Density-dependent positive feedbacks buffer aquatic plants from interactive effects of eutrophication and predator loss.

Self-facilitation allows populations to persist under disturbance by ameliorating experienced stress. In coastal ecosystems, eutrophication and declines of large predatory fish are two common disturbances that can synergistically impact habitat-forming plants by benefitting ephemeral algae. In theory, density-dependent intraspecific plant facilitation could weaken such effects by ameliorating the amount of experienced stress. Here, we tested whether and how shoot density of a common aquatic plant (Myriophyllum spicatum) alters the response of individual plants to eutrophication and exclusion of large predatory fish, using a 12-week cage experiment in the field. Results showed that high plant density benefitted individual plant performance, but only when the two stressors were combined. Epiphytic algal biomass per plant more than doubled in cages that excluded large predatory fish, indicative of a trophic cascade. Moreover, in this treatment, individual shoot biomass, as well as number of branches, increased with density when nutrients were added, but decreased with density at ambient nutrient levels. In contrast, in open cages that large predatory fish could access, epiphytic algal biomass was low and individual plant biomass and number of branches were unaffected by plant density and eutrophication. Plant performance generally decreased under fertilization, suggesting stressful conditions. Together, these results suggest that intraspecific plant facilitation occurred only when large fish exclusion (causing high epiphyte load) was accompanied by fertilization, and that intraspecific competition instead prevailed when no nutrients were added. As coastal ecosystems are increasingly exposed to multiple and often interacting stressors such as eutrophication and declines of large predatory fish, maintaining high plant density is important for ecosystem-based management.

A cross-scale trophic cascade from large predatory fish to algae in coastal ecosystems.

Trophic cascades occur in many ecosystems, but the factors regulating them are still elusive. We suggest that an overlooked factor is that trophic interactions (TIs) are often scale-dependent and possibly interact across spatial scales. To explore the role of spatial scale for trophic cascades, and particularly the occurrence of cross-scale interactions (CSIs), we collected and analysed food-web data from 139 stations across 32 bays in the Baltic Sea. We found evidence of a four-level trophic cascade linking TIs across two spatial scales: at bay scale, piscivores (perch and pike) controlled mesopredators (three-spined stickleback), which in turn negatively affected epifaunal grazers. At station scale (within bays), grazers on average suppressed epiphytic algae, and indirectly benefitted habitat-forming vegetation. Moreover, the direction and strength of the grazer-algae relationship at station scale depended on the piscivore biomass at bay scale, indicating a cross-scale interaction effect, potentially caused by a shift in grazer assemblage composition. In summary, the trophic cascade from piscivores to algae appears to involve TIs that occur at, but also interact across, different spatial scales. Considering scale-dependence in general, and CSIs in particular, could therefore enhance our understanding of trophic cascades.

Effects of sedimentation on macroalgae: species-specific responses are related to reproductive traits.

Although increases in sedimentation have been proposed to interfere with benthic communities in many coastal areas worldwide, few experimental studies have investigated the effect of sedimentation on community composition and assessed species-specific responses. In a field experiment on a rocky shore on the Swedish east coast (northern Baltic Proper) we confirmed the hypotheses that ambient sedimentation influences macroalgal abundance and community composition, and that species-specific responses to sedimentation correlate with reproductive strategies. We followed the establishment and development of macroalgal vegetation on artificial substrates at 8-m and 15-m depth for 4.5 years while manipulating the depositional environment by regularly removing accumulated sediment. Sediment removal significantly favoured macroalgal development and vegetation cover. Responses of macroalgal species to the sediment treatments were clearly species-specific; for example, the ephemeral green algae (Cladophora glomerata and Enteromorpha spp.) were highly tolerant to sedimentation while belt-forming perennial brown algae (Fucus vesiculosus and Sphacelaria arctica) were not. Accordingly, multivariate analyses (redundancy analysis) showed that variance in species abundances were significantly correlated to sediment conditions. The effect of sediment removal was higher at 15-m than at 8-m depth and some species' distributions seemed limited in depth by the present sediment load (e.g. F. vesiculosus). Vegetative propagation was common in the study area and many species mainly depended on dispersal by fragmentation. Generally, species with an extended reproductive period, either by long continuous spore release (C. glomerata and Enteromorpha spp.) or vegetative dispersal by fragmentation (e.g. Furcellaria lumbricalis and Polysiphonia fucoides), were most tolerant to sedimentation. This paper demonstrates long-term effects of sediment deposition on the development of a macroalgal community over several growing seasons. The results indicate that variation in sediment loads is an important constraint for species' local distributions and abundances, and affects the composition of sublittoral rocky-shore macroalgal communities.

