WEBVTT NOTE duration:"01:03:49" NOTE recognizability:0.795 NOTE language:en-us NOTE Confidence: 0.857601583333333 00:00:00.000 --> 00:00:02.235 OK. Hello everyone and welcome NOTE Confidence: 0.857601583333333 00:00:02.235 --> 00:00:04.023 to pathology grand rounds. NOTE Confidence: 0.857601583333333 00:00:04.030 --> 00:00:06.130 So this week we have the pleasure NOTE Confidence: 0.857601583333333 00:00:06.130 --> 00:00:07.849 of welcoming a new speaker, NOTE Confidence: 0.857601583333333 00:00:07.850 --> 00:00:08.956 Doctor Andre Moreira. NOTE Confidence: 0.857601583333333 00:00:08.956 --> 00:00:11.370 And so doctor Andre Moreira has NOTE Confidence: 0.857601583333333 00:00:11.370 --> 00:00:13.512 a long CV amongst many things. NOTE Confidence: 0.857601583333333 00:00:13.512 --> 00:00:15.122 He's a professor of pathology NOTE Confidence: 0.857601583333333 00:00:15.122 --> 00:00:17.150 at the New York University. NOTE Confidence: 0.857601583333333 00:00:17.150 --> 00:00:19.406 He's the director of surgical pathology, NOTE Confidence: 0.857601583333333 00:00:19.410 --> 00:00:21.840 director of the Center for Biospecimen NOTE Confidence: 0.857601583333333 00:00:21.840 --> 00:00:23.460 Research and Development and NOTE Confidence: 0.857601583333333 00:00:23.523 --> 00:00:25.183 Director of Thoracic Pathology NOTE Confidence: 0.857601583333333 00:00:25.183 --> 00:00:26.843 in the same institution. NOTE Confidence: 0.857601583333333 00:00:26.850 --> 00:00:28.835 He has over 190 publication NOTE Confidence: 0.857601583333333 00:00:28.835 --> 00:00:30.290 has been very active. NOTE Confidence: 0.857601583333333 00:00:30.290 --> 00:00:32.882 The field of thoracic pathology done NOTE Confidence: 0.857601583333333 00:00:32.882 --> 00:00:35.297 many contributions in lung cancer, NOTE Confidence: 0.857601583333333 00:00:35.300 --> 00:00:37.320 non tumor lung pathology, NOTE Confidence: 0.857601583333333 00:00:37.320 --> 00:00:38.835 but also mesothelioma, NOTE Confidence: 0.857601583333333 00:00:38.840 --> 00:00:41.540 thymoma and other related diseases. NOTE Confidence: 0.857601583333333 00:00:41.540 --> 00:00:43.437 I realize now he has a lot of expertise NOTE Confidence: 0.857601583333333 00:00:43.440 --> 00:00:46.218 in transplant pathology and and other NOTE Confidence: 0.857601583333333 00:00:46.220 --> 00:00:49.640 areas that are very prominent at NYU. NOTE Confidence: 0.857601583333333 00:00:49.640 --> 00:00:52.272 So he's clinical expertise is very, NOTE Confidence: 0.857601583333333 00:00:52.272 --> 00:00:52.704 very prominent. NOTE Confidence: 0.857601583333333 00:00:52.704 --> 00:00:54.556 He has trained many people. NOTE Confidence: 0.857601583333333 00:00:54.556 --> 00:00:57.730 A few months ago I visited NYU and NOTE Confidence: 0.857601583333333 00:00:57.730 --> 00:00:59.482 I realized that he actually has NOTE Confidence: 0.857601583333333 00:00:59.482 --> 00:01:01.668 other skills that we didn't know. NOTE Confidence: 0.857601583333333 00:01:01.670 --> 00:01:03.482 And because of that I requested NOTE Confidence: 0.857601583333333 00:01:03.482 --> 00:01:05.188 him to speak about a slightly NOTE Confidence: 0.857601583333333 00:01:05.190 --> 00:01:06.314 different topic this time. NOTE Confidence: 0.857601583333333 00:01:06.314 --> 00:01:08.000 So he will not do the NOTE Confidence: 0.857601583333333 00:01:08.066 --> 00:01:09.710 traditional pathology based, NOTE Confidence: 0.857601583333333 00:01:09.710 --> 00:01:10.966 you know, NOTE Confidence: 0.857601583333333 00:01:10.966 --> 00:01:12.850 morphology centered or NOTE Confidence: 0.857601583333333 00:01:12.850 --> 