The Significance of the Nucleic Acid Test (NAT) to Prevent Viral Contamination in Musculoskeletal Tissue Transplantation / A importância da realização do teste de ácidos nucleicos (NAT) para a prevenção de contaminação viral nos transplantes de tecidos musculoesqueléticos

Abstract Objective The present study aims to highlight the significance of the nucleic acid test (NAT) for musculoskeletal tissue donation and to compare the sensitivity of this test on the different available platforms. Method The present study is a retrospective survey in a human tissue bank database and an integrative literature review encompassing the last 10 years. The PubMed portal and the SCOPUS, CINAHL, and Web of Science databases were queried for articles. Results We found no specific studies on the use and sensitivity of NAT in braindead tissue donors. The information presented in the present study consists of specific contents intended for the Brazilian Blood Transfusion Network (Hemorrede Transfusional Nacional, in Portuguese) and internal retrospective data from a tissue bank located at a city in the state of São Paulo, Brazil. Conclusions The NAT is effective in blood samples from living patients. However, since biochemical reactions in braindead patients can be different, specific research, platforms, or both are crucial to tissue banks.

Resumo Objetivo Evidenciar a importância da realização do teste de ácido nucleico (NAT, na sigla em inglês) para doação de tecidos musculoesqueléticos, assim como comparar a sensibilidade deste exame nas diferentes plataformas existentes no mercado. Método Trata-se de um levantamento retrospectivo no banco de dados de um determinado Banco de Tecidos Humanos e de uma revisão integrativa da literatura, operacionalizada nos últimos 10 anos. As buscas de artigos ocorreram no portal PubMed e nas bases de dados SCOPUS, CINAHL e Web of Science. Resultados Não foram encontrados estudos específicos sobre a utilização e a sensibilidade do exame NAT em pacientes doadores de tecidos com morte encefálica (ME), sendo as informações apresentadas no presente estudo conteúdos específicos destinados à Hemorrede Transfusional Nacional e aos dados retrospectivos internos de um Banco de Tecidos do interior do estado de São Paulo, Brasil. Conclusões O exame NAT se apresenta efetivo em amostras de sangue de pacientes vivos. Porém, reações bioquímicas em pacientes com condições de ME podem se apresentar de formas diferenciadas, tornando-se indispensáveis a realização de pesquisas específicas e/ou a indicação de plataformas aos Bancos de Tecidos.

Resultados post operatorios en pacientes con prótesis total de revisión de cadera mas injerto óseo cadavérico de banco de tejidos en el Hospital de Clínicas en el periodo 2017 al 2020 / Postoperative results in patients with total hip revision arthroplasty and cadaveric bone graft of tissue bank at the Hospital de Clínicas in the period 2017 to 2020

Introducción: La artroplastia total de cadera de revisión junto con la utilización de injerto óseo cadavérico de banco de tejidos es una alternativa de tratamiento eficaz ante los procedimientos de reemplazo con déficit óseo femoral o acetabular. El presente estudio, analizó los resultados post operatorios en pacientes intervenidos quirúrgicamente en el Hospital de Clínicas. Materiales y métodos: Estudio descriptivo. Muestreo no probabilístico de casos consecutivos atendidos en la Cátedra de Ortopedia y Traumatología de la Facultad de Ciencias Médicas (U.N.A). Fueron captados pacientes con indicación de artroplastia total de cadera de revisión (ATCR) más injerto óseo cadavérico de banco de tejidos, entre diciembre 2017 - octubre 2020, previo consentimiento informado. Se relevaron datos cuya caracterización fue posible mediante un instrumento establecido previamente, ingresado en base Excel. Resultados: 12 pacientes con déficit óseo femoral y acetabular han sido tratados con artroplastia total de cadera de revisión más injerto óseo cadavérico de banco de tejidos, en donde además de la funcionalidad y a través de seguimientos radiológicos se ha determinado la osteointegración total de los aloinjertos. La relación masculino-femenina fue 1/1, siendo el diagnóstico preoperatorio para la colocación de la prótesis de revisión más injerto óseo cadavérico de banco de tejidos el aflojamiento séptico en un 75%. El motivo de consulta más frecuente fue dolor y la secreción y el tiempo quirúrgico fue en promedio de 116 minutos. Conclusión: La artroplastia total de cadera de revisión más aloinjerto presenta óptimos resultados en relación a la osteointegración total y funcionalidad.

