Permeability of the equine embryonic capsule to ethylene glycol and glycerol in vitro.

Poor survival of cryopreservation by equine expanded blastocysts may involve low penetration of the embryonic capsule by cryoprotective agents (CPAs). This study characterized the permeation and accumulation rates of the CPAs ethylene glycol (EG) and glycerol (GLY) across isolated capsule in vitro, using a dual-chambered Valia-Chien permeation apparatus. Pieces of Days 14 to 18 ± 1 capsules separated media in the "donor" chamber containing either 1.5 M EG (n = 6), 0.74 M EG (n = 5), 0.87 M GLY (n = 7), or 0.15 M NaCl (saline, SAL) (n = 6), from the "recipient" chamber. Concentrations of CPA, determined by gas chromatography, allowed calculation of the capsule's apparent permeability (P(app)) to those CPAs. Permeation of capsule by 1.5 M EG was significantly more rapid than by 0.87 M GLY, or 0.74 M EG; permeation by both CPAs was significantly slower than by SAL. Accumulation of CPA in the recipient chamber depended more on initial donor chamber concentration, rather than type, of CPA. Accumulation rates for CPAs and SAL were linear only when capsule was present, demonstrating that their permeation through capsule was more complex than simple diffusion. Successful cryopreservation of equine expanded blastocysts has been previously linked to lengths of step-wise exposures to CPAs. Based on the present results, we inferred that alternative CPAs, more capable of permeating the capsule, or alternative methods of ensuring CPA entry into the cells, may also be required.

Pulmonary effects of red blood cell transfusion in critically ill, non-bleeding patients.

The aim of the study is to evaluate the effects of red blood cell (RBC) transfusions on pulmonary parameters in critically ill, non-bleeding patients. Retrospective chart analysis was performed on critically ill patients without overt bleeding in the intensive care unit (ICU) of a university hospital. In 83 patients in a 5-month period, who had received at least 1 RBC unit and stayed at least 24 h in the ICU, 199 transfusions of median 2 RBCs per transfusion (n = 504) were studied. Pulmonary parameters were retrieved during the period between 24 h before the start of transfusion and 24-48 h after transfusion. Outcome was assessed. The P(a)O(2)/F(I)O(2) dose-dependently decreased from 250 +/- 105 at baseline to 240 +/- 102 mmHg at 24 h after RBC transfusion (P = 0.003), irrespective of acute lung injury at baseline and RBC storage time. The lung injury score (LIS) also increased dose-dependently, whereas, at 48 h, oxygenation and LIS largely returned to baseline. For every seven RBCs transfused, the LIS transiently increased by 1 unit. There were no changes in haemodynamics, lung mechanics or chest radiography. The total number of RBCs given in the ICU did not directly contribute to ICU and 1-year mortality prediction. Transfusion of RBCs decreases oxygenation thereby increasing the LIS, dose-dependently and transiently, in a heterogeneous population of critically ill, non-bleeding patients, independent of prior cardiorespiratory status and RBC storage time. The effects are subtle, may go unseen and unreported and may represent subclinical transfusion-related acute lung injury. They do not adversely affect outcome, even at 1-year follow-up.

A global review of legislation on HIV/AIDS: the issue of HIV testing.

OBJECTIVE: Critical review of worldwide legislation on HIV/AIDS, with a focus on the issue of HIV testing, mainly in a military context. DESIGN: Analysis of health legislation on HIV/AIDS among 121 of the 191 member states of the World Health Organization (WHO), representing 85% of the world's population. METHODS: The WHO Directory of Legal Instruments Dealing with HIV Infection and AIDS has been the main source consulted. Relevant findings of two global surveys were used to examine HIV testing in the military. RESULTS: AIDS cases are reportable in 60% of the 121 countries, whereas HIV infections in no more than 26%. Notifications are kept confidential by law in 20% of countries. Only 17% have developed HIV-specific legislation against social discrimination, whereas 10% have passed legislation establishing financial reimbursement to those who have acquired HIV infection after injection of HIV-contaminated biologic material, support for occupational risk, and/or social protection for patients. Only 42% of the 121 countries report having legal instruments that require screening of donated blood. Legislative measures that address, generally in a prescriptive but sometimes also in a protective way, vulnerable groups, such as commercial sex workers, men who have sex with men, injecting drug users, and recipients of multiple transfusions of blood or blood-derivatives, are reported in 27% of countries. Other categories considered potentially vulnerable, for which specific legislation has been passed, include immigrants (17% of countries), prisoners (5%), and health personnel (14%). Further legislative measures for HIV prevention address testing pregnant women in the prenatal period (7% of countries), supporting condom promotion (11%), measures requiring quarantine, isolation, or coercive hospitalization of HIV-infected people or AIDS patients (9%), or imposing penal sanctions for HIV-infected people who deliberately expose others to the risk of transmission (10%). A National AIDS Committee responsible for addressing issues related to HIV/AIDS has been established by law in 39% of the 121 countries. Global surveys show that 27 countries carry out compulsory HIV screening on recruitment of military personnel. CONCLUSIONS: These data represent a useful tool to make governments aware of the problem of underreporting of legal instruments to the WHO and of the need to promote legislation in line with the idea that public health and human rights are complementary, not conflicting, goals.

International military human immunodeficiency virus/acquired immunodeficiency syndrome policies and programs: strengths and limitations in current practice.

A survey was conducted to evaluate military human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) policies and programs in 119 countries. Ninety-eight percent of the 62 respondents provide prevention education, 95% in group settings but only 53% individually. Predeployment briefings are more common than postdeployment briefings. Condoms are promoted more often than provided. Seventy-eight respondents report some form of mandatory HIV testing, and 58% perform mandatory recruit testing, with recruitment denied to HIV-positive individuals in 17%. Counseling accompanies mandatory testing less than voluntary testing. In-service care for AIDS patients is universal. Many military prevention programs can be improved through postdeployment briefings and proactive interventions involving education, condom distribution, and counseling combined with testing. Mandatory testing is often inconsistent with stated goals, and AIDS care policies may strain military budgets. Testing based on cost-benefit assessments may increase efficiency in military HIV control. Military budgets may benefit from greater civil-military cost sharing in AIDS care.

Summary of track D: social science: research, policy and action.

SCOPE: This review summarizes the main issues discussed during Track D, which examined the societal impact of HIV/AIDS, and responses to the epidemic by individuals, families, communities and societies worldwide. Micro- and macrolevel issues addressed included the development, implementation and evaluation of programmes for prevention and care; policy development and implementation; structural issues such as the impact of gender relations, development and migration on the development of the epidemic; and the social and economic impact of HIV/AIDS on affected societies and communities. RECURRENT THEMES: Presentations provided strong evidence that peer-led, community-based programmes offer particularly effective ways of working, and that participatory research involving affected communities provides useful results for the design and evaluation of programmes and policies. This is the case across settings, issues, populations and countries. FUTURE DIRECTIONS: Emerging needs include how best to ensure sustainability of national and international responses, how best to scale up successful interventions for wider reach, and how best to work with systematically marginalized, neglected groups and populations. Research priorities include the characterization of the multiple determinants of HIV-related vulnerability, and the evaluation of interventions that take these complex determinants as their starting point. A more coherent and strategic response requires less separation between the different constituencies involved in AIDS work, and the more sustained involvement of people living with HIV/AIDS themselves.