Search

Summary Background The transplantation of cells, tissues, and organs has been recognised by WHO as an important medical task for its member states; however, information about how to best organise transplantation is scarce. We aimed to document the activity worldwide from the beginning of transplantation and search for region adapted indications and associations between transplant rates and macroeconomics. Methods Between Jan 1, 2006, and Dec 31, 2014, the Worldwide Network for Blood and Marrow Transplantation collected data for the evolution of haemopoietic stem-cell transplantation (HSCT) activity and volunteer donors in the 194 WHO member states. Findings 953 651 HSCTs (553 350 [58%] autologous and 400 301 [42%] allogeneic) were reported by 1516 transplant centres from 75 countries. No transplants were done in countries with fewer than 300 000 inhabitants, a surface area less than 700 km 2 , and a gross national income per person of US$1260 or lower. Use of HSCT increased from the first transplant in 1957 to almost 10 000 by 1985. We recorded a cumulative total of about 100 000 transplants by 1995, and an estimated 1 million by December, 2012. Unrelated donor registries contributed 22·3 million typed volunteer donors and 645 646 cord blood products by 2012. Numbers of allogeneic HSCTs increased in the past 35 years with no signs of saturation ( R 2 =0·989). Transplant rates were higher in countries with more resources, more transplant teams, and an unrelated donor infrastructure. Interpretation Our findings show achievements and high unmet needs and give guidance for decisions; to grant access for patients, to provide a donor infrastructure, and to limit overuse by defining risk and region adapted indications for HSCT as an efficient and cost-effective approach for life-threatening, potentially curable diseases. Funding Funding for this study was indirectly provided by support of the WBMT.

Purpose Evidence of the transmission of disease via donor ocular tissue has been demonstrated for adenocarcinoma, rabies, hepatitis B virus, cytomegalovirus, herpes simplex virus, Creutzfeldt-Jakob disease, and a variety of bacterial and fungal infections. Methods Although there is no evidence to date of disease transmission for HIV infection, syphilis, hepatitis C, hepatitis A, tuberculosis, HTLV-1 and -2 infection, active leprosy, active typhoid, smallpox, and active malaria, these entities remain contraindications for transplantation for all eye banks nationally and internationally. The potential sources of contamination include infected donors, during the process of removing tissue from cadaveric donors, the processing environment, and contaminated supplies and reagents used during processing. The transmissions of Herpes simplex virus and HSV via corneal graft have been shown to be responsible for primary graft failure. HSV-1 may also be an important cause of PFG. Results The long latency period of some diseases, the emergence of new infectious disease, and the reemergence of others emphasize the need for long-term record maintenance and effective tracing capabilities. Conclusions The standardization of definitions for adverse events and reactions will be necessary to support the prevention and transmission of disease. International classification of a unique identification system for donors will be increasingly important for vigilance and traceability in cross-national exportation of human cells, tissues, and cellular- and tissue-based products. Opportunities for continuous improvement exist as does the need for constant vigilance and surveillance.

The critical pathway of deceased donation provides a systematic approach to the organ donation process, considering both donation after cardiac death than donation after brain death. The pathway provides a tool for assessing the potential of deceased donation and for the prospective identification and referral of possible deceased donors.

Background and Objectives Introduction of bacteria into blood components at the collection stage seems to be a frequent occurrence. We therefore assessed determinants of bacterial contamination of whole-blood donations to gain insight into contamination mechanisms and direct prevention. Materials and Methods A cross-sectional study was carried out on donors accepted for whole-blood donation in four French blood banks. Each blood bank used its own two-stage procedure for phlebotomy site preparation. Contamination was identified by culturing two 15-ml samples (collected aseptically at the outset of donation) in a BacT/Alert 240® system. Determinants were assessed by logistic regression analysis. Results Bacterial contamination, mainly by skin flora, occurred in 76 (2·2%) out of 3385 donations. Significant determinants were as follows: the blood bank (odds ratio [OR] range = 3·0–5·6, P 35 years (OR = 1·8, P = 0·036). Conclusion Systematic scrub repetition should be implemented to reduce bacterial contamination by skin flora at the collection stage. Further research is required to clarify the role of different antiseptic agents and of donor age.