Treatment with cisplatin and etoposide in patients with neuroendocrine tumors.

BACKGROUND: Patients with malignant endocrine pancreatic tumors (EPTs) are responsive to combinations of chemotherapy with streptozotocin and 5-fluorouracil/doxorubicin, whereas patients with malignant carcinoids are not. For both categories of patients, alpha-interferon and/or somatostatin analogs can produce long-lasting responses. Cisplatin in combination with etoposide has been suggested to be effective in patients with malignant neuroendocrine carcinomas. The authors used this therapy as second-line or third-line treatment in patients with poorly differentiated and/or rapidly progressing disease. METHODS: Thirty-six patients with histopathologically verified malignant neuroendocrine tumors were included: Eighteen tumors were of foregut origin, of which 5 were atypical, and 15 tumors were EPTs, of which 4 were poorly differentiated endocrine carcinomas. Three tumors were of midgut origin. The median patient age was 47.5 years. The median duration of disease from the time of diagnosis was 12 months. All patients had metastatic disease. Thirty of 36 patients had received previous treatment. Etoposide was given at a dose of 100 mg/m(2) per day for 3 days, and cisplatin was given at a dose of 45 mg/m(2) on Days 2 and 3 as a continuous intravenous infusion that was repeated every 4 weeks. RESULTS: Ten of 18 patients with foregut carcinoids (56%) responded radiologically and/or biochemically, with a median duration of 9 months; and 7 of 14 patients with EPTs (50%) responded radiologically and/or biochemically, with a median duration of 9 months. No difference in response was seen between patients with atypical or typical foregut carcinoids or between patients with well differentiated or poorly differentiated endocrine pancreatic carcinoma. Nineteen of 36 patients (53%) experienced World Health Organization (WHO) Grade 1-2 nephrotoxicity, and 23 patients (64%) suffered from WHO Grade 3-4 neutropenia. CONCLUSIONS: The combination of cisplatin and etoposide can produce significant responses in patients with heavily pretreated and poorly differentiated/rapidly progressing neuroendocrine tumors. The toxicity is considerable, and nephrotoxicity is the dose limiting factor.

Opsonization of T1M1 group A Streptococcus: dynamics of antibody production and strain specificity.

A chemiluminescence method was used to study opsonization of group A Streptococcus (GAS) of serotype T1M1 in serum samples ("sera") obtained from Swedish patients with invasive and noninvasive GAS infection and from healthy blood donors. Acute-phase serum samples ("acute sera") generally demonstrated low ability to opsonize the patient's own GAS isolate, regardless of clinical manifestation. Only approximately 15% of serum samples obtained from healthy blood donors demonstrated high opsonic activity against a standard T1M1 strain. Opsonization of 62 T1M1 isolates (obtained during 1980-1998) by a single immune serum sample showed considerable variation; this indicates that high opsonic immunity may develop only against the infecting isolate or identical clones. T1M1 GAS isolated from 1987 through 1990 were better opsonized by the immune serum sample than were isolates obtained before 1987 or after 1990, a finding that suggests a temporal change of the surface properties that affect opsonization.

Anal colonization of group G beta-hemolytic streptococci in relapsing erysipelas of the lower extremity.

Four patients who had frequent relapses of erysipelas but no obvious portal of entry and no beta-hemolytic streptococci in specimens from conventional culture sites all had group G streptococci in cultures of specimens from the anal canal. It is suggested that anal colonization with group G streptococci, and possibly group A and other beta-hemolytic streptococci, may constitute a reservoir for streptococci in such cases.

Invasive group A streptococcal infections: T1M1 isolates expressing pyrogenic exotoxins A and B in combination with selective lack of toxin-neutralizing antibodies are associated with increased risk of streptococcal toxic shock syndrome.