00:01:14.124 clinically oriented talk, NOTE Confidence: 0.857601583333333 00:01:14.124 --> 00:01:15.888 but he will talk about another NOTE Confidence: 0.857601583333333 00:01:15.888 --> 00:01:17.400 operation he has been running NOTE Confidence: 0.857601583333333 00:01:17.400 --> 00:01:18.825 for the last six years, NOTE Confidence: 0.857601583333333 00:01:18.830 --> 00:01:19.718 which is a a NOTE Confidence: 0.8982988 00:01:19.730 --> 00:01:22.020 very important and frequently underestimated NOTE Confidence: 0.843228625 00:01:22.030 --> 00:01:23.821 by repository operation. NOTE Confidence: 0.843228625 00:01:23.821 --> 00:01:26.290 So what he has been doing is supporting NOTE Confidence: 0.843228625 00:01:26.290 --> 00:01:28.670 the whole institution in collecting, NOTE Confidence: 0.843228625 00:01:28.670 --> 00:01:30.239 processing and distributing NOTE Confidence: 0.843228625 00:01:30.239 --> 00:01:31.808 biospecimens for research. NOTE Confidence: 0.843228625 00:01:31.810 --> 00:01:33.282 And this is a substantial NOTE Confidence: 0.843228625 00:01:33.282 --> 00:01:34.794 operation he will talk about. NOTE Confidence: 0.843228625 00:01:34.794 --> 00:01:37.194 And I think the role of the pathologist NOTE Confidence: 0.843228625 00:01:37.194 --> 00:01:39.586 in this type of operations I think NOTE Confidence: 0.843228625 00:01:39.586 --> 00:01:41.671 is very important and it's something NOTE Confidence: 0.843228625 00:01:41.671 --> 00:01:43.806 worth learning about and noting. NOTE Confidence: 0.843228625 00:01:43.810 --> 00:01:45.862 So without further ado, NOTE Confidence: 0.843228625 00:01:45.862 --> 00:01:49.400 I welcome Doctor Moreda and thank you. NOTE Confidence: 0.843228625 00:01:49.400 --> 00:01:50.504 Thank you, Kurt, NOTE Confidence: 0.843228625 00:01:50.504 --> 00:01:52.712 for the introduction and for the NOTE Confidence: 0.843228625 00:01:52.712 --> 00:01:54.439 invitation to talk to you today. NOTE Confidence: 0.843228625 00:01:54.440 --> 00:01:56.124 So as I said, NOTE Confidence: 0.843228625 00:01:56.124 --> 00:01:59.860 what I'm going to talk today is not very NOTE Confidence: 0.843228625 00:01:59.860 --> 00:02:01.738 traditional even for a grand rounds, NOTE Confidence: 0.843228625 00:02:01.740 --> 00:02:04.764 but I think it is interest especially NOTE Confidence: 0.843228625 00:02:04.764 --> 00:02:07.305 for pathologists to see different areas NOTE Confidence: 0.843228625 00:02:07.305 --> 00:02:10.320 that we can be involved and act on. NOTE Confidence: 0.843228625 00:02:10.320 --> 00:02:13.236 So the outline of the talk, NOTE Confidence: 0.843228625 00:02:13.240 --> 00:02:15.832 I'm going to say why there is a NOTE Confidence: 0.843228625 00:02:15.832 --> 00:02:18.066 need for human tissue biospecimens. NOTE Confidence: 0.843228625 00:02:18.066 --> 00:02:20.696 A little bit about collection, NOTE Confidence: 0.843228625 00:02:20.700 --> 00:02:23.172 banking processing and distribution, NOTE Confidence: 0.843228625 00:02:23.172 --> 00:02:26.262 and I'm talking mostly about NOTE Confidence: 0.843228625 00:02:26.262 --> 00:02:29.126 the model that I use at NYU. NOTE Confidence: 0.843228625 00:02:29.130 --> 00:02:32.200 Some financial considerations and the NOTE Confidence: 0.843228625 00:02:32.200 --> 00:02:35.563 challenges that inevitable will come. NOTE Confidence: 0.843228625 00:02:35.563 --> 00:02:39.829 So in the classical research model NOTE Confidence: 0.843228625 00:02:39.830 --> 00:02:42.430 we go for invitro observations, NOTE Confidence: 0.843228625 00:02:42.430 --> 00:02:45.478 testing in cell lines and then NOTE Confidence: 0.843228625 