Lessons learned from rapid environmental risk assessments for prioritization of alien species using expert panels.

Limiting the spread and impacts of invasive alien species (IAS) on biodiversity and ecosystems has become a goal of global, regional and national biodiversity policies. Evidence based management of IAS requires support by risk assessments, which are often based on expert judgment. We developed a tool to prioritize potentially new IAS based on their ecological risks, socio-economic impact and feasibility of management using multidisciplinary expert panels. Nine expert panels reviewed scientific studies, grey literature and expert knowledge for 152 species. The quality assessment of available knowledge revealed a lack of peer-reviewed data and high dependency on best professional judgments, especially for impacts on ecosystem services and feasibility of management. Expert consultation is crucial for conducting and validating rapid assessments of alien species. There is still a lack of attention for systematic and methodologically sound assessment of impacts on ecosystem services and weighting negative and positive effects of alien species.

Suppressive silver methods--a tool for identifying axotomy-induced neuron degeneration.

Suppressive silver methods evolved from empirical observations about 50 years ago that argyrophilia of normal nerve fibers can be suppressed by a short period of oxidation of tissue sections, whereas degenerating nerve fibers in the same preparations were still clearly visible. Based on this property, suppressive silver impregnation became the main technique for investigating pathways in the central nervous system until the early 1970s. Suppressive silver methods were also found to visualize degenerating nerve cell bodies, in addition to degenerating nerve fibers. This possibility has given these methods an important place among current tools for identifying neuronal degeneration in trauma, disease and toxicity. In this article we demonstrate and review the usefulness of suppressive silver methods in identifying neurons undergoing degeneration as a result of peripheral or central axon injury in immature animals. The documentation is based on previously published data from experiments in which silver impregnation was used to demonstrate degeneration of motoneurons following pure motor axon injury or mixed peripheral nerve injury, as well as on new results on degeneration-induced argyrophilia in the inferior olive following cerebellar lesions. We find that silver precipitates resulting from these injuries are localized either to the entire neuronal cytoplasm, to a few (typically two) intranuclear bodies, or to both sites. The findings are discussed in relation to morphological features of apoptosis, necrosis and retrograde neuronal responses. We suggest that suppressive silver methods allow visualization of different processes of neuronal degeneration, and therefore may be a useful adjunct for identifying axotomy-induced neuronal degeneration.

Reduced intraepidermal nerve fiber density in HIV-associated sensory neuropathy.

OBJECTIVE: To explore the relationship between intraepidermal nerve fiber (IENF) density in HIV-associated sensory neuropathy (HIV-SN) to measurements of neuropathy severity and progression of HIV disease. BACKGROUND: SN affects 30% of individuals with AIDS, and treatment is often ineffective. Recombinant human nerve growth factor (rhNGF) has been proposed as a trophic factor for unmyelinated nerve fibers injured in HIV-SN, and a clinical trial has recently concluded. Skin biopsy with IENF density determination has emerged as a diagnostic test for patients with small-fiber sensory neuropathy. METHODS: Sixty-two of the 270 patients with HIV-SN who participated in the trial of rhNGF were included in a substudy examining epidermal nerve fibers. IENF density was compared with neuropathic pain intensity (measured with the Gracely Pain Scale), patient and physician global pain assessments, quantitative sensory testing, CD4 counts, and plasma HIV RNA levels both at baseline and at conclusion of the placebo-controlled phase. RESULTS: IENF density was inversely correlated with neuropathic pain as measured by patient (p = 0.004) and physician (p = 0.05) global pain assessments, but not using the Gracely Pain Scale. Decreased IENF density at the distal leg was associated with lower CD4 counts and higher plasma HIV RNA levels. IENF density measurements were stable over time. CONCLUSIONS: IENF loss at the distal leg is associated with increased neuropathic pain, lower CD4 counts, and higher plasma viral load in HIV-SN. The robustness of the longitudinal measurement of IENF density supports its use in future longitudinal studies and clinical trials.