Introduction: Revision total hip arthroplasty with use of cadaveric bone graft is an effective treatment for replacement procedures in patients with bone loss femoral or acetabular. The present study analyzed the postoperative results in patients who underwent surgery at the Hospital de Clínicas. Materials and methods: Descriptive study. Non-probabilistic sampling of consecutive cases treated at the Department of Orthopedics and Traumatology of Hospital de Clínicas. Data of patients with indication for revision total hip arthroplasty plus cadaveric bone graft from a tissue bank with prior informed consent,were analyzed between December 2017 and October 2020. Results: 12 patients with femoral and acetabular bone deficits have been treated with revision total hip arthroplasty plus cadaveric bone graft from a tissue bank. A radiological and functional follow up was made. The male-female ratio was 1/1, with the preoperative diagnosis for placement of the revision prosthesis plus cadaveric bone graft,from the tissue bank,was septic loosening in 75%. The most frequent symptom was pain, all revision total hip arthroplasties were performed through a posterior approach, and the surgical time was an average of 116 minutes,using a later approach in all cases.Two intraoperative fracture was presented, and were resolved. Conclusion: Revision total hip arthroplasty plus allograft presents optimal results in relation to total osseointegration and functionality.

Evaluation of Histological Properties of Human Meniscal Grafts Stored in a Tissue Bank / Avaliação das propriedades histológicas de enxertos meniscais humanos armazenados em banco de tecido

Abstract Objectives The present paper aims to evaluate and compare the histological features of fresh and frozen menisci stored in a tissue bank for 1 month and for 5 years. Methods The meniscal grafts were subjected to a histological study. A total of 10 menisci were evaluated; 2 were frozen for 5 years, 4 were frozen for 1 month, and 4 were fresh, recently harvested specimens. Histological properties were evaluated in sections stained with hematoxylin and eosin and Masson trichrome methods. Results The menisci frozen for 1 month showed partially preserved collagen fiber structure and no significant hydropic tissue degeneration. The menisci frozen for 5 years presented an evident dissociation of collagen fibers and multiple foci of hydropic degeneration. Discussion Degeneration was much more significant in menisci stored for 5 years, indicating that a long freezing period results in substantial progression of tissue deterioration. This may suggest that the 5-year period, considered the maximum time for graft storage before transplant, is too long. Conclusion Grafts stored for 1 month showed a slight degenerative change in collagen fibers, whereas menisci frozen for 5 years presented significant tissue degeneration.

Resumo Objetivos Avaliar e comparar as características histológicas de meniscos frescos e meniscos congelados armazenados em banco de tecidos por 1 mês e por 5 anos. Métodos Foi feito um estudo histológico com enxertos meniscais. Avaliamos 10 meniscos, sendo 2 que ficaram armazenados sob congelamento por 5 anos, 4 armazenados congelados por 1 mês, e 4 frescos, recém captados. Foram feitos cortes histológicos corados com hematoxilina e eosina e Tricrômico de Masson, para avaliação das propriedades histológicas. Resultados Os meniscos congelados por 1 mês apresentaram preservação parcial da estrutura das fibras colágenas, sem degeneração hidrópica significativa do tecido. Nos meniscos congelados por 5 anos, observamos dissociação evidente das fibras colágenas, com presença de múltiplos focos de degeneração hidrópica. Discussão Encontramos degeneração bem mais significativa nos meniscos armazenados por 5 anos, o que indica que o longo período de congelamento leva à progressão significativa da degeneração do tecido. Isto pode sugerir que o período de 5 anos, considerado período máximo que o enxerto pode permanecer armazenado antes de ser transplantado, é um período muito longo. Conclusão Nos enxertos armazenados por 1 mês, existiu apenas discreta alteração degenerativa das fibras colágenas, enquanto que nos meniscos com 5 anos de congelamento foi observada degeneração significativa do tecido. Tibiais

Comparative Study of the Osteointegration of Irradiated and Non-irradiated Bone Grafts Used in Patients with Revision Hip Arthroplasty / Estudo comparativo da osteointegração de enxertos ósseos irradiados e não irradiados utilizados em pacientes com revisão de artroplastia do quadril