BACKGROUND : Transfusion-related bacterial contamination is a serious problem. The introduction of bacteria into donations at the collection stage seems frequent, despite well-conducted phlebotomy site preparation. Additional preventive measures are required. STUDY DESIGN AND METHODS : The aim of this study was to assess the potential efficacy of excluding the first 15 mL of blood to reduce the bacterial contamination of donations. A special device allowed the aseptic collection of two samples at the beginning of donation: S1 (first 15 mL) and S2 (next 15 mL). Bacteriologic cultures of S1 and S2 were performed by using an automated system. The procedure′s efficacy was measured by the proportion of positive donations in S1 that were then negative in S2. RESULTS : S1 and/or S2 were positive in 76 (2.2%) of 3385 donations. In about three-fourths of the culture-positive donations, contamination was detected in the first 15-mL sample only. Gram-positive cocci accounted for 81 percent of species, gram-positive bacilli for 14 percent, and gram-negative bacilli for 5 percent. The new procedure would have prevented the introduction of bacteria in 55 donations, reducing to 0.6 percent the risk of contamination from the first 15 mL collected. CONCLUSION : Although the final effect on blood component bacterial contamination rates cannot be derived from the study, excluding the first 15 mL of blood may reduce the rate of bacterial contamination in donations.

Background The world health report 2008 emphasizes "that putting people at the centre of service delivery" is not only about service delivery models from a short-term perspective, but rather about long-term commitment to health care. (1) Given the critical shortage of the health workforce, investments in training, retaining and sustaining them are necessary. Sub-Saharan Africa is a prime example of uneven distribution of health-care personnel. The subcontinent carries 24% of the global burden of disease in 11% of the world's population, but has as little as 3% of the world's health workers. (2) The concern for countries in sub-Saharan Africa and other nations was recognized by the World Health Assembly resolution WHA59.23 that urged for rapid scaling up of health workforce production. (3) Addressing the situation should take into account the four reforms (universal coverage, people-centred service delivery, leadership and public policies) towards refocusing health systems through primary health care. Importance of anaesthesia workforce The contribution of surgical conditions to the global burden of disease and the potential impact of the provision of basic surgical services at the first referral level facility is widely under appreciated. It is estimated that 11% of the world's disability-adjusted life years (or years lost from healthy lives) are from conditions that are very likely to require surgery. (2) Adequate surgical care as a primary care strategy can address and greatly alleviate this burden. (4) Increasing evidence is beginning to emerge that maternal and infant survival is proportionately correlated to the number of health workers providing obstetric care that includes anaesthesia. (5,6) The delivery of surgical (including obstetrics and trauma) care is highly dependent on the availability and retention of a trained anaesthesia healh workforce. The United Kingdom Confidential Enquiry for Perioperative Death in 1987 reported one death per 185 000 anaesthetic procedures; whereas in Zambia (University teaching hospital), it was one death per 1925. The avoidable anaesthesia-mortality rate in Malawi (central hospital) was one death per 504; in Nigeria (teaching hospital) for Caesarean sections, one death per 387 anaesthetic procedures; in Togo (teaching hospital), one death per 133; and in Zimbabwe (district hospital), one death per 482. (7) Many of these unnecessary deaths were a result of airway problems and hypovolaemia in healthy young patients. (7) Though the common perception is that anaesthesia services are only required at the level of secondary and tertiary health-care facilities, the availability of basic services at the first referral level facility can contribute significantly to a reduction in death and disability. At the district and sub-district level, health personnel are expected to provide a range of anaesthesia services (local, intravenous ketamine, spinal and general anaesthesia) for the management of pregnancy-related complications, unsafe abortion, injuries (road traffic accidents, domestic violence, burns, falls, rape), complications of female genital mutilation, congenital anomalies as well as other surgical conditions. To safely deliver anaesthesia in emergency and surgical procedures, investments for appropriate training are required. The role of anaesthesia extends beyond the operating room, and is necessary in postoperative monitoring, intensive care units, for co-existing medical conditions, as well as providing pain relief (particularly in children and women in labour). A workforce trained in basic anaesthetic techniques at the primary health care level can also resuscitate critically ill patients or those with severe trauma and stabilize their condition, before transfer to a more specialized facility. The anaesthesia services required at the first referral level facilities can mostly be delivered by trained nonphysician anaesthetists. Current situation Physician anaesthetists are scarce in many developing countries and not available at first referral level health facilities. …