Analysis of 132 group A streptococcal (GAS) isolates from 151 invasive episodes, including streptococcal toxic shock syndrome (STSS), from 1983 to 1995 showed great genetic variation by use of T serotyping in combination with restriction fragment length polymorphism. In contrast, genetically homogenous T1M1 isolates appeared in epidemic patterns with significantly increased risk of STSS. The speA gene, with the allelic variants speA2 and speA3 carried by the T1M1 and T3M3 serotypes, respectively, was strongly associated with STSS. Infection with a GAS isolate carrying speA, alcohol abuse, and malignancy recently treated with cytostatic drugs were factors independently related to STSS. Neutralization of SpeA lymphocyte mitogenicity was totally absent in sera from patients with STSS and low in sera from persons with uncomplicated bacteremia compared with levels in sera from uncomplicated erysipelas. Neutralization of SpeB was significantly lower in sera of patients with STSS than in sera from persons with bacteremia or erysipelas.

Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors.

BACKGROUND: Patients with neuroendocrine gastrointestinal tumors usually present with inoperable metastatic disease and severe hormonal symptoms. Specific chemotherapy, interferon-alpha (IFN), and somatostatin analogs are established therapies for these patients, but all of them eventually fail. Hepatic arterial embolization can provide reduction of both hormonal symptoms and tumor burden in these patients. METHODS: Between 1981 and 1995, a total of 55 liver embolizations with gel foam powder were performed on 41 patients with histopathologically verified neuroendocrine tumors; 29 had carcinoid tumors and 12 had endocrine pancreatic tumors (EPTs). All patients had received medical treatment, including chemotherapy (n = 18), IFN (n = 31), and octreotide (n = 19), and were experiencing treatment failure when liver embolization was performed at a median of 37 months after diagnosis of liver metastases. Medical treatment was continued after embolization. RESULTS: An overall objective response was noted in 15 of 29 patients with carcinoid tumors (52%). The median duration of effect was 12 months in patients with midgut carcinoid tumors. An overall objective response was observed in 6 of 12 patients with EPTs (50%), with a median duration of effect of 10 months. Adverse events were observed, and, in agreement with earlier reports, the rate of serious complications was 10%. Survival analyses showed a median survival of 80 months and a 5-year survival rate of 60% from the performance of embolization on patients with midgut carcinoid tumors, whereas for patients with EPTs the median survival from embolization was only 20 months. CONCLUSIONS: Liver embolizations performed relatively late in the clinical course in our series appeared to be as effective as "early" embolizations in other series of patients with carcinoid tumors. The results for those with EPTs were poorer, and earlier embolizations may result in better outcomes for these patients. Considering the morbidity associated with the procedure, it is imperative to select patients according to extent of liver involvement, severity of carcinoid heart disease, and somatostatin receptor status.

Epidemiological and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome.

In a retrospective study of invasive infections due to group A Streptococcus (GAS) in Stockholm during 1987 to 1995, the average incidence per 100,000 residents per year was 2.3, varying between 3.7 per 100,000 (in 1988) and 1.3 per 100,000 (in 1993). Incidence was 1.8 in the age group of 0-4 years but otherwise increased by age, from 0.48 in the age group of 5-14 years to 6.1 among those over 65 years of age. A review of 151 invasive episodes occurring in 1983-1995 showed cyclic increases of infections due to T1M1-serotype strains during 1986-1990 and 1993-1995. The T1M1 serotype accounted for 27 (20%) of 135 available GAS strains. Streptococcal toxic shock syndrome (STSS) developed in 19 (13%) of the 151 episodes. The case fatality rate was 11% overall but 47% among patients with STSS. In a multivariate logistic regression model, STSS was associated with a history of alcohol abuse (odds ratio [OR], 6.3; P = .004) and infection with a T1M1 strain (OR, 6.7; P = .007). Case fatality was associated with age (OR, 14.5; P = .08), immunosuppression (OR, 4.7; P = .02), and STSS (OR, 21.5; P < .0001) but not with T1M1 infection. Hypotension was significantly associated with a fatal outcome, regardless of whether STSS developed (P < .0001).