00:02:45.478 --> 00:02:47.510 move to animal models. NOTE Confidence: 0.843228625 00:02:47.510 --> 00:02:50.132 That is an easy experimentation and NOTE Confidence: 0.843228625 00:02:50.132 --> 00:02:52.777 can manipulate the system much easier NOTE Confidence: 0.843228625 00:02:52.777 --> 00:02:55.249 than anything else than in humans. NOTE Confidence: 0.843228625 00:02:55.250 --> 00:02:57.000 And then basically used to NOTE Confidence: 0.843228625 00:02:57.000 --> 00:02:58.050 formulate your questions, NOTE Confidence: 0.843228625 00:02:58.050 --> 00:03:00.180 your hypothesis and then you need NOTE Confidence: 0.843228625 00:03:00.180 --> 00:03:03.097 to go to human for a confirmation NOTE Confidence: 0.843228625 00:03:03.097 --> 00:03:05.457 and validation of your findings. NOTE Confidence: 0.843228625 00:03:05.460 --> 00:03:08.218 So the problem with this approach is NOTE Confidence: 0.843228625 00:03:08.218 --> 00:03:11.054 that it takes a very long time and NOTE Confidence: 0.843228625 00:03:11.054 --> 00:03:13.566 and there are a lot of issues that NOTE Confidence: 0.843228625 00:03:13.566 --> 00:03:16.276 why we still need human at the end. NOTE Confidence: 0.843228625 00:03:16.280 --> 00:03:16.918 For instance, NOTE Confidence: 0.843228625 00:03:16.918 --> 00:03:17.556 cell lines, NOTE Confidence: 0.843228625 00:03:17.556 --> 00:03:20.479 we know that they don't have a stable genome. NOTE Confidence: 0.843228625 00:03:20.480 --> 00:03:23.328 They may not be representative of the disease NOTE Confidence: 0.843228625 00:03:23.328 --> 00:03:26.163 that they originally came from or even from NOTE Confidence: 0.843228625 00:03:26.163 --> 00:03:28.960 the organ that they originally come from. NOTE Confidence: 0.843228625 00:03:28.960 --> 00:03:30.080 So everybody that have NOTE Confidence: 0.843228625 00:03:30.080 --> 00:03:31.200 worked with cell lines, NOTE Confidence: 0.843228625 00:03:31.200 --> 00:03:33.276 I mean there's a very well NOTE Confidence: 0.843228625 00:03:33.276 --> 00:03:34.660 known ovarian cell line, NOTE Confidence: 0.843228625 00:03:34.660 --> 00:03:36.358 there is not a single ovarian. NOTE Confidence: 0.843228625 00:03:36.360 --> 00:03:38.010 More that looks like those cells, NOTE Confidence: 0.843228625 00:03:38.010 --> 00:03:40.686 but that's where they come from. NOTE Confidence: 0.843228625 00:03:40.690 --> 00:03:43.282 So the observations may not translate NOTE Confidence: 0.843228625 00:03:43.282 --> 00:03:46.006 very well to clinical cases or NOTE Confidence: 0.843228625 00:03:46.006 --> 00:03:48.306 especially to a general population. NOTE Confidence: 0.843228625 00:03:48.310 --> 00:03:50.110 In the animal models, NOTE Confidence: 0.843228625 00:03:50.110 --> 00:03:51.910 we have different physiologies, NOTE Confidence: 0.843228625 00:03:51.910 --> 00:03:54.040 therefore there is a very NOTE Confidence: 0.843228625 00:03:54.040 --> 00:03:55.744 different response to stimuli. NOTE Confidence: 0.843228625 00:03:55.750 --> 00:03:58.288 What you can expect from humans. NOTE Confidence: 0.843228625 00:03:58.290 --> 00:04:00.666 There is a great variation in NOTE Confidence: 0.843228625 00:04:00.666 --> 00:04:02.720 morphology and especially for tumor. NOTE Confidence: 0.843228625 00:04:02.720 --> 00:04:04.610 I'll show you some examples NOTE Confidence: 0.843228625 00:04:04.610 --> 00:04:06.614 and again the observations. NOTE Confidence: 0.843228625 00:04:06.614 --> 00:04:07.616 Cannot be. NOTE Confidence: 0.843228625 00:04:07.620 --> 00:04:10.772 They may not translate very well to the NOTE Confidence: 0.843228625 00:04:10.772 --> 00:04:13.200 