Long-term treatment with recombinant nerve growth factor for HIV-associated sensory neuropathy.

HIV-associated distal sensory polyneuropathy (DSP) is a common complication of AIDS. No effective treatment is available. The authors investigated the long-term effect (48 weeks) of the neurotrophin nerve growth factor (NGF) in an open-label study of 200 subjects with HIV-associated DSP. Similar to their previously reported double-blind study, the authors showed that NGF was safe and well tolerated and significantly improved pain symptoms. However, there was no improvement of neuropathy severity as assessed by neurologic examination, quantitative sensory testing, and epidermal nerve fiber density.

ECEM (eye closure eye movements): integrating aspects of EMDR with hypnosis for treatment of trauma.

The paper addresses distinctions between hypnotic interventions and Eye Movement Desensitizing and Reprocessing (EMDR) and discusses their effect on persons who have symptoms of Posttraumatic Stress Disorder (PTSD). Eye movements in hypnosis and EMDR are considered in terms of the different ways they may affect responses in treatment. A treatment intervention within hypnosis called ECEM (Eye Closure, Eye Movements) is described. ECEM can be used for patients with histories of trauma who did not benefit adequately from either interventions in hypnosis or the EMDR treatment protocol used separately. In ECEM the eye movement variable of EMDR is integrated within a hypnosis protocol to enhance benefits of hypnosis and reduce certain risks of EMDR.

A phase II trial of nerve growth factor for sensory neuropathy associated with HIV infection. AIDS Clinical Trials Group Team 291.

OBJECTIVE: To evaluate the safety and efficacy of recombinant human nerve growth factor (rhNGF) in HIV-associated sensory neuropathy (SN) within a multicenter, placebo-controlled, randomized trial (ACTG 291). BACKGROUND: SN affects 30% of individuals with AIDS, is worsened by neurotoxic antiretrovirals, and its treatment is often ineffective. NGF is trophic for small sensory neurons and stimulates the regeneration of damaged nerve fibers. METHODS: A total of 270 patients with HIV-associated SN were randomized to receive placebo, 0.1 microg/kg rhNGF, or 0.3 microg/kg rhNGF by double-blinded subcutaneous injection twice weekly for 18 weeks. The primary outcome was change in self-reported neuropathic pain intensity (Gracely Pain Scale). Secondary outcomes included an assessment of global improvement in neuropathy by patients and investigators, neurologic examination, use of prescription analgesics, and quantitative sensory testing. In a subset, epidermal nerve fiber densities were determined in punch skin biopsies. RESULTS: Both doses of NGF produced significant improvements in average and maximum daily pain compared with placebo. Positive treatment effects were also observed for global pain assessments (p = 0.001) and for pin sensitivity (p = 0.019). No treatment differences were found with respect to mood, analgesic use, or epidermal nerve fiber densities. Injection site pain was the most frequent adverse event, and resulted in unblinding in 39% of subjects. Severe transient myalgic pain occurred in eight patients, usually from accidental overdosing. There were no changes in HIV RNA levels or other laboratory indices. CONCLUSIONS: We found a positive effect of recombinant human nerve growth factor on neuropathic pain and pin sensitivity in HIV-associated sensory neuropathy. rhNGF was safe and well tolerated, but injection site pain was frequent.

Failure of cytarabine in progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection. AIDS Clinical Trials Group 243 Team.