Abstract Objective To evaluate and compare the osteointegration of irradiated and nonirradiated frozen bone grafts used in 21 patients undergoing revision hip arthroplasty procedures with the Exeter technique. Methods A retrospective study of 21 patients undergoing revision hip arthroplasty with the Exeter technique using bone tissues treated or not with gamma radiation between 2013 and 2014. The patients were divided into two groups according to the use of grafts treated or not with ionizing radiation (gamma rays); as such, these groups were classified as irradiated or non-irradiated. The osteointegration results determined by radiographic analysis of these grafts were compared in the postoperative period of 6 and 12months. Results Comparing the graft osteointegration in all patients at 6 and 12months postoperatively, we noticed a significant difference in the radiographic evaluations in this period (p = 0.031). Out of the patients studied, 7 were from the irradiated group, and 14 belonged to the non-irradiated group. No statistically significant differences were observed (p = 0.804) regarding osteointegration when we compared the irradiated and non-irradiated groups. Conclusion There was no significant difference in the use of irradiated or nonirradiated grafts in revision hip arthroplasty procedures with the Exeter technique.

Resumo Objetivo Avaliar e comparar a osteointegração dos enxertos ósseos congelados irradiados e não irradiados utilizados em 21 pacientes submetidos a revisão de prótese do quadril pela técnica Exeter. Métodos Foi realizado estudo retrospectivo de 21 pacientes submetidos a revisão de artroplastia do quadril pela técnica Exeter comutilização de tecidos ósseos tratados ou não com radiação gama no período entre 2013 e 2014. Dividimos os pacientes em dois grupos, de acordo com o uso do enxerto tratado ou não com radiação ionizante (raios gama), que foram, portanto, classificados como: grupo irradiado e não irradiado. Os resultados da osteointegração por análise radiográfica destes enxertos foram comparados no pós-cirúrgico de 6 e 12 meses. Resultados Quando comparamos a osteointegração dos enxertos no pós-cirúrgico de 6 e 12 meses de todos os pacientes, notamos que houve diferença significativa entre as avaliações radiográficas neste período (p= 0,031). Dos pacientes estudados, 7 pertenciam ao grupo irradiado, e 14, ao grupo não irradiado. Não foram observadas diferenças estatisticamente significativas (p= 0,804) quando a osteointegração entre os grupos irradiados e não irradiados foi comparada. Conclusão Não houve diferença significativa no uso de enxerto irradiado e não irradiado nas revisões de artroplastias do quadril pela técnica Exeter.

Proposal for the development of a human biological material management system for research hospitals

In this paper, the authors suggest more effective conditions for human tissue preparation in research hospitals. Because recent genetic and molecular studies have contributed to the rapid development of molecular and genetic medicine, human tissue is now again being considered as a valuable research resource. Basically, high-quality research-oriented tissue bank organizations are a very important part of a research hospital. The current management system for human tissue, however, is not very effective from either legal or practical perspectives. In this article, the authors propose some improvements on the human tissue management system. The laws on human tissue such as the Bioethics and Safety Act should be changed to contain suitable language applying on-site and efficient multi-dimensional information. Informed consent should be an essential requirement before surgery. Pathologists should be supported as the essential manpower of human tissue banks by law. A committee composed of a clinician, researcher, pathologist, information manager, and coordinator should be established to manage human tissue banks in hospitals. The Institutional Review Board should pay more attention to preventing the leakage of the private information of donors, and researchers should know about the review process and guidelines. This suggestion will create a more stable and effective system for the management of human tissue banks, and it will also create a complete and integrated system for research institutions. Therefore, human tissue banks can play an important role in improving research hospitals' competitiveness by providing a valuable collection of material for research.

