A multimodal assessment of driving performance in HIV infection

OBJECTIVE

To examine if HIV-seropositive (HIV+) individuals are at risk for impaired driving.

METHODS

Sixty licensed drivers (40 HIV+, 20 HIV-) completed a neuropsychological (NP) test battery and driving assessments. Eleven HIV+ subjects were NP-impaired. Driving-related skills were assessed using 1) two driving simulations (examining accident avoidance and navigational abilities), 2) the Useful Field of View (UFOV) test, and 3) an on-road evaluation.

RESULTS

HIV+ NP-impaired subjects had greater difficulty than cognitively intact subjects on all driving measures, whereas the HIV- and HIV+ NP-normal groups performed similarly. On the UFOV, the HIV+ NP-impaired group had worse performance on Visual Processing and Divided Attention tasks but not in overall risk classification. They also had a higher number of simulator accidents (1.3 vs 2.0; p = 0.03), were less efficient at completing the navigation task (3.2 vs 9.2 blocks; p = 0.001), and were more likely to fail the on-road evaluation (6 vs 36%; p = 0.02). Impairment in Executive Functioning was the strongest NP predictor of failing the on-road drive test. NP performance and both simulations independently contributed to a model predicting 48% of the variance in on-road performance.

CONCLUSION

HIV+ NP-impaired individuals are at increased risk for on-road driving impairments, whereas HIV+ individuals with normal cognition are not at a significantly higher risk than HIV- subjects. Executive Functioning is most strongly associated with impaired on-road performance. Cognitive and simulator testing may each provide data in identifying driving-impaired individuals.

Nutrient minimisation in the pulp and paper industry: an overview

This paper reviews nutrient issues within the pulp and paper industry summarising: nitrogen and phosphorus cycles within treatment systems; sources of nutrients within pulping and papermaking processes; minimising nutrient discharge; new approaches to nutrient minimisation; and the impact of nutrients in the environment. Pulp and paper industry wastewaters generally contain insufficient nitrogen and phosphorus to satisfy bacterial growth requirements. Nutrient limitation has been linked to operational problems such as sludge bulking and poor solids separation. Nutrients have been added in conventional wastewater treatment processes to ensure optimum treatment performance. Minimising the discharge of total nitrogen and phosphorus from a nutrient limited wastewater requires both optimised nutrient supplementation and effective removal of suspended solids from the treated wastewater. In an efficiently operated wastewater treatment system, the majority of the discharged nutrients are contained within the biomass. Effective solids separation then becomes the controlling step, and optimisation of secondary clarification is crucial. Conventional practice is being challenged by the regulatory requirement to reduce nitrogen and phosphorus discharge. Two recent developments in pulp and paper wastewater treatment technologies can produce discharges low in nitrogen and phosphorus whilst operating under conventionally nutrient limited conditions: i) the nutrient limited BAS process (Biofilm-Activated Sludge) which combines biofilm and activated sludge technologies under nutrient limited conditions and ii) an activated sludge process based on the use of nitrogen-fixing bacteria. Aerated stabilisation basins often operate without nutrient addition, relying on settled biomass in the benthal zone feeding back soluble nutrients, or the fixation of atmospheric nitrogen. Thus effective nutrient minimisation strategies require a more detailed understanding of nutrient cycling and utilisation. Where it is not possible to meet discharge constraints with biological treatment alone, a tertiary treatment step may be required. In setting nutrient control guidelines, consideration should be given to the nutrient limitations of the receiving environment, including other cumulative nutrient impacts on that environment. Whether an ecosystem is N or P limited should be integrated with wastewater treatment considerations in the further design and development of treatment technology and regulatory guidelines. End-of-pipe legislation alone cannot predict environmental effects related to nutrients and must be supplemented by an effects-based approach.

A Methylobacterium-like organism from algal crusts covering silicone rubber electric insulators in Africa

AIMS

The primary goals of this study were to isolate, identify and characterize culturable bacteria living in a close association with microalgae within green crusts covering silicone rubber electric insulators in Tanzania.