clinical practice or to the patients NOTE Confidence: 0.843228625 00:04:13.200 --> 00:04:15.160 due to difference in Physiology, NOTE Confidence: 0.843228625 00:04:15.160 --> 00:04:16.390 general population, NOTE Confidence: 0.843228625 00:04:16.390 --> 00:04:19.465 genomic variations and everything else. NOTE Confidence: 0.843228625 00:04:19.470 --> 00:04:21.726 So this is just some examples. NOTE Confidence: 0.843228625 00:04:21.730 --> 00:04:23.200 I'm talking about lung cancer NOTE Confidence: 0.843228625 00:04:23.200 --> 00:04:24.376 because as he said, NOTE Confidence: 0.843228625 00:04:24.380 --> 00:04:27.300 that's what I work most of the time. NOTE Confidence: 0.843228625 00:04:27.300 --> 00:04:30.188 So in in animals. NOTE Confidence: 0.843228625 00:04:30.190 --> 00:04:34.126 In most or many models of lung cancer NOTE Confidence: 0.843228625 00:04:34.126 --> 00:04:38.606 in in in mice you can modify you can NOTE Confidence: 0.843228625 00:04:38.606 --> 00:04:41.174 increase the expression of 1 gene NOTE Confidence: 0.843228625 00:04:41.174 --> 00:04:44.046 gave Ross P53 any other gene that you NOTE Confidence: 0.843228625 00:04:44.046 --> 00:04:46.590 want to express it will always form NOTE Confidence: 0.843228625 00:04:46.590 --> 00:04:49.201 exactly the same the same tumor it NOTE Confidence: 0.815492733666667 00:04:49.277 --> 00:04:52.042 start with a very small round nodule NOTE Confidence: 0.815492733666667 00:04:52.042 --> 00:04:55.058 very well behaved that there is nothing NOTE Confidence: 0.815492733666667 00:04:55.058 --> 00:04:58.105 like that in humans and if you live long NOTE Confidence: 0.815492733666667 00:04:58.105 --> 00:05:00.158 enough they will have a little bit of. NOTE Confidence: 0.815492733666667 00:05:00.160 --> 00:05:03.100 Angela formation. And like here, NOTE Confidence: 0.815492733666667 00:05:03.100 --> 00:05:05.572 so you know, it sort of starts to NOTE Confidence: 0.815492733666667 00:05:05.572 --> 00:05:07.060 recapitulate the human tissue. NOTE Confidence: 0.815492733666667 00:05:07.060 --> 00:05:09.034 But when you look at lung cancer, NOTE Confidence: 0.815492733666667 00:05:09.040 --> 00:05:11.000 it is completely variable. NOTE Confidence: 0.815492733666667 00:05:11.000 --> 00:05:13.534 There is a very high NOTE Confidence: 0.815492733666667 00:05:13.534 --> 00:05:15.256 heterogeneity in morphology. NOTE Confidence: 0.815492733666667 00:05:15.256 --> 00:05:18.700 These patterns are very much mixed NOTE Confidence: 0.815492733666667 00:05:18.787 --> 00:05:21.319 and in lung cancers in humans, NOTE Confidence: 0.815492733666667 00:05:21.320 --> 00:05:23.924 every single pattern has a different meaning, NOTE Confidence: 0.815492733666667 00:05:23.930 --> 00:05:25.832 different prognostic significance, NOTE Confidence: 0.815492733666667 00:05:25.832 --> 00:05:31.030 which you cannot reproduce in mice, OK. NOTE Confidence: 0.815492733666667 00:05:31.030 --> 00:05:34.397 So then there is has been this. NOTE Confidence: 0.815492733666667 00:05:34.400 --> 00:05:38.620 Shift in for translational research. NOTE Confidence: 0.815492733666667 00:05:38.620 --> 00:05:42.324 So this came mostly after the the TCG NOTE Confidence: 0.815492733666667 00:05:42.324 --> 00:05:46.146 study that looked at all the the genome, NOTE Confidence: 0.815492733666667 00:05:46.150 --> 00:05:48.878 the human genome so and it became available. NOTE Confidence: 0.815492733666667 00:05:48.880 --> 00:05:51.336 So it was much easier to investigate and NOTE Confidence: 0.815492733666667 00:05:51.336 --> 00:05:53.928 have that as a platform to investigate human