BACKGROUND: Progressive multifocal leukoencephalopathy affects about 4 percent of patients with the acquired immunodeficiency syndrome (AIDS), and survival after the diagnosis of leukoencephalopathy averages only about three months. There have been anecdotal reports of improvement but no controlled trials of therapy with antiretroviral treatment plus intravenous or intrathecal cytarabine. METHODS: In this multicenter trial, 57 patients with human immunodeficiency virus (HIV) infection and biopsy-confirmed progressive multifocal leukoencephalopathy were randomly assigned to receive one of three treatments: antiretroviral therapy alone, antiretroviral therapy plus intravenous cytarabine, or antiretroviral therapy plus intrathecal cytarabine. After a lead-in period of 1 to 2 weeks, active treatment was given for 24 weeks. For most patients, antiretroviral therapy consisted of zidovudine plus either didanosine or stavudine. RESULTS: At the time of the last analysis, 14 patients in each treatment group had died, and there were no significant differences in survival among the three groups (P=0.85 by the log-rank test). The median survival times (11, 8, and 15 weeks, respectively) were similar to those in previous studies. Only seven patients completed the 24 weeks of treatment. Anemia and thrombocytopenia were more frequent in patients who received antiretroviral therapy in combination with intravenous cytarabine than in the other groups. CONCLUSIONS: Cytarabine administered either intravenously or intrathecally does not improve the prognosis of HIV-infected patients with progressive multifocal leukoencephalopathy who are treated with the antiretroviral agents we used, nor does high-dose antiretroviral therapy alone appear to improve survival over that reported in untreated patients.

Tissue oxygen during a critical developmental period controls the death and survival of photoreceptors.

PURPOSE: To study the death of photoreceptors in normally developing and dystrophic retina and to test the role of hypoxia in causing that death. METHODS: Death of photoreceptors was detected in the albino, hooded, and Royal College of Surgeons (RCS) strains of rat, and in the rabbit and cat, using the TUNEL technique. Retinas of selected ages from animals raised normally and those from rat pups raised for periods in hyperoxia (75% oxygen) or hypoxia (10% oxygen) were studied. RESULTS: In all species and strains examined, a naturally occurring wave of photoreceptor death was detected during the last stages of retinal development. In the albino rat, this wave, which began approximately at postnatal day 15 (P15) and peaked at P22, was reduced by hyperoxia and was intensified by hypoxia, producing a "hypoxic dystrophy" of photoreceptors. In the RCS rat, photoreceptor death also commenced at approximately P15 and then proceeded to exhaustion. This degeneration was greatly reduced by hyperoxia. In the RCS rat, hyperoxia was effective in photoreceptor rescue only during a discrete period, from P16 to P22. In the albino rat, the effectiveness of hypoxia in inducing photoreceptor death was much greater between P15 and P21 than at earlier ages, or in the adult. CONCLUSIONS: During a critical period extending approximately from P15 to P22, tissue oxygen levels strongly influence photoreceptor death and survival in dystrophic and normally developing strains of rat. This period is evident in normal development as a period of naturally occurring photoreceptor death and is evident experimentally as a period during which hyperoxia is effective in rescuing dying photoreceptors and during which hypoxia is effective in inducing death of otherwise viable photoreceptors.

Fate of DNA from retinal cells dying during development: uptake by microglia and macroglia (Müller cells).

The tunel technique of labelling fragmenting dna was used to examine cell death in the developing retina of the rabbit, rat and cat. TUNEL-labelled structures included the still-intact nuclei of retinal cells and smaller, strongly labelled bodies interpreted as fragments of disintegrating nuclei (apoptotic or pyknotic bodies). With confocal microscopy, the cytoplasm around labelled nuclei was observed to be labelled, suggesting that DNA fragments spread into the cytoplasm of the dying cell. Also observed were cells whose nuclei were TUNEL-but whose cytoplasm was TUNEL+, so that their morphology could be discerned. Evidence is presented that these are phagocytes, their cytoplasmic labelling resulting from the ingestion of the fragmenting DNA of a dying neighbour. Results suggest that in developing retina fragmenting DNA is phagocytosed principally by microglia and Müller cells, with a few neurones and no astrocytes active as phagocytes. In the postnatal material studied, microglia are the predominant phagocytes for cells dying in the ganglion cell and inner nuclear layers. Müller cells appear able to phagocytose cells dying in any retinal layer and, since microglia do not normally enter the outer nuclear layer, may be important for the phagocytosis of dying photoreceptors.

