers to work (e.g., low education and children) and limited economic and social opportunities in communities reduce the likelihood of leaving TANF. The results show that African‐American exits from TANF are more influenced by human capital and local economic, social, and spatial conditions than are whites' TANF exits.

Conclusion. The work‐first initiative under TANF is most viable where individual barriers to work are limited and economic opportunities and community support to become self‐sufficient exist for all people.
State Growth Management and Housing Prices*
Authors: Anthony Jerry
Published: February 2006

Objective. In the United States, growth regulations aimed at environmental protection and better‐quality urban areas have become very popular since the 1960s. Although many studies have examined the housing‐price effects of local and regional growth management regulations, none has examined the effects of a state law. Past research has also tended to be cross‐sectional, rather than longitudinal, and has frequently ignored alternate hypotheses that could explain housing‐price trends. The research presented in this article examines the housing‐price effects of Florida's Growth Management Act of 1985.

Methods. Using secondary source data from all 67 counties of the state for the period 1980–1995 and employing pooled time‐series analysis techniques I test the hypothesis that the Act had an inflationary effect on single‐family house prices.

Results. After controlling for alternate hypotheses such as population, income, and size of house, I find a statistically significant increase in the price of single‐family houses attributable to statewide growth management. Also, the demand‐side and supply‐side price inflationary effects of growth management are similar in magnitude.

Conclusions. Since higher housing prices could become the Achilles heel of growth management programs and thwart their implementation, I suggest a few ways some of the price inflationary effects may be reduced.
Region, Race, and Support for the South Carolina Confederate Flag*
Authors: Cooper Christopher A. , Knotts H. Gibbs
Published: February 2006

Objective. Existing research suggests that conservative racial attitudes are one of the strongest factors explaining support for the Confederate flag, but this conclusion has been reached by examining the attitudes of only white southerners. We provide a more complete understanding of this issue, focusing on both white and black opinion from across the country.

Methods. We use a rolling cross‐sectional survey with a large sample size to model support for the South Carolina Confederate flag nationally and then among two groups: southerners and nonsoutherners.

Results. Although racial attitudes are important among both southerners and nonsoutherners, region and race also influence support for the Confederate flag. Southern whites have the greatest support for the flag followed by nonsouthern whites, nonsouthern blacks, and southern blacks.

Conclusions. Support for the Confederate flag is not simply about racial attitudes, but a more complex phenomenon where region and race exert important influences.
Partisan Gerrymandering and the Voting Rights Act*
Authors: Forgette Richard , Winkle John W.
Published: February 2006

Objective. The goal of the study is to empirically assess the extent of partisan and incumbent gerrymandering in the 2000 congressional redistricting. Critics of congressional redistricting have argued that recent partisan gerrymandering severely undermines electoral competitiveness to the point of violating constitutional equal protection standards.

Method. We first analyze the legal precedents and arguments central to the contemporary redistricting debate. We then analyze district‐level data measuring the change in a congressional incumbent's presidential party vote share before and after the 2000 redistricting. We conduct regression analyses that test for partisan and incumbent gerrymandering effects with an eye toward noting implications for the Voting Rights Act, particularly majority‐minority districting.

Results. We find that recent redistricting significantly contributed to a further decline in electoral competitiveness; however, most of this decline in competitiveness came through incumbency protection, not partisan gerrymandering. Majority‐minority districts lost about 5 percent incumbent party vote share, though only 3 percent in southern states.

Conclusion. Given these results, we conclude that the logic of partisan gerrymandering is at variance with the mandate of racial redistricting. One effect of establishing a strict judicial standard limiting statewide partisan biases would be to restrict states' capacity to draw majority‐minority districts.
Interstate Competition and Environmental Regulation: A Test of the Race‐to‐the‐Bottom Thesis*
Authors: Woods Neal D.
Published: February 2006

Objective.This study assesses the effect of interstate competition on the stringency with which states enforce environmental regulations.

Method.Pooled cross‐sectional time‐series analysis of state surface‐mining regulation is used to determine if the enforcement gap between a state and competitor states affects the stringency of state enforcement.

Results.The results suggest that state enforcement is systematically affected by the behavior of regional competitors. States adjust their enforcement in response to competitor states when their enforcement stringency exceeds that of their competitors. When competitors' enforcement is more stringent, however, their behavior does not have a significant effect.