The Global Database on Donation and Transplantation represents the most comprehensive source to date of worldwide data concerning activities in organ donation and transplantation derived from official sources, as well as information on legal and organizational aspects. The objectives are to collect, analyse and disseminate this kind of information of the WHO Member States and to facilitate a network of focal persons in the field of transplantation. They are responsible for providing the legislative and organizational aspects and the annual activity practices through a specific questionnaire. 104 out of the 194 WHO Member States that cover the 90% of the global population contribute to this project.Although we know the numerous limitations and biases as a result of the different interpretations of the questions, based on cultural factors and language, there is no other similar approach to collect information on donation and transplantation practices all over the world. The knowledge of demand for transplantation, availability of deceased and living donor organs and the access to transplantation is essential to monitor global trends in transplantation needs and donor organ availability. Information regarding the existence of regulatory oversight is fundamental to ensure the ethical practice of organ donation and transplantation.

Automatic recognition of facial expression is a necessary step toward the design of more natural human-computer interaction systems. This work presents a user-independent approach for the recognition of facial expressions from image sequences. The faces are normalized in scale and rotation based on the eye centers' locations into tracks from which we extract features representing shape and motion. Classification and localization of the center of the expression in the video sequences are performed using a Hough transform voting method based on randomized forests. We tested our approach on two publicly available databases and achieved encouraging results comparable to the state of the art.

Objective: A high mortality rate is associated with anesthesia in low and middle income countries. The provision of basic and emergency surgical services in developing countries includes safe anesthetic care. We sought to determine the resources available to deliver anesthesia care in low and middle income countries. Methods: A standard World Health Organization tool was used to collect data from 34 Low and Middle-Income Countries (LMICs) regarding infrastructure and capacity of facilities. We then performed a database query to extract information on anesthesia-related capacity. Findings: Twelve countries were excluded for providing data on less than four facilities, leaving 22 countries in our results, with a total of 590 facilities surveyed. Thirty five percent of hospitals had no access to oxygen and 40% had no anaesthesia machines; despite this, 58.5% of hospitals offered general inhalational anesthesia. All facilities reported presence of an anaesthesia provider: a nurse or clinical assistant was present in all 590 facilities. Hospitals with > 200 beds reported a range of 2-10 providers; the average number of anesthesia physicians increased from one to four as the hospital size increased from less than to greater than 300 beds. The majority of facilities were district/rural/community hospitals (34.7%), followed by health centres (23.2%), private/NGO/missions hospitals (16.6%), provincial hospitals (11.7%), and general hospitals (13.1%). Conclusion: The delivery of anesthesia is limited by deficiencies in human resources, equipment availability and system capacity in many low and middle income countries.

Summary Roughly 100 000 patients worldwide undergo organ transplantation annually, but many other patients remain on waiting lists. Transplantation rates vary substantially across countries. Affluent patients in nations with long waiting lists do not always wait for donations from within their own countries. Commercially driven transplantation, however, does not always ensure proper medical care of recipients or donors, and might lengthen waiting times for resident patients or increase the illegal and unethical purchase of organs from living donors. Governments should systematically address the needs of their countries according to a legal framework. Medical strategies to prevent end-stage organ failure must also be implemented. In view of the Madrid Resolution, the Declaration of Istanbul, and the 63rd World Health Assembly Resolution, a new paradigm of national self-sufficiency is needed. Each country or region should strive to provide a sufficient number of organs from within its own population, guided by WHO ethics principles.

We introduce hedonic, modeling benchmarks for the field of sensory science evaluation. Our benchmark framework provides a general means of defining a response surface which we call a “sensory map”. A sensory map is described by a mathematical expression which rationalizes domain specific knowledge of the explanatory variables and their individual or higher order contribution to hedonic, response. The benchmark framework supports the sensory map’s socalled ground truth to be controllably distorted to mimic the human and protocol factors that obscure it. To provide a baseline for future algorithm comparison, we evaluate a public research release of genetic programming symbolic regression algorithm on a sampling of the framework’s benchmarks.