Tissue preservation and cell culture of Przewalskii´s horse (Equus przewalskii): an endangered species / Preservação de tecidos e cultura de células do cavalo de Przewalski (Equus przewalskii): uma espécie em extinção

The Przewalskii´s horse or Mongolian wild horse (Equus przewalskii, Poljakov, 1881) is presently the only species of wild horse in existence. Originally from Asia, it is, classified as in extremely high risk of extinction which puts the species in the seriously threatened category. The aim of this work was the preservation of tissues and the development of cell cultures from tissue samples obtained from a Przewalskii´s horse after its death. Biopsies of skin, skeletal and cardiac muscle, and ear cartilage were removed from a recently dead horse, added to Phosphate Buffer Saline (PBS) and refrigerated until processing. Some of the samples were frozen in liquid nitrogen and the other was grown as explants to generate fibroblast cell monolayers. The cell cultures obtained, were subsequently propagated with low passages, and frozen in liquid nitrogen, thus avoiding genetic and phenotypic alterations. The tissues and cell cultures were thawed to ascertain their viability by checking its progressive grow in a flask. It was not possible to obtain cultures from cardiac muscle. A bank of tissues and cells from the single Przewalskii´s horse that existed in Uruguay was generated, and can be used for scientific purposes and for the conservation of the species in the future

Avaliação da qualidade das córneas doadoras em relação à idade do doador e causa do óbito / Evaluation of the quality of donor corneas in relation to the age of donor and cause of death

OBJETIVO: Analisar a qualidade das córneas avaliadas em lâmpada de fenda no Banco de Tecidos Oculares do Hospital de Clínicas da Universidade Federal do Paraná (BTO HC-UFPR) relacionando com a idade e causa de óbito. MÉTODOS: Foram analisadas retrospectivamente fichas de avaliações padronizadas de 492 córneas, avaliadas no BTO HC-UFPR, do período de agosto de 2006 a agosto de 2008. Cada córnea avaliada foi classificada em relação a sua qualidade em: Muito bom, bom, regular e ruim; mediante os seguintes fatores: claridade da córnea, edema epitelial, defeito epitelial, edema estromal, dobras de Descemet, opacidade estromal, cicatrizes corneanas, densidade endotelial e guttata. RESULTADOS: A idade média dos doadores foi de 42,74 anos (dp=17,77). Dentre as causas de óbito, a mais comum foi trauma com 46,18 por cento, seguindo por causas cardiovasculares com 41,86 por cento. Na avaliação da córnea, foram classificadas: 57,11 por cento como "bom", seguido por 20,73 por cento "regular", 16,87 por cento "muito bom" e 5,28 por cento "ruim". Com aplicação de testes estatísticos baseados em modelo de regressão ordinal verificou-se que as córneas provenientes de mortes por traumas tendem a ser melhores, bem como aquelas de pacientes mais jovens. CONCLUSÕES: Estatisticamente, córneas de doadores mais jovens tendem a ter melhores graduações na avaliação, bem como córneas provenientes de doadores com morte por trauma tendem a ser de melhor qualidade quando comparadas com as provenientes de mortes por doenças cardiovasculares e outras doenças sistêmicas.

PURPOSE: To analyze the quality of the corneas evaluated by slit lamp examination in the Eye Bank of the Hospital de Clínicas UFPR and its relation to donor age and cause of death. METHODS: Analysis of 492 corneas, evaluated in BTO HC-UFPR between August 2006 to August 2008. Each cornea was classified regarding the quality as: very good, good, regular and bad; and according to clarity, epithelial defect, stromal edema, Descemet's folds, stromal opacity, corneal scarring, endothelial density and guttata. RESULTS: The mean donor age was 42.74 years (sd=17.77 years). Among the causes of death, trauma was the most common with 46.18 percent, followed by cardiovascular causes with 41.86 percent. In relation to the cornea, 57.11 percent were classified as "good", followed by 20.73 percent as "regular", 16.87 percent as "very good" and 5.28 percent as "bad". With the application of statistical tests based on ordinal regression model, trauma deaths corneas tend to be better, as well as those of younger patients. CONCLUSIONS: Statistically, the corneas from younger donors tend to have better graduations in the assessment, as well as the corneas from donors dead by trauma that tend to have better quality when compared to corneas from donors dead by cardiovascular and other systemic diseases.