NOTE Confidence: 0.815492733666667 00:05:53.928 --> 00:05:56.499 genomes and in in the disease as well. NOTE Confidence: 0.815492733666667 00:05:56.500 --> 00:05:59.506 So a lot of technologists especially NOTE Confidence: 0.815492733666667 00:05:59.506 --> 00:06:02.045 molecular technologists can now do NOTE Confidence: 0.815492733666667 00:06:02.045 --> 00:06:04.320 paraffin embedded tissue which is. NOTE Confidence: 0.815492733666667 00:06:04.320 --> 00:06:05.577 There's a large, NOTE Confidence: 0.815492733666667 00:06:05.577 --> 00:06:08.510 much larger amount of samples than if NOTE Confidence: 0.815492733666667 00:06:08.596 --> 00:06:12.075 you use fresh tissue or frozen tissue NOTE Confidence: 0.815492733666667 00:06:12.075 --> 00:06:14.350 specifically collected for research. NOTE Confidence: 0.815492733666667 00:06:14.350 --> 00:06:15.040 And again, NOTE Confidence: 0.815492733666667 00:06:15.040 --> 00:06:17.110 most of my clients they need NOTE Confidence: 0.815492733666667 00:06:17.110 --> 00:06:18.370 now fresh tissue, NOTE Confidence: 0.815492733666667 00:06:18.370 --> 00:06:21.560 so they create xenograft models. NOTE Confidence: 0.815492733666667 00:06:21.560 --> 00:06:25.585 Though so the collection of fresh tissue NOTE Confidence: 0.815492733666667 00:06:25.585 --> 00:06:28.741 from human for experimental pathology NOTE Confidence: 0.815492733666667 00:06:28.741 --> 00:06:32.467 or experimental models in the rise. NOTE Confidence: 0.815492733666667 00:06:32.470 --> 00:06:35.305 This is very important for drug development NOTE Confidence: 0.815492733666667 00:06:35.305 --> 00:06:37.742 and for personalized medicine because again, NOTE Confidence: 0.815492733666667 00:06:37.742 --> 00:06:39.698 you can start one lung cancer, NOTE Confidence: 0.815492733666667 00:06:39.700 --> 00:06:41.002 it's not going to be exactly NOTE Confidence: 0.815492733666667 00:06:41.002 --> 00:06:41.870 like the other one, NOTE Confidence: 0.815492733666667 00:06:41.870 --> 00:06:43.040 so they need. NOTE Confidence: 0.815492733666667 00:06:43.040 --> 00:06:46.793 That human variation in order to look at the NOTE Confidence: 0.815492733666667 00:06:46.793 --> 00:06:49.607 genomic and personalized medicine in them. NOTE Confidence: 0.815492733666667 00:06:49.610 --> 00:06:53.460 So we need a comprehensive human tissue NOTE Confidence: 0.815492733666667 00:06:53.460 --> 00:06:55.796 banking that can increase utilization. NOTE Confidence: 0.815492733666667 00:06:55.796 --> 00:06:58.540 We need to have a very well characterized NOTE Confidence: 0.815492733666667 00:06:58.598 --> 00:07:00.423 population for the scientists to NOTE Confidence: 0.815492733666667 00:07:00.423 --> 00:07:02.248 investigate and these samples need NOTE Confidence: 0.815492733666667 00:07:02.305 --> 00:07:04.629 to have clinical rotation so they can NOTE Confidence: 0.815492733666667 00:07:04.629 --> 00:07:07.760 correlate with whatever they find. NOTE Confidence: 0.815492733666667 00:07:07.760 --> 00:07:10.304 So just going to show 2 examples of NOTE Confidence: 0.815492733666667 00:07:10.304 --> 00:07:13.012 this is a recent paper that basically NOTE Confidence: 0.815492733666667 00:07:13.012 --> 00:07:16.023 talked about the need of fresh human NOTE Confidence: 0.815492733666667 00:07:16.023 --> 00:07:17.895 tissue for human research. NOTE Confidence: 0.815492733666667 00:07:17.900 --> 00:07:19.608 And here they create, NOTE Confidence: 0.815492733666667 00:07:19.608 --> 00:07:21.316 they're basically specifically talking NOTE Confidence: 0.815492733666667 00:07:21.316 --> 00:07:22.600 about Zeno graph. NOTE