The origins of the vaccine cold chain and a glimpse of the future

International efforts to eradicate smallpox in the 1960s and 1970s provided the foundation for efforts to expand immunization programmes, including work to develop immunization supply chains. The need to create a reliable system to keep vaccines cold during the lengthy journey from the manufacturer to the point of use, even in remote areas, was a crucial concern during the early days of the Expanded Programme on Immunization. The vaccine cold chain was deliberately separated from other medical distribution systems to assure timely access to and control of vaccines and injection materials. The story of the early development of the vaccine cold chain shows how a number of challenges were overcome with technological and human resource solutions. For example, the lack of methods to monitor exposure of vaccines to heat during transport and storage led to many innovations, including temperature-sensitive vaccine vial monitors and better methods to record and communicate temperatures in vaccine stores. The need for appropriate equipment to store and transport vaccines in tropical developing countries led to innovations in refrigeration equipment as well as the introduction and widespread adoption of novel high performance vaccine cold-boxes and carriers. New technologies also helped to make injection safer. Underlying this work on technologies and equipment was a major effort to develop the human resources required to manage and implement the immunization supply chain. This included creating foundational policies and a management infrastructure; providing training for managers, health workers, technicians, and others. The vaccine cold chain has contributed to one of the world's public health success stories and provides three priority lessons for future: the vaccine supply chain needs to be integrated with other public health supplies, re-designed for efficiency and effectiveness and work is needed in the longer term to eliminate the need for refrigeration in the supply chain.

Biopreservation of hepatocytes: current concepts on hypothermic preservation, cryopreservation, and vitrification

Isolated liver cells (primarily isolated hepatocytes) have found important applications in science and medicine over the past 40 years in a wide range of areas, including physiological studies, investigations on liver metabolism, organ preservation and drug de-toxification, experimental and clinical transplantation. An integral component of many of these works is the need to store the isolated cells, either for short or long-term periods. This review covers the biopreservation of liver cells, with a focus on the history of liver cell biopreservation, the application of hypothermia for short-term storage, standard cryopreservation methods for isolated hepatocytes, the biopreservation of other types of liver cells, and recent developments such as vitrification of hepatocytes. By understanding the basis for the different approaches, it will be possible to select the best options for liver cell biopreservation in different applications, and identify ways to improve preservation protocols for the future.

Stratospheric ozone, global warming, and the principle of unintended consequences--an ongoing science and policy success story

In 1974, Mario Molina and F. Sherwood Rowland warned that chlorofluorocarbons (CFCs) could destroy the stratospheric ozone layer that protects Earth from harmful ultraviolet radiation. In the decade after scientists documented the buildup and long lifetime of CFCs in the atmosphere; found the proof that CFCs chemically decomposed in the stratosphere and catalyzed the depletion of ozone; quantified the adverse effects; and motivated the public and policymakers to take action. In 1987, 24 nations plus the European Community signed the Montreal Protocol. Today, 25 years after the Montreal Protocol was agreed, every United Nations state is a party (universal ratification of 196 governments); all parties are in compliance with the stringent controls; 98% of almost 100 ozone-depleting chemicals have been phased out worldwide; and the stratospheric ozone layer is on its way to recovery by 2065. A growing coalition of nations supports using the Montreal Protocol to phase down hydrofluorocarbons, which are ozone safe but potent greenhouse gases. Without rigorous science and international consensus, emissions of CFCs and related ozone-depleting substances (ODSs) could have destroyed up to two-thirds of the ozone layer by 2065, increasing the risk of causing millions of cancer cases and the potential loss of half of global agricultural production. Furthermore, because most, ODSs are also greenhouse gases, CFCs and related ODSs could have had the effect of the equivalent of 24-76 gigatons per year of carbon dioxide. This critical review describes the history of the science of stratospheric ozone depletion, summarizes the evolution of control measures and compliance under the Montreal Protocol and national legislation, presents a review of six separate transformations over the last 100 years in refrigeration and air conditioning (A/C) technology, and illustrates government-industry cooperation in continually improving the environmental performance of motor vehicle A/C.

Follow-up study of the use of refrigerated homogenous bone transplants in orthopaedic operations : Philip D. Wilson MD (1886-1969). The 3rd president of the AAOS 1934

Philip Duncan Wilson was born in Columbus, Ohio. His father was a family physician who held the Chair of Obstetrics in the Sterling Medical School [1]. The young Philip graduated from Harvard College in 1909 and then served as President of his graduating class at Harvard Medical School. He spent two years as a surgical intern at MGH, after which he returned to Columbus to practice. During WWI he was invited back to Boston to join the Harvard Unit under Harvey Cushing, and served with that unit when it was housed in the Lycée Pasteur. (The members of that unit included Marius Smith-Petersen, who also spent many years at the Massachusetts General Hospital and also became AAOS President.) He rejoined MGH on the staff in 1919. In 1925 he published an influential monograph with W.A. Cochrane (formerly of the Edinburgh Royal Infirmary), entitled, “Fractures and Dislocations” [5].

Toward the end of his years in Boston he helped found the American Academy of Orthopaedic Surgeons. In 1934 he was appointed as Surgeon-in-Chief at the Hospital for the Ruptured and Crippled in New York City. Dr. Wilson was active in many organizations, and reorganized and renamed the hospital he served (Hospital for Special Surgery), oversaw the building of a new hospital at its current site on the Cornell University medical campus, and raised money for a large research building. His zest inspired generations, and he was known for his gracious hospitality.

Dr. Wilson was one of three of the first fifteen Presidents (the others being Drs. John C. Wilson, Sr. and Melvin Henderson) whose son (Dr. Philip D. Wilson, Jr.) succeeded him as a President of the American Academy of Orthopaedic Surgeons.

Dr. Wilson had a long interest in bone grafting and wrote numerous research papers, a few of which are referenced here [2–4]. In the article reprinted in this issue [3], he described the rapid increase in use of a bone bank he developed at the Hospital for Special Surgery in 1946: 19 operations using grafts in 1946, 48 in 1947, 106 in 1948, 134 in 1949, and 259 in 1950. He describes his animal experiments with autogenous grafts in which grafts rapidly incorporated. He further describes biopsies of previously implanted autogenous and homogenous bone transplants in patients undergoing serial fusions for scoliosis. The pathologist (Dr. Milton Helpern) commented they found “...no evidence that the cells in the bone transplants survived...” Autogenous grafts, his evidence suggested, incorporated more rapidly that homogenous grafts, but “...in the end the results are the same.” His followup studies suggested successful incorporation of graft in 210 of 248 cases. Philip Duncan Wilson, MD is shown. Photograph is reproduced with permission and ©American Academy of Orthopaedic Surgeons. Fifty Years of Progress , 1983.

References

Philip Duncan Wilson, MD 1886–1969. J Bone Joint Surg Am . 1969;51:1445–1447. Wilson PD. Experiences with a bone bank. Ann Surg . 1947;126:932–945. Wilson PD. Experience with the use of refrigerated homogenous bone. J Bone Joint Surg Br . 1951;33:301–315. Wilson PD. Follow-up study of the use of refrigerated homogenous bone grafts in orthopaedic operations. J Bone Joint Surg Am . 1951;33:307–323. Wilson PD, Cochrane WA. Fractures and Dislocations . Philadelphia, PA: JB Lippincott; 1925.