METHODS AND RESULTS

Twenty-four bacterial colonies were isolated from an Apatococcus crust. Characterization by statistical analyses of total cellular protein profiles demonstrated that they were highly similar to one another. Final identification was achieved using 16S rDNA sequencing and fatty acid methyl ester profiling. These analyses revealed the presence of microbes with high similarity to Methylobacterium radiotolerans. The selected isolate, A1, displayed strong inhibitory activity against Rhizoctonia solani and was found to be resistant to relatively high concentrations of zinc in the growth medium.

CONCLUSIONS

This study revealed the presence of M. radiotolerans bacteria in a novel environment--within algal crusts formed on electrical insulators in Africa. Moreover, this bacterium was found to be a predominant culturable species within those complex algal-microbial associations. The isolate also shared some traits of biotechnological importance with other members of the Methylobacterium genus.

SIGNIFICANCE AND IMPACT OF THE STUDY

The data presented provide a valuable contribution concerning the formation and function of associations between green microalgae and bacteria. This study also provides some information about the utility of bacteria from the genus Methylobacterium in biotechnological applications, such as biocontrol of rhizoctoniosis and bioremediation of heavy metal-contaminated soils.

Promiscuous binding of proinsulin peptides to Type 1 diabetes-permissive and -protective HLA class II molecules

AIMS/HYPOTHESIS

Presentation of peptide epitopes derived from beta-cell autoantigens, such as insulin and its precursor molecules, by MHC class II molecules to autoreactive T-cells is believed to play a role in the development of Type 1 diabetes. However, little is known about the interaction between peptides of (prepro)insulin and MHC class II molecules permissive and protective for Type 1 diabetes. In this study therefore, peptides spanning the human preproinsulin sequence were assessed for their binding characteristics to Type 1 diabetes-protective and -permissive HLA molecules.

METHODS

HLA-DR2, -DQ6.2 (Type 1 diabetes-protective) and HLA-DR4, -DQ8 (Type 1 diabetes permissive) molecule binding affinity for overlapping synthetic 20mer peptides spanning human preproinsulin was measured in a direct competition binding assay against a biotinylated indicator peptide.

RESULTS

All HLA molecules tested showed similarity in their binding characteristics across the preproinsulin molecule, with regions of the insulin A-chain showing the highest affinity and C-peptide regions the lowest affinity for all HLA molecules tested. Furthermore, an insulin peptide implicated as a major CD4+ T-cell target in disease pathogenesis (B9-23) had high affinity binding to both protective and permissive HLA molecules but did not represent the highest affinity region of (prepro)insulin identified in either case.

CONCLUSION/INTERPRETATION

The results suggest that peptide binding affinity alone is unlikely to be the major determinant of disease susceptibility in relation to interactions between (prepro)insulin epitopes and HLA molecules. The identification of epitopes derived from beta-cell autoantigens that bind promiscuously to diabetes-permissive HLA molecules could be important in the design of peptide-based immunotherapeutic strategies for the prevention of Type 1 diabetes.

A randomized clinical trial of CPI-1189 for HIV-associated cognitive-motor impairment

BACKGROUND

CPI-1189 is a compound with antioxidant properties that blocks tumor necrosis factor-alpha (TNFalpha) effects in animal models. It has neuroprotective properties in model systems for HIV-associated neurotoxicity and thus is a candidate for neuroprotective therapy in humans with HIV-associated CNS disease.

OBJECTIVE

To assess the tolerability and safety of CPI-1189 in treating HIV-associated cognitive-motor impairment.

METHODS

Sixty-four subjects with mild to moderate HIV-associated cognitive-motor impairment were randomized to receive either placebo or 50 or 100 mg daily of CPI-1189 in addition to optimal HIV therapy. Subjects were followed prospectively in a double-masked study for 10 weeks. The primary assessment was tolerability and safety of the compound. Secondary objectives examined neuropsychological and functional change associated with this treatment.