Confidence: 0.815492733666667 00:07:22.600 --> 00:07:26.110 What is the how, how they. NOTE Confidence: 0.815492733666667 00:07:26.110 --> 00:07:27.640 Organize their research. NOTE Confidence: 0.815492733666667 00:07:27.640 --> 00:07:30.482 Some, not all, tumors that we try NOTE Confidence: 0.815492733666667 00:07:30.482 --> 00:07:32.450 to create a scenographic will grow. NOTE Confidence: 0.815492733666667 00:07:32.450 --> 00:07:33.596 We know that. NOTE Confidence: 0.815492733666667 00:07:33.596 --> 00:07:36.945 But those that grow are becoming a very NOTE Confidence: 0.815492733666667 00:07:36.945 --> 00:07:39.925 important source for DNA fingerprinting, NOTE Confidence: 0.815492733666667 00:07:39.930 --> 00:07:43.060 genomic variations. NOTE Confidence: 0.815492733666667 00:07:43.060 --> 00:07:45.635 See absolutely models and and NOTE Confidence: 0.815492733666667 00:07:45.635 --> 00:07:49.060 drug and testing of drugs as well. NOTE Confidence: 0.815492733666667 00:07:49.060 --> 00:07:51.993 This is another paper just to show NOTE Confidence: 0.815492733666667 00:07:51.993 --> 00:07:54.000 again the limitations of mouse. NOTE Confidence: 0.815492733666667 00:07:54.000 --> 00:07:55.550 We have a mouse here, NOTE Confidence: 0.815492733666667 00:07:55.550 --> 00:07:58.022 but basically this is a study NOTE Confidence: 0.815492733666667 00:07:58.022 --> 00:08:00.857 on Melanoma where we we do not NOTE Confidence: 0.815492733666667 00:08:00.857 --> 00:08:03.053 have a mouse model for Milano. NOTE Confidence: 0.815492733666667 00:08:03.060 --> 00:08:03.565 OK, NOTE Confidence: 0.815492733666667 00:08:03.565 --> 00:08:06.595 so basically we provided in biorepository. NOTE Confidence: 0.815492733666667 00:08:06.600 --> 00:08:09.498 This is a paper from NYU that NOTE Confidence: 0.815492733666667 00:08:09.500 --> 00:08:11.060 I'm not involved as an author, NOTE Confidence: 0.815492733666667 00:08:11.060 --> 00:08:13.164 but the BIOREPOSITORY provided NOTE Confidence: 0.815492733666667 00:08:13.164 --> 00:08:15.794 the tissue for this study. NOTE Confidence: 0.815492733666667 00:08:15.800 --> 00:08:18.360 Basically they look at metastatic NOTE Confidence: 0.815492733666667 00:08:18.360 --> 00:08:19.896 Melanoma metastatic from. NOTE Confidence: 0.815492733666667 00:08:19.900 --> 00:08:21.481 Brain metastasis from, NOTE Confidence: 0.815492733666667 00:08:21.481 --> 00:08:24.649 not from the brain tissue and what NOTE Confidence: 0.815492733666667 00:08:24.649 --> 00:08:26.767 they notice there is a different NOTE Confidence: 0.815492733666667 00:08:26.767 --> 00:08:28.738 expression in protein and basically NOTE Confidence: 0.815492733666667 00:08:28.738 --> 00:08:31.072 suggests that whenever the Melanoma that NOTE Confidence: 0.8227872176 00:08:31.134 --> 00:08:33.049 establishes itself in the brain, NOTE Confidence: 0.8227872176 00:08:33.050 --> 00:08:36.804 they secrete. Upload best, NOTE Confidence: 0.8227872176 00:08:36.804 --> 00:08:39.664 better that suppresses inflammation that NOTE Confidence: 0.8227872176 00:08:39.664 --> 00:08:42.400 allows certain metastasis to take hold. NOTE Confidence: 0.8227872176 00:08:42.400 --> 00:08:45.536 So again showing even the same tumor the NOTE Confidence: 0.8227872176 00:08:45.536 --> 00:08:48.400 same disease location is very important. NOTE Confidence: 0.8227872176 00:08:48.400 --> 00:08:50.332 So it is important to have an NOTE Confidence: 0.8227872176 00:08:50.332 --> 00:08:51.840 annotation where it comes from, NOTE Confidence: 0.8227872176 00:08:51.840 --> 00:08:55.134 where is the source so that can allow the NOTE