Pericardial effusion in AIDS. Incidence and survival.

BACKGROUND: Although pericardial effusion is known to be common among patients infected with HIV, the incidence of pericardial effusion and its relation to survival have never been described. METHODS AND RESULTS: To evaluate the incidence of pericardial effusion and its relation to mortality in HIV-positive subjects, 601 echocardiograms were performed on 231 subjects recruited over a 5-year period (inception cohort: 59 subjects with asymptomatic HIV, 62 subjects with AIDS-related complex, and 74 subjects with AIDS; 21 HIV-negative healthy gay men; and 15 subjects with non-HIV end-stage medical illness). Echocardiograms were performed every 3 to 6 months (82% had follow-up studies). Sixteen subjects were diagnosed with effusions (prevalence of effusion for AIDS subjects entering the study was 5%). Thirteen subjects developed effusions during follow-up; 12 of these were subjects with AIDS (incidence, 11%/y). The majority of effusions (80%) were small and asymptomatic. The survival of AIDS subjects with effusions was significantly shorter (36% at 6 months) than survival for AIDS subjects without effusions (93% at 6 months). This shortened survival remained significant (relative risk, 2.2, P = .01) after adjustment for lead time bias and was independent of CD4 count and albumin level. CONCLUSIONS: There is a high incidence of pericardial effusion in patients with AIDS, and the presence of an effusion is associated with shortened survival. The development of an effusion in the setting of HIV infection suggests end-stage HIV disease (AIDS).

Assessment of structurally related chemicals: toxicity and ecotoxicity of acrylic acid and acrylic acid alkyl esters (acrylates), methacrylic acid and methacrylic acid alkyl esters (methacrylates).

BUA compiled the available data on toxicity and ecotoxicity for several acrylic and methacrylic acid esters and their corresponding acids. A comparison of these data revealed a qualitative similarity in the toxicological and ecotoxicological properties of the compounds considered. The data indicate that methacrylates are less reactive than the corresponding acrylates.

The glial ensheathment of the soma and axon hillock of retinal ganglion cells.

We have studied the glial investment of ganglion cells of the cat's retina, orienting the sections taken for electron microscopy so that the investment could be traced from the soma along the axon. The soma of each ganglion cell is covered by a close-fitting, continuous sheath formed by Müller cells. The axon hillock and the first part of the initial segment are invested by an extension of the somal sheath, and are thus enclosed in the same glial compartment as the soma. The initial segment extends a few microns past the Müller cell sheath; this last length of the initial segment is contacted by numerous processes of astrocytes, which converge on it in a pattern found also on nodes of the same axons, in the optic nerve. Beyond the initial segment, the intraretinal lengths of the axons are invested by both Müller cells and astrocytes, but the investment is strikingly incomplete. Large areas of axonal membrane have no glial cover, and lie close to other axonal membranes. The sequential arrangement of these distinct forms of glial wrapping of the soma, initial segment, and axon is described here for the first time. It is suggested that this pattern of glial investment controls the flow of current between dendrite and initial segment of the ganglion cell, defines the site of initiation of action spikes, and controls the formation of synapses on the soma and initial segment.

JC virus DNA in cerebrospinal fluid of human immunodeficiency virus-infected patients: predictive value for progressive multifocal leukoencephalopathy.