Conclusion.This study provides empirical evidence for a race to the bottom in state environmental regulation.
Perivascular myoma of myopericytoma and myofibromatosis‐type arising in a chronic scar
Authors: Scott Rolf Sjuve , Blank Kristie L. , Proffer Liana H. , Kraus Eric W. , Heim‐Hall Josefine
Published: February 2006

We describe a case of a cutaneous perivascular myoma with features overlapping between the myofibromatosis and the myopericytoma type. The patient is a 58‐year‐old woman with a painless plaque‐like and multinodular lesion in the pretibial dermis and subcutaneous tissue. She had repeated trauma to this site, first in her early youth that left an area of hyperpigmentation, and then again at age 40. The biopsy showed a biphasic pattern with a myofibromatosis‐type component composed of spindle cell myoid nodules and more cellular round cell areas. The myopericytoma‐like areas appeared to be infiltrating along vessels. These areas contained aggregates of immature‐appearing cells arranged concentrically around vascular lumina in a manner reminiscent of pericytes. Immunohistochemical stains showed focal positivity for smooth muscle actin. Immunohistochemical and ultrastructural studies have showed these pericyte‐like cells to be of a myoid origin. The reason for the neoplastic proliferation of perivascular myoid cells is presently unknown. The association of trauma and neoplastic transformation of the skin is rare. We report the first case of a cutaneous perivascular myoma arising in a chronic scar.
Squamous cell carcinoma of the skin: dual differentiations to rare basosquamous and spindle cell variants
Authors: Mitsuhashi Tomoko , Itoh Tomoo , Shimizu Yoshihiko , Ban Shinichi , Ogawa Fumihiro , Hirose Takanori , Shimizu Michio
Published: February 2006

Abstract:  Basosquamous carcinoma (BSC) is defined as a tumor containing the areas of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with a transition zone linking the two. Spindle cell squamous carcinoma (SCSC) may have a variable component of conventional SCC and spindle cells. We present a case of an 89‐year‐old woman with an eruption on the scalp for several decades. Grossly, the lesion measured 8.5 × 6.0 × 1.8 cm and consisted of a gray‐white and focally black tumor. Microscopically, a non‐ulcerated upper part of the tumor consisted of large polygonal squamoid cells with occasional keratinization (SCC), trabecular growth of basaloid cells with peripheral palisading (BCC), and an area in which both the components were intermingled. The rest of the tumor was a myxoid area with elongated fusiform spindle cells, which appeared to arise from conventional SCC. Immunohistochemically, the tumor cells in the SCSC (both conventional and spindle cell) area co‐expressed CAM5.2, and vimentin. Ber‐EP4 was positive in the BCC area with the transition zone of SCC and BCC showing diminished staining. Epithelial membrane antigen was focally positive in the conventional SCC area. To our knowledge, this is the first case report of SCC of the skin that has dual differentiations to BSC and SCSC.
Smooth muscle pattern is more reliable than the presence or absence of an internal elastic lamina in distinguishing an artery from a vein
Authors: Dalton Scott R. , Fillman Eric P. , Ferringer Tammie , Tyler William , Elston Dirk M.
Published: February 2006

Background:  Major pathology textbooks suggest that the shape of the vessel and the presence or absence of an internal elastic lamina are the best means to distinguish an artery from a vein. Because the shape of the vessel is highly dependent upon the plane of section, the internal elastic lamina is often cited as a more reliable criterion. After evaluating a patient with superficial thrombophlebitis, in whom these conventional criteria had led to a misdiagnosis of polyarteritis nodosa, we sought to determine whether the pattern of smooth muscle in the media is a more sensitive discriminator between an artery and a vein.

Methods:  Anatomically identified arteries and veins were harvested from extremity amputation specimens and stored autopsy organ specimens and reviewed by two dermatopathologists who were blinded to the gross pathologist's impression. The biopsies were assessed for the smooth muscle pattern and the presence or absence of an internal elastic lamina.

Results:  Forty‐seven of the 50 cases (94%) were concordant with the pathologist's gross impression using only the smooth muscle pattern to differentiate an artery from a vein. On the basis of the presence or absence of an internal elastic lamina, 41 of 50 cases (82%) were concordant with the prosector's designation of the vessel.

Limitations:  Vessels were harvested from a variety of sites, with lower extremity vessels predominating. There may be some regional variability not addressed in this study.

Conclusion:  In this study, the pattern of muscle fibers within the vascular media discriminated between arteries and veins better than assessment of the presence or absence of an internal elastic lamina. Although no single criterion is 100% reliable, assessment of both these criteria may minimize the risk of misinterpreting vessels in the deep dermis and subcutis.
Characterization of induced mucosal connective tissue separation – a comparison of six different techniques
Authors: Bez Cristina , Moneghini Laura , Nicali Andrea , Cazzaniga Arianna , Lodi Giovanni , Bosari Silvano , Sardella Andrea , Carrassi Antonio
Published: February 2006

Background:  Artificial separation of oral mucosa into epithelium and connective tissue represents the first step in investigating both the basement membrane zone and its two components (epithelium and connective tissue) separately. It is a useful tool in analysing the possible role of hepatitis C virus in the pathogenesis of oral lichen planus (OLP). The aim of the present study was to test different methods to separate the epithelium from the connective tissue of oral mucosa affected by OLP as a preliminary step for further immunohistochemical or molecular investigations.