Their Roles and Functions of the Tissue Banks

Tissue bank with profer personnels (medical director, tissue bank speciality, and so on), facilities, equipments, standard of procedures (SOP) and quality control (QC) programs should get the permission from Korea Food and Drug Administration (KFDA). All kinds of tissues are donated from live donors, cadavers or brain deaths without any rewards. Permission to acquire tissues shall be obtained through the granting of informed consent by a consenting person in accordance with applicable Korean law and regulations for anatomical gifts. One or two more tissue banks participate in recovery, preservation, quarantine, processing, packaging, storage, and/or distribution. The relationship and responsibilities of each shall be delineated in writing and that documentation shall be maintained at each participating bank or facility. Each tissue bank should keep the safety for all tissues under the strict SOP and QC programs, including donor screening, donor testing and donor exclusion criteria. And also, the final human tissue products should keep in sterile package and transfer to medical facilities for reconstruction of patients' defects under profer temperature within transportation containers. Potential adverse reactions, suspected transmission of disease or complications, directly or indirectly related the allograft, shall be reported to KFDA for the further safety

Establishment of the allograft menisci bank and preliminary clinical application / 中国矫形外科杂志

[Objective] To investigate the establishment of the Allograft Menisci Bank so as to provide suitable allograft meniscus for clinical study of allograft meniscus transplantation.[Method]The allograft menisci from the plentiful donors of the tissue bank were achieved and preserved with the deep-frozen technique.Clinical use of allograft menisci should be based on practical requirement of patients and the data recorded in the Menisci Bank.[Result]From 2005 to the end of 2006,an Allograft Menisci Bank was established which consisted with about 300 different-sized menisci and 14 allograft menisci were provided for clinical study.[Conclusion]Establishment of the Allograft Menisci Bank can provide a base for clinical meniscus transplantation.The short-term effects of the allograft menisci transplantation are satisfactory,but the long-term outcomes need more cases and further observation.

Bacterial Contamination of Allografts from Living Donors / 대한정형외과학회잡지

PURPOSE: To analyze the rate of allograft contamination from living donors using a swab culture method and to determine the necessity of antibacterial processing. MATERIALS AND METHODS: From September 2001 to June 2004, 334 allografts were obtained from living donors undergoing total joint arthroplasty. Two hundred and fourteen allografts were obtained from the femoral heads, 86 from the knee joint, and 34 from other sources. All allografts from donors with inflammatory diseases were discarded. After retrieving the graft, the entire surface of the allograft was carefully swabbed, and the specimen was inoculated and cultured on blood agar for 48 hours. A bacterial culture with the entire tissue was also carried out on discarded allografts, and the rate of contamination was compared with that of used allografts. RESULTS: Of the 334 allografts, 20 (6%) allografts were culture positive using swab method. 132 allografts were discarded. The reasons for discarding were a prior medical history in 26, no informed consent in 54 and a positive blood test in 10. The rate of contamination of the discarded allografts was 15% (20/132) using the swab method, and 19% (25/132) using entire tissue culture method. The sensitivity of the swab culture technique was only 44%. CONCLUSION: The low sensitivity implies that the swab method is unsuitable for detecting bacterial contamination. Unprocessed swab-culture-negative grafts may be contaminated with organisms that can cause infections. Therefore, additional antibiotic processing such as gamma-irradiation will be required.

Bioethical Review on the Use of Human Tissue

Hospitals and medical research institutions have vast holdings of tissues stored in tissue banks. Tissue can end up in a tissue bank for many different reasons. Tissue samples are taken as part of normal diagnostic procedures, and the remaining samples after analysis may be stored for secondary analysis to confirm the diagnosis, for quality control or for research purposes. If the tissues have been stored properly, in principle, it is possible to perform almost all the genetic tests. This opens up possibilities for an expanded use of such tissues in medical research, and therefore tissue banks have become scientifically and economically valuable resources. New genetic testing technologies with their scientific and economic potential are raising ethical concerns about the use of older, stored tissue samples, in particular those that were obtained for one purpose and can now be used for other purposes. Much of these tissues was obtained without consent or with a consent that does not cover genetic testing. There are no general ethical guidelines that can decide whether a specific research project is justifiable. In some cases, proxy consent or an analysis of ownership may be useful. However, use of tissue samples, in most cases, will depend on whether the project is worthwhile and ethically acceptable according to today's standards.

A Non-Frozen Living Tissue Bank for Allotransplantation Using Green Tea Polyphenols

Generally, mammalian cells and living tissues can be cryopreserved in a frozen state at very low temperatures over a long storage term. The survival rate of cell suspensions is often acceptable however, living tissues suffer a variety of injuries. In this paper, it was demonstrated that the addition of polyphenols extracted from green tea to conventional cell culture medium and tissue compatible liquid, can control cell proliferation and also preserve tissues for several months at ordinary room temperature, including such tissues as blood vessels, cartilage, islet cells and corneas. This protocol allows a non-frozen living tissue bank to be established using the preservation fluid described.