Progressive multifocal leukoencephalopathy (PML) is a lytic infection of oligodendrocytes by the human papovavirus JC. Patients with defects in cell-mediated immunity are at risk for active disease: a usually lethal demyelination of the brain. PML develops in at least 4% of patients with the acquired immunodeficiency syndrome (AIDS). Definitive diagnosis currently requires brain biopsy. Previous attempts to detect JC virus DNA by polymerase chain reaction in cerebrospinal fluid of PML patients, particularly those with human immunodeficiency virus type 1 (HIV-1) infection, have been of low sensitivity. In the present study, cerebrospinal fluid was assayed by polymerase chain reaction from 26 HIV-1-positive patients with PML, 114 HIV-1-positive control subjects, and 16 control subjects who were HIV-1 negative or were without risk factors for HIV disease. Polymerase chain reaction conditions were optimized to detect a single copy of viral DNA in 50 microliters of cerebrospinal fluid. Specificity of the polymerase chain reaction product was confirmed by size on gel electrophoresis and Southern blot hybridization. JC virus DNA was detected in 24 of 26 samples from patients with PML: 8 of 8 with tissue diagnosis and 16 of 18 with strong clinical and magnetic resonance imaging evidence of PML. Among control subjects, 11 of 130 samples were positive for JC virus: 10 of 114 samples from HIV-infected patients and one from an HIV-negative patient with risk factors for PML and an unexplained hemiparesis. Overall sensitivity was 92% (24/26); specificity was, at minimum, 92% (119/130). Treatments for PML are now in clinical trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence of constriction of optic nerve axons at the lamina cribrosa in the normotensive eye in humans and other mammals.

The ultrastructure of optic nerve axons was examined in several mammals (human, cat, rat, sheep, ox, pig, guinea pig, rabbit). Human material was obtained from normotensive, glaucoma-free eyes and from eyes with a history of glaucoma and raised intra-ocular pressure (IOP). We describe accumulations of organelles (principally mitochondria) in optic nerve axons where they traverse the lamina cribrosa. Accumulations were most prominent in unmyelinated lengths of axons close to lamellae of the lamina cribrosa. Comparable accumulations were not apparent in axons in the retina or optic nerve, suggesting that axoplasmic flow is constricted at the lamina cribrosa. Accumulations were observed both centrally and peripherally to the lamellae, suggesting that flow is constricted in both ortho- and anterograde directions. Accumulations of organelles were more marked in unmyelinated axons than in adjacent, myelinated axons. In the rabbit, in which most axons are myelinated as they traverse the optic nerve head, organelle accumulations were observed only in a sparse population of unmyelinated axons. In human eyes with a history of raised IOP and glaucoma, the accumulations were abnormally large and frequent and in many axons showed dense-body and fibrillar changes not seen in normotensive eyes. It is suggested that chronic, partial constriction of axoplasmic flow is present at the lamina cribrosa of normotensive eyes in a wide range of mammals, including humans, that the constriction results from the pressure gradient across the lamina cribrosa and that the constriction may be a factor in the many cases of primary glaucoma in which IOP is not raised.

Hepatitis C in HIV-infected patients with and without AIDS: prevalence and relationship to patient survival.

BACKGROUND: Limited information is available about the prevalence of hepatitis C virus in patients with human immunodeficiency virus in relation to specific risk factors or about the influence of hepatitis C virus coinfection on survival. This retrospective study addressed these questions. METHODS: The study population consisted of 512 predominantly non-intravenous drug-using male homosexuals, 224 of whom had AIDS. Samples positive for hepatitis C virus antibody by second-generation enzyme immunoassay were further tested by means of strip immunoblot assay, and for hepatitis C virus RNA by means of polymerase chain reaction amplification. A randomly selected set of enzyme immunoassay-negative samples was also tested for hepatitis C virus RNA and, if hepatitis C virus RNA positive, by a second-generation recombinant immunoblot assay. RESULTS: The prevalence of hepatitis C virus infection unaccounted for by intravenous drug use or transfusion was 11.7% by enzyme immunoassay, and 87% of sera positive by enzyme immunoassay were also positive by second-generation recombinant immunoblot assay or hepatitis C virus RNA analysis. Hepatitis C virus RNA was detectable in 53% of enzyme immunoassay-positive samples but in only about 1% of enzyme immunoassay-negative samples. Hepatitis C virus coinfection did not influence survival of HIV-infected patients with or without manifestations of AIDS. CONCLUSIONS: Hepatitis C virus infection in nontransfused, non-intravenous drug-using patients with HIV infection is several times more prevalent than in volunteer blood donors, suggesting homosexual transmission of hepatitis C virus. About half of patients seropositive for hepatitis C virus antibody have detectable hepatitis C virus RNA, and serologically occult hepatitis C virus viremia is rare. Hepatitis C virus coinfection does not appear to adversely influence survival.