Confidence: 0.8227872176 00:08:55.134 --> 00:08:57.398 scientists to make those discoveries. NOTE Confidence: 0.8227872176 00:08:57.400 --> 00:08:59.972 So what is biobanking? NOTE Confidence: 0.8227872176 00:08:59.972 --> 00:09:03.187 It is a systematic procurement, NOTE Confidence: 0.8227872176 00:09:03.190 --> 00:09:04.718 processing, annotation, NOTE Confidence: 0.8227872176 00:09:04.718 --> 00:09:07.774 storage and distribution of NOTE Confidence: 0.8227872176 00:09:07.774 --> 00:09:10.830 biospecimen for research activity. NOTE Confidence: 0.8227872176 00:09:10.830 --> 00:09:13.392 Biobanking of human specimens in many NOTE Confidence: 0.8227872176 00:09:13.392 --> 00:09:16.010 institutions is part of a broader NOTE Confidence: 0.8227872176 00:09:16.010 --> 00:09:18.110 strategy to support an advanced, NOTE Confidence: 0.8227872176 00:09:18.110 --> 00:09:21.182 high impact biomedical research. NOTE Confidence: 0.8227872176 00:09:21.182 --> 00:09:24.477 OK, I'll show you that there are some. NOTE Confidence: 0.8227872176 00:09:24.480 --> 00:09:28.010 Very different types of biobanks. NOTE Confidence: 0.8227872176 00:09:28.010 --> 00:09:29.430 When I arrived at NYU, NOTE Confidence: 0.8227872176 00:09:29.430 --> 00:09:31.098 everybody was doing their NOTE Confidence: 0.8227872176 00:09:31.098 --> 00:09:32.349 own biobanking side. NOTE Confidence: 0.8227872176 00:09:32.350 --> 00:09:33.970 There is someone doing this, NOTE Confidence: 0.8227872176 00:09:33.970 --> 00:09:35.059 someone doing that, NOTE Confidence: 0.8227872176 00:09:35.059 --> 00:09:36.874 but there is no correlation. NOTE Confidence: 0.8227872176 00:09:36.880 --> 00:09:40.111 There is no integration of that NOTE Confidence: 0.8227872176 00:09:40.111 --> 00:09:41.819 material in that resource. NOTE Confidence: 0.8227872176 00:09:41.820 --> 00:09:42.085 OK. NOTE Confidence: 0.8227872176 00:09:42.085 --> 00:09:43.940 So that's why it is important to NOTE Confidence: 0.8227872176 00:09:43.940 --> 00:09:45.373 have one institutional component NOTE Confidence: 0.8227872176 00:09:45.373 --> 00:09:47.887 that can really serve for multiple NOTE Confidence: 0.8227872176 00:09:47.887 --> 00:09:49.728 purposes and that will allow, NOTE Confidence: 0.8227872176 00:09:49.730 --> 00:09:51.938 and I'll show you some examples NOTE Confidence: 0.8227872176 00:09:51.938 --> 00:09:53.647 later allow for more. NOTE Confidence: 0.8227872176 00:09:53.647 --> 00:09:57.229 Grant support and and everything else. NOTE Confidence: 0.8227872176 00:09:57.230 --> 00:09:59.720 So there are very many different NOTE Confidence: 0.8227872176 00:09:59.720 --> 00:10:00.965 types of vibank. NOTE Confidence: 0.8227872176 00:10:00.970 --> 00:10:03.628 Excuse me, there is no specific. NOTE Confidence: 0.8227872176 00:10:03.630 --> 00:10:05.774 One model fits all. NOTE Confidence: 0.8227872176 00:10:05.774 --> 00:10:08.990 There are biobanks that are more. NOTE Confidence: 0.8227872176 00:10:08.990 --> 00:10:10.550 Towards precision medicine, NOTE Confidence: 0.8227872176 00:10:10.550 --> 00:10:13.150 others about population based and NOTE Confidence: 0.8227872176 00:10:13.150 --> 00:10:15.845 others are disease specific, OK, NOTE Confidence: 0.8227872176 00:10:15.845 --> 00:10:18.260 so there is no specific model but NOTE Confidence: 0.8227872176 00:10:18.260 --> 00:10:20.597 they can function all of this. NOTE Confidence: 0.8227872176 00:10:20.600 --> 00:10:23.426 There are initiatives and we are NOTE Confidence: 0.8227872176 00:10:23.426 --> 00:10:26.450 the biobank for those initiatives. NOTE Confidence: 0.8227872176 00:10:26.450 --> 00:10:29.030 