Patients and methods:  Fourteen tissue biopsies of the oral mucosa of clinically and histopathologically confirmed OLP lesions underwent epithelial connective separation (ECS) using six different reagents.

Results and conclusions:  Among the separation methods tested, CaCl2 1 m at 37 °C for 30 min, NaCl 1 m at 4 °C for 26 h and elastase at 4 °C for 22 h allowed good ECS without structural alteration or tissue loss. The present study provides useful information regarding techniques to separate the epithelium from the connective tissue as a preliminary step to investigate oral mucosa affected by OLP from an immunohistochemical or molecular viewpoint.
Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification
Authors: Cassarino David S. , DeRienzo Damian P. , Barr Ronald J.
Published: February 2006

Cutaneous squamous cell carcinoma (SCC) includes many subtypes with widely varying clinical behaviors, ranging from indolent to aggressive tumors with significant metastatic potential. However, the tendency for pathologists and clinicians alike is to refer to all squamoid neoplasms as generic SCC. No definitive, comprehensive clinicopathological system dividing cutaneous SCCs into categories based upon their aggressiveness has yet been promulgated. Therefore, we have proposed the following based upon the malignant potential of SCC variants, separating them into categories of low (≤2% metastatic rate), intermediate (3–10%), high (greater than 10%), and indeterminate behavior. Low‐risk SCCs include SCC arising in actinic keratosis, HPV‐associated SCC, tricholemmal carcinoma, and spindle cell SCC (unassociated with radiation). Intermediate‐risk SCCs include adenoid (acantholytic) SCC, intraepidermal epithelioma with invasion, and lymphoepithelioma‐like carcinoma of the skin. High‐risk subtypes includede novoSCC, SCC arising in association with predisposing factors (radiation, burn scars, and immunosuppression), invasive Bowen's disease, adenosquamous carcinoma, and malignant proliferating pilar tumors. The indeterminate category includes signet ring cell SCC, follicular SCC, papillary SCC, SCC arising in adnexal cysts, squamoid eccrine ductal carcinoma, and clear‐cell SCC. Subclassification of SCC into these risk‐based categories, along with enumeration of other factors including tumor size, differentiation, depth of invasion, and perineural invasion will provide prognostically relevant information and facilitate the most optimal treatment for patients.
Use of the oral chelator deferiprone in the treatment of iron overload in patients with Hb H disease
Authors: Chan Joyce C. W. , Chim Chor‐Sang , Ooi Clara G. C. , Cheung Bernard , Liang Raymond , Chan Tai‐Kwong , Chan Vivian
Published: February 2006

Seventeen non‐transfusion‐dependent Chinese haemoglobin H (Hb H) disease patients (age 29–76 years) with serum ferritin >900 μg/l were treated with deferiprone for up to 18 months. One patient withdrew and data from 16 patients were analysed. Sixteen other Hb H patients with ferritin <900 μg/l, matched for age and genotype, acted as controls. Treatment was well tolerated except for mild arthralgia. Serum ferritin fell with treatment, reaching significance at 6 and 18 months (from 1492·3 ± 901·4 to 519·4 ± 405·4 μg/l at 18 months, P = 0·0008). Nine of 16 patients had levels below 397 μg/l before 18 months. Serum ferritin remained stable 6 months after stopping treatment. In contrast, there was no change in ferritin levels in the control group. Magnetic resonance imaging was used for measurement of liver iron content. Spin echo T1‐signal intensity ratio (T1‐SIR) and gradient echo T2‐signal intensity ratio (T2‐SIR) increased with treatment. T2‐SIR rose from 0·17 ± 0·08 pretreatment to 0·58 ± 0·50 at 2 years (P = 0·0055). Improvement occurred in 12 of 16 patients, reaching normal in three patients. Using echocardiography, peak early diastolic : late diastolic blood flow (E/A) remained unchanged with treatment, but isovolumic relaxation time (IVRT) was prolonged at 2 years indicating mild impairment of diastolic function. All systolic function parameters were normal. A longer treatment period is desirable to demonstrate improvement in cardiac function.
Phase I/II study of vaccination with dendritic‐like leukaemia cells for the immunotherapy of acute myeloid leukaemia
Authors: Roddie H. , Klammer M. , Thomas C. , Thomson R. , Atkinson A. , Sproul A. , Waterfall M. , Samuel K. , Yin J. , Johnson P. , Turner M.
Published: February 2006