Effect of zidovudine therapy on CD8+ T cell anti-HIV activity.

CD8+ T cell suppression of HIV replication in vitro was evaluated over 1-2 years in 12 HIV-infected individuals receiving daily dosages of Zidovudine (AZT) and in 9 untreated subjects. In the 12 AZT-treated patients, the level of CD8+ cell antiviral activity increased an average of 6.6-fold above pretreatment levels. These increases in antiviral activity observed were only transient in 6 of the subjects, returning to pretreatment levels, or lower, over the study period. In the other 4 subjects, the CD8+ cell antiviral response remained elevated at the end of the study period. The changes in CD8+ cell responses did not correlate with observed alterations in the absolute number or the percentage of CD4+ or CD8+ peripheral blood lymphocytes. Untreated HIV-infected subjects generally showed a gradual decrease in the CD8+ cell response over time to as much as 16-fold below baseline and in contrast to the treated group, these changes correlated with similar changes in CD4+ cell counts (P = 0.02). The average level of CD8+ cell antiviral activity observed over the entire study period was more than 2-fold above baseline in the 12 AZT-treated subjects, whereas it was more than 3-fold below baseline in the untreated subjects (P = 0.0001). Culturing CD8+ cells in the continued presence of AZT (1 microM) showed no effect on the ability of the cells to inhibit replication of an AZT-resistant HIV-1 strain. The results suggest that AZT therapy can have a beneficial effect, albeit often of limited duration, on CD8+ T cell function in HIV-infected individuals.

Diagnostic lumbar puncture in HIV-infected patients: analysis of 138 cases.

PURPOSE: This study was designed to describe the cerebrospinal fluid (CSF) findings and neurologic diagnoses observed in human immunodeficiency virus (HIV)-infected adults undergoing diagnostic lumbar puncture (LP) and to correlate the results of LP with indications and CD4 counts. DESIGN: Retrospective cross-sectional chart review study. SETTING: University hospital clinic for patients with HIV infection. PATIENTS: All patients of the University of California, San Francisco (UCSF) AIDS Clinic who underwent LP between mid-1987 and mid-1990 for headache, fever, altered mental status, or a combination of these indications. Sixty-seven percent had an AIDS diagnosis at the time of LP; the median CD4 count was 0.091 x 10(9)/L. RESULTS: A total of 138 LPs was analyzed. Elevation of CSF protein and leukocytes occurred in 33% and 27% of specimens, respectively. Seventy-two new neurologic diagnoses were established in 67 patients, but only 30 diagnoses were the result of CSF analysis. Of these 30 diagnoses, 18 were of aseptic meningitis attributed to HIV. None of the 12 treatable diagnoses established by LP occurred in patients known to have a CD4 count of 0.200 x 10(9)/L or greater. Patients undergoing LP because of headache had a lower incidence of new diagnoses than those with altered mental status (35% versus 72%), but LP revealed a higher proportion of diagnoses in the group with headache. CONCLUSIONS: CSF abnormalities were common at all stages of disease. LP was diagnostic in 22% of cases, but fewer than half of the diagnoses were of treatable secondary complications. Patients with a CD4 count higher than 0.200 x 10(9) have a very low incidence of opportunistic complications. The relatively low yield of LP in patients with altered mental status suggests that other testing modalities should be used prior to LP.