RESULTS

The study compound was well tolerated, with 91% of CPI-1189-treated subjects and 76% of placebo-treated subjects completing the trial. Skin rash was seen equally in placebo and active arms, but the only study withdrawals due to skin rash occurred in CPI-1189-treated subjects (n = 2). One subject developed a cataract on drug (100 mg/day). CD4 lymphocyte counts and plasma HIV viral load remained stable in all groups throughout the trial. No significant treatment effects were observed on the change in composite Z-scores for eight neuropsychologic measures (NPZ-8). The Grooved Pegboard Test (nondominant) showed improved performance with CPI-1189 at 100 mg/day (p = 0.01), but no other neuropsychometric or functional measures demonstrated significant improvement.

CONCLUSIONS

CPI-1189 was well tolerated in HIV subjects with cognitive-motor disorder. This study was not powered to conclusively determine efficacy and showed no consistent treatment-associated improvement in cognitive or functional measures.

Neurocognitive dysfunction predicts postmortem findings of HIV encephalitis

OBJECTIVE

To investigate the value of antemortem cognitive functioning in predicting postmortem evidence of HIV encephalitis (HIVE).

METHODS

Thirty-nine subjects were assessed during life with a comprehensive neuropsychological battery and went on to autopsy within 18 months of testing. Cognitive impairment was determined by blind clinical ratings, based on demographically corrected test scores. Presence of HIVE was based on postmortem immunocytochemical detection of the viral protein gp41 or by measurement of HIV RNA by PCR in multiple brain areas as well as by histopathologic evidence such as microgliosis, presence of multinucleated giant cells, and myelin pallor in several brain regions.

RESULTS

The sensitivity and specificity of neurocognitive impairment in detecting the occurrence of HIVE were 67 and 92%. Eighteen of 19 subjects with antemortem neurocognitive impairment had evidence of HIV-related brain disease (positive predictive value = 95%).

CONCLUSION

Neuropsychological assessment can help select HIV-positive patients for treatment of CNS disease.

A retrospective analysis of long-term survival in severe aplastic anemia patients treated with allogeneic bone marrow transplantation or immunosuppressive therapy with antithymocyte globulin and cyclosporin A at a single institution

Severe aplastic anemia can be treated with either bone marrow transplantation (BMT) or immunosuppressive therapy (IST). A retrospective review of patients with severe aplastic anemia treated with both of these modalities was conducted. Fifteen BMT and 16 IST patients were available for analysis, and follow-up of 22 and 15 years was available for the BMT and IST groups, respectively. Median survival was limited to 4.3 months in BMT patients vs. 135.2 months in IST patients, despite the older median age of the latter (22 vs. 55 years). Actuarial survival at 1 and 5 years was 87% and 78% for the IST patients and 40% and 33% for the BMT patients. Hematologic response rates, as defined by achievement of transfusion independence, were similar for the two groups. Long-term responses and survival are possible with antithymocyte globulin/cyclosporin A.

Exposure of reproductively maturing rainbow trout to a New Zealand pulp and paper mill effluent

Long-term studies on the reproductive fitness of fish under controlled exposure conditions are necessary to address some of the controversy surrounding the field-based studies of pulp and paper effluent effects. This study undertook effluent exposures of 2+ age rainbow trout that were approximately halfway through gonadal growth. Trout were exposed to a mixed thermomechanical/bleached kraft effluent in 12,000-L flow-through exposure tanks at an environmental research facility located at a pulp and paper mill in Kawerau, New Zealand. Trout were exposed to either upstream river water or 10% effluent in upstream river water and were maintained at a ration of 0.7% of body wet weight during the experiment. Results of the 2-month study indicated that trout survival was not significantly different between effluent-exposed tanks and reference tanks. There was extensive growth during the exposure but no differences were found due to effluent exposure. Gonadal development was not significantly different between treatments. Steroid hormone concentrations in males and females were not affected by effluent exposure. The effluent showed no potential to be estrogenic as indicated by a lack of vitellogenin induction in male trout. Other physiological indicators of energy storage and utilization also showed no significant differences. Modest induction of hepatic 7-ethoxyresorufin-O-deethylase (2.5-fold) was the only detectable biological effect of the exposure. Biliary concentration of effluent-related compounds were typical of pulp mill effluent exposure and further suggested that the source of phytosterols was in fact dietary and not effluent-derived.