BACKGROUND: Xenotransplantation carries inherent risks of infectious disease transmission to the recipient and even to society at large, and it should only be carried out with strict regulation and oversight. In collaboration with the International Xenotransplantation Association, the University Hospital Geneva, and the World Health Organization, an international inventory has been established (www.humanxenotransplant.org) aiming to collect basic data on all types of currently ongoing or recently performed xenotransplantation procedures in humans. METHODS: We collected information from publications in scientific journals, presentations at international congresses, the internet, and declarations of International Xenotransplantation Association members on xenotransplantation procedures in humans performed during the past 15 years. RESULTS: We identified a total of 29 human applications of xenotransplantation, including 7 that were currently ongoing. Procedures involved transplantation of xenogeneic cells, i.e., islets of Langerhans, kidney cells, chromaffin cells, embryonic stem cells, fetal and adult cells from various organs or extracorporeal perfusion using hepatocytes, liver, spleen, or kidney. The treatments were performed in 12 different countries, 9 of them having no national regulation on xenotransplantation. CONCLUSION: Several clinical applications of cell xenotransplantation are ongoing around the world, often without any clear governmental regulation. This information should be used to inform national health authorities, healthcare staff, and the public, with the objective of encouraging good practices, with internationally harmonized guidelines and regulation of xenotransplantation.

Hypothesis Surgical and anesthetic care is increasingly recognized as a neglected but cost-effective component of primary health care in low- and middle-income countries (LMICs). Strengthening delivery can help achieve Millennium Development Goals 4, 5, and 6. Large gaps in access to essential surgical care in LMICs result in considerable morbidity and mortality. The goal of this study was to provide a baseline overview of essential surgical and anesthetic capacity at district-level health facilities in multiple LMICs. Design Survey. Setting District-level health facilities in multiple LMICs Main Outcome Measures A standardized World Health Organization tool was used at selected district-level hospitals to assess infrastructure, supplies, and procedures relating to essential surgical and anesthetic capacity. The analysis included facilities from countries that assessed more than 5 health facilities. All data were aggregated and blinded to avoid intercountry comparisons. Results Data from 132 facilities were analyzed from 8 countries: Democratic Socialist Republic of Sri Lanka (n = 32), Mongolia (n = 31), United Republic of Tanzania (n = 25), Islamic State of Afghanistan (n = 13), Republic of Sierra Leone (n = 11), Republic of Liberia (n = 9), Republic of The Gambia (n = 6), and Democratic Republic of Sao Tome and Principe (n = 5). Universally, facilities demonstrated shortfalls in basic infrastructure (water, electricity, oxygen) and functioning anesthesia machines. Although 73% of facilities reported performing incision and drainage of abscesses, only 48% were capable of undertaking an appendectomy. In line with Millennium Development Goals 4, 5, and 6, only 32% of facilities performed congenital hernia repairs, 44% of facilities performed cesarean sections, and few facilities always had goggles and aprons to protect surgical health care workers from human immunodeficiency virus. Conclusion Enormous shortfalls in infrastructure, supplies, and procedures undertaken are common at district-level health facilities in LMICs.

In Afghanistan, the number of surgically amenable injuries related to civil unrest and ongoing conflict or consequent to road traffic accidents, trauma, or pregnancy-related complications is rising and becoming a major cause of death and disability. This study was designed to evaluate availability of basic lifesaving and disability-preventive emergency surgical and anesthesia interventions representing most of the country. Evaluation was performed outside Kabul to represent a cross-section of the country. Data were collected from Afghanistan health facilities, using the WHO Tool for Situation Analysis to Assess Emergency and Essential Surgical Care, covering case volume, travel distances, infrastructures, human resources, supplies, equipment, and interventions characterizing basic trauma, surgery, and anesthesia capacities. In 30% of the 17 facilities examined, oxygen supply is limited and irregular; uninterrupted running water is not accessible in 40%; electrical power is not available continuously in 66%. Shortage of equipment and personnel is evident in peripheral health facilities: certified surgeons are present in 63.6% and certified anesthesiologists in 27.2%. Continuous 24 h surgical service is available in 29.4%. Lifesaving procedures are performed in 17–42% of peripheral hospitals; 23.5% are without emergency obstetric service. Limited access to surgery is highly remarkable in Afghanistan, with a severe shortage of emergency surgical capacities in provincial and district hospitals, where availability of basic and emergency surgical care is far from satisfactory. A comprehensive approach for strengthening basic surgical capacities at the primary health care level should be introduced.