Twenty‐two patients with acute myeloid leukaemia were recruited into a phase I/II clinical trial investigating the vaccination of patients in complete remission (CR) with autologous dendritic‐like leukaemia cells (DLLC). At trial entry, leukaemia cells were harvested and tested for their ability to undergo cytokine‐induced dendritic cell differentiation. Patients were then treated with intensive chemotherapy. Five patients achieved both CR and had leukaemia cells that successfully underwent differentiation and therefore proceeded to vaccination. Four escalating doses of DLLC were administered weekly by subcutaneous injection. Vaccination was generally well tolerated although one patient developed extensive eczema and an increased antinuclear factor titre possibly indicating induction of autoimmunity. Development of anti‐leukaemic T‐cell responses was assessed by enzyme‐linked immunospot analysis of gamma‐interferon secreting T lymphocytes and by human leucocyte antigen tetramer analysis for WT1‐specific T cells. Increases in anti‐leukaemic T‐cell responses were demonstrated in four patients, but only two of the five remained in remission more than 12 months postvaccination. The study has demonstrated that generation of DLLC is feasible in only a subgroup of patients and is currently neither broadly applicable or clinically effective.
Securin can have a separase cleavage site by substitution mutations in the domain required for stabilization and inhibition of separase
Authors: Nagao Koji , Yanagida Mitsuhiro
Published: February 2006

Securin‐separase complex is required for sister chromatid separation. Securin degrades in an APC/cyclosome dependent manner. Separase is activated on the destruction of securin and cleaves cohesin. Fission yeast securin/Cut2 required for proper separase localization has the motifs for destruction and separase‐binding at the N‐ and C‐termini, respectively. We report here the third essential domain, which becomes toxic when the 76‐amino acid fragment (81–156) in the middle is overproduced. The fragment inhibits separase, while separase is recruited normally and securin is destroyed. It may interfere with separase activation after destruction of securin. If the 127DIE129 stretch is substituted for AIA, the fragment toxicity and the full‐length function are abolished. Interestingly, Cut2 is cleaved in a separase dependent manner if the cleavage consensus is introduced following the DIE sequence. This finding is consistent with the proposed model that the DIE region may mimic the cleavage site of separase and inhibit the activation of separase. Evidence for physical interaction between the fragment and separase is provided. A temperature sensitive mutation cut1‐K73 isolated by its specific resistance to the fragment toxicity resides in the superhelical region of separase, suggesting that the catalytic site and the helical region in separase may cooperate for activation.
Oocyte growth‐dependent progression of maternal imprinting in mice
Authors: Hiura Hitoshi , Obata Yayoi , Komiyama Junichi , Shirai Motomu , Kono Tomohiro
Published: February 2006

In mammals, some genes categorized as imprinted genes are exclusively expressed either from maternal or paternal allele. This parental‐origin‐specific gene expression is regulated by epigenetic modification of DNA methylation in differentially methylated region (DMR), which is independently imposed during oogenesis and spermatogenesis. It is known that methylation of DMR in the female germ line is established during oocyte growth phase. However, the cause of the progression of methylation on DMR, due to either aging of mice or growth‐size of oocyte was unclear up to now. Here, we analyzed the methylation of DMR for each eight imprinted genes (Igf2r, Lit1, Zac1, Snrpn, Peg1/Mest, Impact, Meg1/Grb10, and H19) by bisulfite sequencing methylation assay, using oocytes from 10 dpp (days post partum), 15 dpp, 20 dpp, and adult mice. To find whether the size of oocytes is the cause of methylation, above oocytes were classified into seven groups (each oocyte diameter ranging from 40 to 75 µm with intervals of 5 µm). The results from juvenile mice oocytes showed that DMR methylation progressed according to oocyte growth each imprinted gene. More than 85% of DMR methylation was achieved for both Igf2r, Zac1 & Lit1 with oocyte size of reaching 55 µm and Snrpn, Peg1/Mest, Impact, and Meg1/Grb10 with oocyte size of reaching 60 µm. Preferential methylation of maternal allele was observed in Zac1 and Peg1/Mest of juvenile oocytes and in Snrpn of juvenile and adult oocytes. The oocyte size‐dependent‐methylation progressed equally for all three different‐age juvenile mice. The size‐dependent‐methylation was also recognized in the growing oocytes collected from adult mice, although the progress is slightly slower than that of juvenile mice. From these results, we concluded that DNA methylation is established with oocyte size dependent manner, not with aging of mice.