Legal Issues in Tissue Bank

Tissue transplantation is a modern medical technology which develops rapidly and raises many ethical, legal, and political issues. In Korea, many tissue transplantations are performed and many tissue banks seem to be managed. However, there are no legal regulations and standards which control these behaviors. When we discuss tissue transplantations and tissue banking, the safety of tissues, the respect for donors' autonomy, the proper operation of the tissue bank, and the fair distribution of the tissues must be taken into account. And the autonomic regulation by medical professionals must be considered. An Act that controls tissue transplantation and tissue banking must be established, and must be enforced. The Act must be in harmony with the autonomic regulation by medical professionals. The practices that may pose severe risk to human body or threat to human life must be banned, and persons who perform this kind of practices must be punished. However, if the practices remain within the acceptable range, medical professionals can do their practices legally.

Ethical Issues Related to Tissue Banking

Organ transplantations have become popular procedures for diseases in modern medical field with developing medical science. There have been so many hot discussions about ethical issues of organ transplantation, especially brain death, whenever medical ethics was addressed. However, we have not so far discussed ethical issues related to tissue banking, even though the history of tissue banking in medicine is longer than that of organ transplantation and the range of use of Human-based tissues is wider than that of organ transplantation. Tissue banking has medically and ethically similar aspects with organ transplantation, but tissue banking system has unique characteristics in total process. Ethical questions related to tissue banking involve informed consent, conflicts of interest, and the equitable distribution of human-based tissues and related profit issues. Families expect that their beloved ones' tissue will be used to improve the lives of people with medical needs, either through transplantation or medical research. However, concerns have been raised that some tissue might be used for purpose other than those intended by the donor. Donors may intend or believe that donated skin shall be used for the treatment of burn victims. However, in some cases it might be used for elective cosmetic surgery. It is not clear how much human-based tissues are currently used for cosmetic purposes, but there is always a potential commercial application of human-based tissues. The question is whether this is morally acceptable. We should always honor and treat with respect to the donors' wishes, and distribute the human-based tissues maximizing its usefulness and minimizing its hazards and waste the tissue.

Current Status of the Bone Bank in Korea and a Proposal for Quality Improvement of the Bank

Since surgical bone banks were set up at several university hospitals in early 1970s, the number of allograft is getting increased in Korean society. Most orthopedic surgeons have used allografts supplied by their own surgical bone banks for tumor reconstruction, arthroplasty, and ligament reconstruction. In 2000, a nation-wide survey for surgical bone banks was performed by Korean orthopedic Association. The questionnaires were prepared by the Committee on Tissue Bank in the Association, and sent to 110 university and training hospitals. Fifty-six surgical bone banks were encountered. However, facilities of the banks were not updated. Most of them were using one or two deep freezers only. Most of them do not have a full-time technician. While most bone banks were using surgically excised femoral heads and amputated limbs, some banks retrieved the tissues from cadaver or organ donors. Since the law for organ transplantation from brain death was established in February 2000, the number of allograft transplantation is growing tremendously. In order to secure the safety of allograft transplantation, the enactment of "the Law for Tissue Transplantation" is mandatory. Unlike organs, the tissues can be procured and stored in advance and can be used whenever they are needed by establishing and operating a form of tissue bank. Therefore, since it is difficult to regulate or supervise tissue banking by "the Law on the Organs and Transplantation", the enactment of a separate law is highly recommended. The government should set the certification standards for the bone and tissue banks suitable for the domestic circumstances. The request of certification of bone and tissue banks should be obtained by the banks that are currently in operation. Also, actual inspection team should be organized involving the professionals and public officers. This team will be responsible for audit of the banks. The certified bone and tissue banks should renew by paper review or actual inspection every 2~3 years. For safe and smooth operation of the banks, the licence system for certified tissue bank specialist(CTBS) should be adopted. Requirements such as academic requirement or professional experience in bone and tissue banks for a certain period of time will be needed.