The federal shariat court of Pakistan recently upheld the country’s 2007 Transplantation of human organs and tissue ordinance.1 A courageous campaign had originally established this legislation in Pakistan,2 a country in which poor people once received a pittance for selling their organs, while some organ brokers, doctors and hospitals became rich. The ordinance prohibits commercial organ donation, legalizes deceased donation, excludes donations to foreigners from unrelated Pakistani donors and establishes a human organ transplant authority to monitor transplantation activities and ensure transparency. The transplant authority – at the Ministry of Health – must implement and enforce ethical practices and combat the resurgence of clandestine organ trafficking. Advocates of commercial transplantation and transplant tourism have openly sought to challenge the law. A society of transplant professionals interested in the sale of kidneys and the provision of transplantation services to tourists from abroad petitioned the federal shariat court on various grounds, including a claim that the prohibition against payment constituted a hurdle to the saving of human lives. This petition exemplifies the persistent threats to ethical transplantation practice globally, highlighting the commercial appeal of paying vulnerable organ vendors to provide organs for distant elites. For example, patients from Saudi Arabia were regularly reported as clients of kidney transplantation clinics in Pakistan before the introduction of the 2007 ordinance. Saudi Arabia has since mirrored the Pakistani response to this threat, with both governments demonstrating that the pursuit of national self-sufficiency in human organs is the only way to progress towards equitable transplantation practice on a global level. The number of Saudi patients transplanted abroad has steadily decreased and donations from deceased donors increased to unprecedented levels in 2008.3 The Saudi authorities are clearly taking responsibility for meeting transplantation needs in the Kingdom, thereby minimizing the harmful effects of transplant tourism. Other countries once recognized as transplant tourism destinations – such as Egypt and the Philippines – have recently adopted or are now considering draft laws banning commercial transplants.4,5 Countries that have previously resorted to transplant tourism have established – or are pursuing – self-sufficiency at the national or sub-regional level, for example in Israel, Japan and the Republic of Korea.6–8 Meeting transplantation needs at the national level avoids predatory behaviour at the expense of underprivileged populations in other countries. However, this goal can only be achieved by increasing deceased donations through efficient organ procurement organizations, as well as safely developing live-related kidney donation. The Member States of the World Health Organization were urged to do so in Resolution 57.18 of the 2004 World Health Assembly.9 Advocates of payment for living donation claim that altruism has been shown to be inefficient and insufficient, yet some countries, provinces and states have shown that self-sufficiency is within reach. Some countries have achieved success in the absence of paid donation, thus avoiding exploitative practices that shift the burden of organ donation to the poor. The pursuit of national self-sufficiency in human material for transplantation is the collective responsibility of all citizens, inasmuch as they are necessary participants in the prevention and management of all diseases leading to the need for transplantation. The shariat court judgment was a victory for the federal government and dedicated medical professionals in Pakistan seeking to establish and maintain ethical standards in organ procurement and transplantation. It was also a powerful affirmation of Islamic bioethics in harmony with the universal values expressed in the WHO guiding principles on human cell, tissue and organ transplantation and the Declaration of Istanbul.10,11 By putting a stop to the exploitation of vulnerable human beings and equipping the country with the legislation necessary to establish donation and transplantation services using organs from deceased donors, Pakistan has adopted the path to national self-sufficiency by which the health authorities invite citizens to donate organs after death. Potential donors are also reminded that they themselves may be potential beneficiaries of organs from deceased donors. In the pursuit of self-sufficiency, altruism, reciprocity and civic consciousness are the main motivations for donation. ■