Factors associated with success of the extreme drug resistance assay in primary breast cancer specimens

The extreme drug resistance (EDR) assay has not been widely studied in the setting of non-metastatic breast cancer. We evaluated the feasibility of performing the assay in 144 primary breast tumor specimens from two institutions by determining the rate of successful tumor culture for assays, number of drugs evaluated per assay, and time from tumor biopsy to receipt of results. We also sought to determine factors that are associated with assay success. An exploratory analysis was performed to detect possible associations between estrogen receptor (ER), progesterone receptor (PR) and HER2/NEU over-expression and extreme drug resistance demonstrated by the assay for specific chemotherapeutic agents. Of 144 tumor specimens submitted, tumor was successfully cultured for assay in 101(70%) of cases. A median of five drugs was evaluated per assay (range 2-9). Results were obtained in a median of 8 days (range 2-29). Young age, high tumor grade, PR negativity, and higher tumor submission weight were predictive for a successful assay. EDR was observed in 7-15% of tumors to doxorubicin, cyclophosphamide, 5-fluorouracil (5FU) and mitoxantrone, but EDR to paclitaxel was observed in 35%. Extreme drug resistance to 5-FU was associated with negative ER and PR status. There was a trend toward association between EDR to paclitaxel and HER2/NEU over-expression. The EDR assay may be successfully performed in the majority of tumors, and assay results are available in a timely fashion such that adjuvant treatment drug selection could be guided by results. These results may be helpful for designing possible future trials that evaluate the assay's role in adjuvant chemotherapy selection.

Molecular chaperones: inside and outside the Anfinsen cage

The GroEL/GroES chaperonin system acts as a passive anti-aggregation cage for refolding rubisco and rhodanese, and not as an active unfolding device. Refolding aconitase is too large to enter the cage but reversible binding to GroEL reduces its aggregration. Unexpectedly, confinement in the cage increases the rate of refolding of rubisco, but not rhodanese.

Mobile linear accelerators for intraoperative radiation therapy

Intraoperative radiation therapy (IORT) is becoming an increasingly common procedure for treating gross tumors or tumor beds after resection. Traditionally, IORT delivery required either heavily shielded ORs or transporting anesthetized patients to the department of radiation oncology. The availability of a self-shielded mobile electron linear accelerator has made this treatment modality accessible to institutions that otherwise would not consider performing IORT. This article describes IORT equipment and supplies and addresses perioperative nursing issues, as well as the roles of other team members involved in the delivery of IORT.

A new approach to intraoperative radiation therapy

Intraoperative radiation therapy (IORT) is an adjuvant treatment in which a large single dose of radiation is delivered during a surgical procedure to resected tumor beds or to an unresectable tumor. This article discusses the implementation of an IORT program and highlights the successful collaboration needed between the OR and radiation oncology departments. A better understanding of IORT in the OR setting will contribute to smooth program implementation.

Macromolecular crowding: obvious but underappreciated

Biological macromolecules evolve and function within intracellular environments that are crowded with other macromolecules. Crowding results in surprisingly large quantitative effects on both the rates and the equilibria of interactions involving macromolecules, but such interactions are commonly studied outside the cell in uncrowded buffers. The addition of high concentrations of natural and synthetic macromolecules to such buffers enables crowding to be mimicked in vitro, and should be encouraged as a routine variable to study. The stimulation of protein aggregation by crowding might account for the existence of molecular chaperones that combat this effect. Positive results of crowding include enhancing the collapse of polypeptide chains into functional proteins, the assembly of oligomeric structures and the efficiency of action of some molecular chaperones and metabolic pathways.

Opioid blockade improves human recognition memory following physiological arousal

RATIONALE

States of heightened emotion and arousal, such as those that may occur during crimes or traumatic accidents, can impair human memory. Animal models suggest that such memory alterations may be mediated by opioid neuropeptides. In some experimental paradigms, opioid blockade reverses memory impairments related to arousal.