Cryopreservation of Cardiovascular Tissue

Since Dr. Angell introduced cryopreservation method for tissue preservation in 1980s, it became a preferred method for cardiovascular tissues. Cryopreservation has been proven to provide better cell viavility and clinical result than any other preservation method. The quality of cryopreserved cardiovascular tissue is a very critical point of patients' survival when transplanted. To obtain high quality cryopreserved tissue, each processing methods from harvesting to delivery should be standardized. Various factors, such as range of possible tissues, acceptable ischemic time, temperature during transportation, facility for processing, method of freezing, use of cryoprotectant, method of storage, condition of delivery, and method of thawing for cardiovascular tissues should be standardized. Different standards should be established and applied to different tissues. Various kinds of tissues can be harvested from each living or cadaveric donor. Therefore, it is reasonable to harvest and handle all tissues in one laboratory by one tissue bank. In U.S.A, tissue banks are operated under standardized condition. The American Association of Tissue Banks affords the certification of specialist and tissue banks on very strict conditions, and provides the Food and Drug Administration with consultation in making regulations regarding tissue transplantation. In Korea, tissues have been simply stored in refrigerator since mid 1990s, and cryopreservation method is getting popular. Tissue banking has been started recently and now six major hospitals treat the cardiovascular tissues and are equipped with good facilities. Korean Association of Tissue Banks was established last year and now setting up regulations and standards. In Conclusion, I suggest that the cardiovascular tissue bank should belong to a university hospital till regulations and standards are completed. And then commercial tissue bank will be able to take it over to manage more tissues. The financial state of tissue banking is also an important point to be considered to balance between quality control and easy access to the public. Also the cost of cryopreserved allograft should be covered by medical insurance.

Tissue Bank : Current Status and Development in the Field of Plastic Surgery in Korea

The brief history of human tissue bank is reviewed, and the current status of tissue bank in the field of plastic surgery in Korea is presented. We sent a questionnaire to 58 plastic and reconstructive surgery training hospitals. The survey was completed in 27 hospitals. The results were as follows : the number of hospitals managing a tissue bank was 16, and the remaining 11 hospitals did not manage a tissue bank. Less than 30% of the plastic and reconstructive surgery training hospitals' tissue banks were managed by the plastic and reconstructive department by itself. In the field of plastic surgery in Korea, skin banks are most popular among the tissue banks. The development of the national skin bank is needed and there are a lot of parts to be improved in the management of tissue banks.

Establishment and Management of Pediatric Tumor Tissue Bank / 대한소아혈액종양학회지

PURPOSE: Current pediatric cancer research requires an organized pediatric tumor tissue bank with standardized guidelines for preparation and storage of human tumor tissue samples, white cells, serum, genomic DNA, RNA, cDNA and proteins.. Our institution established and managed pediatric tumor tissue bank for the last one year, and we want to present an overview of our experiences and guidelines. METHODS: From leukemia patients, peripheral blood and bone marrow aspirates were collected at initial diagnosis. Leukemic cells were prepared by Ficoll density-gradient centrifugation and stored at 196oC liquid nitrogen. For solid tumors, tissue cultures were performed as soon as possible after surgical excision or needle biopsy. Serum free media and primary cultured cells were collected and stored at 20degrees C and at 196degrees C, respectively. Genomic DNA, RNA and cDNA were isolated from leukemic cells and cultured solid tumor cells, and stored at 20degrees C. We also isolated genomic DNA from white blood cells of solid tumor patients and stored at 20degrees C. Finally we collected serum samples from all pediatric cancer patients at diagnosis and stored at 20degrees C. RESULTS: Among the 41 cases of leukemia and 100 cases of solid tumor patients who were diagnosed at department of pediatrics, Samsung Medical Center, from August 2000 to July 2001, 26 cases (63%) of leukemia and 59 cases (59%) of solid tumor patients were registered to Pediatric Tumor Tissue Bank. Primary cell cultures were performed in 21 cases of solid tumors and were successful in 19 cases (90%). The isolated genomic DNA, RNA and cDNA were all in high quality confirmed by electrophoresis in agarose gel. CONCLUSION: The problem of tissue sample size obtained by needle biopsy could be overcome by primary cell cultures. For the effective management of pediatric tumor tissue bank, fresh tissue collection with active cooperation of surgeons, organized personnel structure, and multidisciplinary standardized guidelines are necessary.