A WHO 'Training of Trainers' workshop on essential emergency surgical procedures was organised in collaboration with the Ministry of Health, Mongolia. The participants included doctors and nurses from the six selected aimags (provinces). Facilitators of the workshop included experts from the Faculty of Health Science University, Mongolian Surgeon's Association and Mongolian Association of Anaesthesiologists association with the Swiss Surgical Team of the International College of Surgeons, Surgical Department of Nurse's College, Trauma Orthopaedic Clinical Hospital, the Department of Quality Assurance of the Directorate of Medical Services, Ministry of Health. Facilitators from the Hospital University of Geneva, Geneva Foundation of Medical Education and Research (RHR) and Evidence and Information for Policy in Geneva, Switzerland participated via video link. The workshop included lectures, discussions, role playing and 'hands on' basic skills training. Videoconference and e-learning sessions using the WHO e-learning tools were conducted at the Global Development Learning Centre. The topics covered during this training workshop included team responsibility and organisation in a health care facility; patient safety; disaster planning; appropriate use of oxygen; management of bleeding, burns and trauma; basic anaesthetic and resuscitation techniques; prevention of HIV transmission; sterilisation of equipment; waste disposal; hygiene; record keeping, monitoring and evaluation of quality of care and checklists prior to surgery to assure that the correct patient gets the correct surgery on the correct side at the correct time. Recommendations were made by the participants on the next steps after this training.

Haemovigilance was part of the reform of the French transfusion system. The haemovigilance network is now operational with approximately 4600 transfusion incidents reported annually. Immediate incidents observed within 8 days after transfusion account for 85 % of the reports. A cause cannot be identified in 41% of these, usually concerning minor clinical incidents with transient fever and /or shivers. An allergic reaction is described in 31% of transfusion reactions. Immunological conflicts account for 18% and bacteria associated transfusion reactions for 6%. The importance of bacteria associated transfusion reactions, the first identified cause of death associated with transfusion is one of the findings of haemovigilance. Improvement in the haemovigilance systems aims at obtaining better descriptions of transfusion incidents, standardisation of severity and imputability assessment and definitions of denominators such as the actual number of recipients. Delayed incidents will ultimately provide a true vision of post transfusion immunisation and infection The improvement of haemovigilance now considered as part of transfusion medicine practice is a continuous process.

Since the first report by Nobel laureate, the late E. Donnall Thomas (NEJM, 1957, 257), HSCT has developed from an experimental to an established curative treatment for many congenital or acquired disorders of the hematopoietic system. The key steps of this success story are linked to progress in tissue typing, donor selection, supportive care and immunosuppression and fostered by intensive collaboration of physicians around the world through outcome and donor registries. The WBMT, a federation and official Non-governmental Organization of the World Health Organization, has collected HSCT activity data from its member societies and from national registries not part of an international HSCT society. Data collection did include the first transplants by ED Thomas and the first global report by M. Bortin (Transplantation 1970, 571). European data were derived from the Med A form of the European Group for Blood and Marrow Transplantation-EBMT for the years 1965-1989 and from the annual activity survey since 1990. Non-European data back to 1969 were provided by the Center for International Blood and Marrow Transplant Research-CIBMTR, with additional recent data provided by the Asia-Pacific Blood and Marrow Transplantation Group (APBMT, since 1974), the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR, since 1980), the Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT, since 1984), the Canadian Blood and Marrow Transplantation Group (CGBMT, since 2002), the Latin American Blood and Marrow Transplantation Group (LABMT, since 2009) and the African Blood and Marrow Transplant Group (AFBMT, since 2010). Double reporting was minimized by crosschecking registries and unrelated donations. Missing data from a few regions in 2012 were extrapolated from previous years assuming a 5% increase. As of December 2012, the 1450 transplant centers from 72 countries over 5 continents had reported 1.000.000 HSCT (58% autologous, 42% allogeneic). The dramatic recent increase in rate of utilization of HSCT is illustrated by the fact that there were 10.000 HSCTs worldwide by 1985, 50.000 by 1990, 100.000 by 1994, 500.000 by 2004 and 1.000.000 by December 2012. The absolute and relative contribution differed significantly with Europe providing 53%, the Americas 31%, Australasia 14% and Eastern-Mediterranean and Africa 2% to the total HSCT number (allogeneic HSCT: 45%, 32%, 20% and 3%; autologous HSCT: 58%, 31%, 10% and 1%). The increase in activity has been almost linear over the past 55 years with two exceptions, a decrease in autologous HSCT for breast cancer from 1999 especially in the Americas and a decrease in allogeneic HSCT for CML after 2000 seen everywhere except in the Eastern-Mediterranean/African region. The rise in HSCT numbers during the last decade was mainly due to an increase in allogeneic HSCT from unrelated donors; the relative increase being highest in Australasia. Recent growth was primarily due to increases in activity in existing transplant centers, rather than in the number of transplant centers. The main indications for autologous HSCT today are lymphoproliferative disorders 87% (myeloma 46% and lymphoma 41%), solid tumors 8.6% and AML 2.75%; for allogeneic HSCT leukemias 73% (AML 34.6%; ALL 16.8%; CML 4%; myelodysplastic and myeloproliferative disorders 13.3%; CLL 2.9% and other leukemias 1%), lymphoproliferative disorders 14.3% and bone marrow failure syndromes 5.5%. In 2010, cord blood was used as stem cell source in 19% of unrelated HSCT. These data were compiled through collaboration of the global HSCT community. Global collaboration has also been essential for the diffusion of HSCT as a therapy and especially for unrelated HSCT. More than 22 million unrelated donors are available today from a global network (World Marrow Donor Association, WMDA) of donor registries and cord blood banks and about 30% of unrelated HSCT involve a donor and recipient in different countries. The success of HSCT serves as a model for organ repair by the use of healthy stem cells and as a model for global cooperation in meeting the needs of an international patient population. These data also illustrate the challenges for the global medical community in providing state of the art care in regions with constrained resources and the need to find ways to make the therapy more available in order to provide better outcomes for patients with life-threatening but potentially curable diseases. Disclosures: Gluckman: Cord use: Honoraria; gamida: Honoraria.