OBJECTIVES

The present study evaluated the hypothesis that, under conditions of heightened arousal, opioid blockade would enhance memory in human subjects.

METHODS

Memory for story information was evaluated among subjects randomized to one of four study groups (two orthogonal study conditions): (1) no arousal+no opioid blockade, (2) no arousal+opioid blockade, (3) arousal+no opioid blockade, and (4) arousal+opioid blockade. Both free recall and recognition memory were assessed. Opioid receptor blockade was achieved using a single oral dose of naltrexone.

RESULTS

With heightened arousal, subjects receiving naltrexone performed better than those receiving placebo on tests of total and incidental recognition memory. In contrast, with emotionally neutral stimuli, naltrexone subjects performed worse than placebo subjects.

CONCLUSIONS

These findings demonstrate that opioid peptides mediate alterations in specific aspects of human memory during heightened emotional states, and help to explain why memories may be selectively deficient under conditions of stress.

Comparison of microbial and meiofaunal community analyses for determining impact of heavy metal contamination

The impact of long-term heavy metal contamination on soil communities was assessed by a number of methods. These included plate counts of culturable bacteria, community level physiological profiling (CLPP) by analysis of the utilization of multiple carbon sources in BIOLOG plates, community fatty acid methyl ester (C-FAME) profiling and dehydrogenase enzyme activity measurements. These approaches were complemented with microscopic assessments of the diversity of the nematode community. Samples from two sites with different histories of heavy-metal input were assessed. Major differences in microbial and meiofaunal parameters were observed both between and within the sites. There was a large degree of congruence between each of the microbiological approaches. In particular, one sample appeared to be distinguished by a reduction in culturable bacteria (especially pseudomonads), limited response to carbon sources in CLPP, and major differences in extracted fatty acid profiles. The use of multivariate analysis to examine the relationship between microbial and physicochemical measurements revealed that CLPP and plate counts were useful for determining the gross effect of metals on soil microbial communities, whereas proportions of metal-resistant bacteria and dehydrogenase activity differentiated between the two sites. Copper and zinc concentrations and pH all showed significant correlation with the microbial parameters. Nematode community structure was affected to a greater extent by soil pH than by metal content, but the within-site rankings were the same as those achieved for microbiological analyses. The use of these methods for field evaluation of the impact of industrial pollution may be possible provided care is taken when interpreting the data.

Elevated cerebrospinal fluid quinolinic acid levels are associated with region-specific cerebral volume loss in HIV infection

Neuronal injury, dendritic loss and brain atrophy are frequent complications of infection with human immunodeficiency virus (HIV) type 1. Activated brain macrophages and microglia can release quinolinic acid, a neurotoxin and NMDA (N-methyl-D-aspartate) receptor agonist, which we hypothesize contributes to neuronal injury and cerebral volume loss. In the present cross-sectional study of 94 HIV-1-infected patients, elevated CSF quinolinic acid concentrations correlated with worsening brain atrophy, quantified by MRI, in regions vulnerable to excitotoxic injury (the striatum and limbic cortex) but not in regions relatively resistant to excitotoxicity (the non-limbic cortex, thalamus and white matter). Increased CSF quinolinic acid concentrations also correlated with higher CSF HIV-1 RNA levels. In support of the specificity of these associations, blood levels of quinolinic acid were unrelated to striatal and limbic volumes, and CSF levels of beta(2)-microglobulin, a non-specific and non-excitotoxic marker of immune activation, were unrelated to regional brain volume loss. These results are consistent with the hypothesis that quinolinic acid accumulation in brain tissue contributes to atrophy in vulnerable brain regions in HIV infection and that virus replication is a significant driver of local quinolinic acid biosynthesis.

Radioimmunoguided imaging of prostate cancer foci with histopathological correlation

PURPOSE

We have previously presented a technique that fuses ProstaScint and pelvic CT images for the purpose of designing brachytherapy that targets areas at high risk for treatment failure. We now correlate areas of increased intensity seen on ProstaScint-CT fusion images to biopsy results in a series of 7 patients to evaluate the accuracy of this technique in localizing intraprostatic disease.