Xenotransplantation carries the potential risk of the transmission of infection with the cells or tissues of the graft. The degree of risk is unknown in the absence of clinical trials. The clinical application of xenotransplantation has important implications for infectious disease surveillance, both at the national and international levels. Preclinical data indicate that infectious disease events associated with clinical xenotransplantation from swine, should they occur, will be rare; data in human trials are limited but have demonstrated no transmission of porcine microorganisms including porcine endogenous retrovirus. Xenotransplantation will necessitate the development of surveillance programs to detect known infectious agents and, potentially, previously unknown or unexpected pathogens. The development of surveillance and safety programs for clinical trials in xenotransplantation is guided by a “Precautionary Principle,” with the deployment of appropriate screening procedures and assays for source animals and xenograft recipients even in the absence of data suggesting infectious risk. All assays require training, standardization and validation, and sharing of laboratory methods and expertise to optimize the quality of the surveillance and diagnostic testing. Investigation of suspected xenogeneic infection events (xenosis, xenozoonosis) should be performed in collaboration with an expert data safety review panel and the appropriate public health and competent authorities. It should be considered an obligation of performance of xenotransplantation trials to report outcomes, including any infectious disease transmissions, in the scientific literature. Repositories of samples from source animals and from recipients prior to, and following xenograft transplantation are essential to the investigation of possible infectious disease events. Concerns over any potential hazards associated with xenotransplantation may overshadow potential benefits. Careful microbiological screening of source animals used as xenotransplant donors may enhance the safety of transplantation beyond that of allotransplant procedures. Xenogeneic tissues may be relatively resistant to infection by some human pathogens. Moreover, xenotransplantation may be made available at the time when patients require organ replacement on a clinical basis. Insights gained in studies of the microbiology and immunology of xenotransplantation will benefit transplant recipients in the future. This document summarizes approaches to disease surveillance in individual recipients of nonhuman tissues.

Objective To document infrastructure, personnel, procedures performed, and supplies and equipment available at all county hospitals in Liberia using the World Health Organization Tool for Situational Analysis of Emergency and Essential Surgical Care. Design Survey of county hospitals using the World Health Organization Tool for Situational Analysis of Emergency and Essential Surgical Care. Setting Sixteen county hospitals in Liberia. Main Outcome Measures Infrastructure, personnel, procedures performed, and supplies and equipment available. Results Uniformly, gross deficiencies in infrastructure, personnel, and supplies and equipment were identified. Conclusions The World Health Organization Tool for Situational Analysis of Emergency and Essential Surgical Care was useful in identifying baseline emergency and surgical conditions for evidenced-based planning. To achieve the Poverty Reduction Strategy and delivery of the Basic Package of Health and Social Welfare Services, additional resources and manpower are needed to improve surgical and anesthetic care.

As long as the global supply of tissues, cells and organs for transplant does not meet needs, desperate patients are easy prey for unscrupulous individuals. Yet countries including Spain and the Unit-ed States of America have shown that it is possible to make progress towards self sufficiency in transplants by meeting these needs with altruistic donations. Achieving national self-sufficiency is not easy. It requires a level of commitment from society that very few countries have been able to garner, but building this commitment arguably costs much less in the long term than relying on the payment of “volunteers”– inevitably the poor and vulnerable.In contrast to organs, most human tissues and cells destined for transplan-tation can be processed, preserved and stored, often for long periods. Their transportation can be very easy and ship-ping across national boundaries is some-times necessary to best meet patients’ needs. Risks of ethical breaches arise at all stages; from consent to donation through to the allocation of transplants, and the clinical care of donors and re-ceipients. Recent cases of cadaveric tissue theft have shown how unethical behav-iour in tissue procurement bypasses the safety barriers designed to decrease the risk of transmitting infectious diseases to receipents.

Adsorption and desorption isotherms of nitrogen, obtained by the volumetric (B.E.T.) method, have been used to determine the specific surface and the porosity of a series of chrysotile asbestos fibers, before and after chemical treatments. It was shown that the phosphorus compounds that are formed by the reaction of POCl3 and chrysotile asbestos seal the surface of the fibrils and block the pores between the fibrils. These chemical modifications result in an important diminution of the specific surface and of the porosity of the fibers. Washing the fibers with 0.1 M HCl results in an increase of the specific surface and of the porosity. Solvation of the impurities and leaching of the brucitic surface of the fibers are responsible for this increase. [Journal translation]

The human Y chromosome carries numerous copies of a tandemly repeated Pvu II sequence, 2.4 kb long. These sequences are specific to humans, and are present in a much smaller amount in the DNA of females. They are localized on the long arm of the Y chromosome. We have compared this sequence with the Hae III 2.1 kb Y-specific repeated sequence, already described.

The adsorption isotherm technique in liquid chromatography was developed on asbestos fibres of different sizes. A new mini-column was designed for the application of short chrysotile asbestos having a mean length of 0.85 μm. Chromatographic isotherm measurements obtained by a data acquisition system are possible for an equilibrium concentration (Ce) lower than 0.01 mmol l−1. The precision of the dynamic and static methods has been compared at very low equilibrium concentrations.

A new technique to evaluate the adsorption of polycyclic aromatic hydrocarbons (PAHs) from solution in toluene on asbestos fiber was studied by liquid chromatography. The length of the new column used is only 3.5 cm and the applied flow is 1 mL min/sup -1/. The pressure applied on this column at 25/sup 0/C is about 18 MPa (2600 psi). The range of PAHs in the samples injected into the column was from 10 nmol to 1000 nmol, except for phenanthrene which was up to 10 ..mu..mol. We estimated Henry's constant at 25 and 40/sup 0/C and we noted that benzo(a)pyrene is more adsorbed, comparatively, than the other PAHs. We demonstrated the influence of the HPLC solvent dryness. We estimate an error of less than 5% in reproducibility with another column. By this method it is possible to produce an adsorption isotherm more easily and rapidly than by static adsorption. The method may be used to test the carcinogenic potential of chemically treated fibers. 11 references, 5 figures, 1 table.

Many reports indicate that the carcinogenic (genotoxic) potential of benzo[a]pyrene (B[a]P) may be enhanced several-fold by the promoter (epigenetic) effect of asbestos particles. This promoting effect could be related to the fact that when B[a]P is adsorbed onto the particles, there is a resulting enhanced transport and uptake of the carcinogen into microsomial membranes. These in vitro data bear relevance to the epidemiological studies which indicate an association between exposure to inhaled asbestos dusts and the high incidence of pulmonary cancers in smokers. Using HPLC, it has been observed that B[a]P has great affinity for natural asbestos fibers, and that chemical modification of natural chrysotile with POCl3 results in the complete loss of this adsorption potential of chrysotile for benzo[a]pyrene.