METHODS AND MATERIALS

The 7 patients included in this study were evaluated between June 1998 and March 29, 1999 at Metrohealth Medical Center and University Hospitals of Cleveland in Cleveland, Ohio. ProstaScint and CT scans of each patient were obtained before transperineal biopsy and seed implantation. Each patient's prostate gland was biopsied at 12 separate sites determined independently of Prostascint-CT scan results.

RESULTS

When correlated with biopsy results, our method yielded an overall accuracy of 80%: with a sensitivity of 79%, a specificity of 80%, a positive predictive value of 68%, and a negative predictive value of 88%.

CONCLUSION

The image fusion of the pelvic CT scan and ProstaScint scan helped identify foci of adenocarcinoma within the prostate that correlated well with biopsy results. These data may be useful to escalate doses in regions containing tumor by either high-dose rate or low-dose rate brachytherapy, as well as by external beam techniques such as intensity modulated radiotherapy (IMRT).

Macromolecular crowding: an important but neglected aspect of the intracellular environment

Biological macromolecules have evolved over billions of years to function inside cells, so it is not surprising that researchers studying the properties of such molecules, either in extracts or in purified form, take care to control factors that reflect the intracellular environment, such as pH, ionic strength and composition, redox potential and the concentrations of relevant metabolites and effector molecules. There is one universal aspect of the cellular interior, however, that is largely neglected--the fact that it is highly crowded with macromolecules. It is proposed that the addition of crowding agents should become as routine as controlling pH and ionic strength if we are to meet the objective of studying biological molecules under more physiologically relevant conditions.

Chromosomal insertion of phenazine-1-carboxylic acid biosynthetic pathway enhances efficacy of damping-off disease control by Pseudomonas fluorescens

A disarmed Tn5 vector (pUT::Ptac-phzABCDEFG) was used to introduce a single copy of the genes responsible for phenazine-1-carboxylic acid (PCA) biosynthesis into the chromosome of a plant-growth-promoting rhizobacterium Pseudomonas fluorescens. The PCA gene cluster was modified for expression under a constitutive Ptac promoter and lacked the phzIR regulators. PCA-producing variants significantly improved the ability of the wild-type P. fluorescens to reduce damping-off disease of pea seedlings caused by Pythium ultimum, even under conditions of heavy soil infestation. Under conditions of oxygen limitation that are typical of the rhizosphere, PCA production per cell in vitro was greater than that recorded in fast-growing, nutrient-rich cultures. Similarly, when the in vitro nutrient supply was limited, P fluorescens::phz variants that produced the most PCA effectively competed against P. ultimum by suppressing mycelial development. Soil-based bioassays confirmed that the level of PCA biosynthesis correlated directly with the efficacy of biological control and the persistence of inocula in soil microcosms. They also showed that soil pretreatment with bacteria provides a suitable method for plant protection by reducing infection, effectively decontaminating the soil. These data demonstrate that the insertion of a single chromosomal copy of the genes for a novel antifungal compound, PCA, enhances the ecological fitness of a natural isolate already adapted to the rhizosphere and capable of suppressing fungal disease.

Alternative techniques of intraoperative radiotherapy

AIMS

The article reviews current techniques for the delivery of intraoperative radiotherapy (IORT).

METHODS

Various techniques have been developed to allow for IORT to be given as an adjuvant to surgical resection in the operating room during surgery. This article reviews these different techniques including: dedicated IORT units, intraoperative high dose rate brachytherapy and mobile IORT units such as the Mobetron.

RESULTS

IORT may be safely delivered by various methods during operation. Mobile linear accelerators, such as the Mobetron, may allow wider applications of IORT. Preliminary results of IORT at various institutions show promising results.

CONCLUSIONS

Widespread applications for IORT are feasible due to improvements in the technology. Future studies should define the proper role for IORT at various disease sites.