So the for instance an example, NOTE Confidence: 0.8227872176 00:10:29.030 --> 00:10:32.120 there is a group of investigators NOTE Confidence: 0.8227872176 00:10:32.120 --> 00:10:35.420 that NYU that is collecting. NOTE Confidence: 0.8227872176 00:10:35.420 --> 00:10:39.356 Samples from patients with Asian descent, NOTE Confidence: 0.8227872176 00:10:39.360 --> 00:10:39.764 OK, NOTE Confidence: 0.8227872176 00:10:39.764 --> 00:10:42.188 There's a big part of our NOTE Confidence: 0.8227872176 00:10:42.188 --> 00:10:43.400 National Health Institute, NOTE Confidence: 0.8227872176 00:10:43.400 --> 00:10:45.654 so we are the biorepository for them. NOTE Confidence: 0.8227872176 00:10:45.660 --> 00:10:47.996 So that is more of a population based. NOTE Confidence: 0.8227872176 00:10:48.000 --> 00:10:51.093 There is a group that collects lupus brino NOTE Confidence: 0.8227872176 00:10:51.093 --> 00:10:54.194 biopsies from lupus that's more like a NOTE Confidence: 0.8227872176 00:10:54.194 --> 00:10:56.114 disease specific disease biobanking. NOTE Confidence: 0.8227872176 00:10:56.114 --> 00:10:58.778 But again they can all be NOTE Confidence: 0.8227872176 00:10:58.778 --> 00:11:00.110 integrated into the. NOTE Confidence: 0.8227872176 00:11:00.110 --> 00:11:03.290 Deep central biorepository. NOTE Confidence: 0.8227872176 00:11:03.290 --> 00:11:06.818 So what is the most important thing of NOTE Confidence: 0.8227872176 00:11:06.818 --> 00:11:09.390 biobanking today is informed consent. NOTE Confidence: 0.8227872176 00:11:09.390 --> 00:11:12.182 So we need to have an informed consent NOTE Confidence: 0.8227872176 00:11:12.182 --> 00:11:14.388 for patients that will allow them. NOTE Confidence: 0.8227872176 00:11:14.390 --> 00:11:16.082 To collected material that NOTE Confidence: 0.8227872176 00:11:16.082 --> 00:11:18.197 will be used for research. NOTE Confidence: 0.8227872176 00:11:18.200 --> 00:11:20.916 The biobanking needs to conform to local, NOTE Confidence: 0.8227872176 00:11:20.920 --> 00:11:23.340 regional and federal regulations. NOTE Confidence: 0.8227872176 00:11:23.340 --> 00:11:24.550 I unfortunately, NOTE Confidence: 0.8227872176 00:11:24.550 --> 00:11:26.716 unfortunately I work in New York NOTE Confidence: 0.8227872176 00:11:26.716 --> 00:11:28.760 that's tightly regulated all the labs. NOTE Confidence: 0.8227872176 00:11:28.760 --> 00:11:32.054 So my lab is inspected by New York State, NOTE Confidence: 0.8227872176 00:11:32.060 --> 00:11:35.219 by the CHP and we have a lot of NOTE Confidence: 0.8227872176 00:11:35.219 --> 00:11:37.980 paperwork to fill that we will NOTE Confidence: 0.8227872176 00:11:37.980 --> 00:11:40.295 fulfill all of these regulations. NOTE Confidence: 0.8227872176 00:11:40.300 --> 00:11:42.519 One important thing of our bank is NOTE Confidence: 0.8227872176 00:11:42.519 --> 00:11:44.659 the standard and quality assurance, NOTE Confidence: 0.8227872176 00:11:44.660 --> 00:11:46.888 and that's extremely important. NOTE Confidence: 0.8227872176 00:11:46.888 --> 00:11:50.831 I'll give you 2 very bad examples NOTE Confidence: 0.8227872176 00:11:50.831 --> 00:11:53.316 when I was a postdoc. NOTE Confidence: 0.8227872176 00:11:53.320 --> 00:11:55.888 I come from Brazil and I was doing NOTE Confidence: 0.8227872176 00:11:55.888 --> 00:11:58.577 my PhD and there was an investigator NOTE Confidence: 0.8227872176 00:11:58.577 --> 00:12:02.032 at the time that was doing fantastic NOTE Confidence: 0.8227872176 00:12:02.032 --> 00:12:05.239 discoveries in large smania. NOTE Confidence: 0.8227872176 00:12:05.240 --> 00:12:06.530 And he was saying that, NOTE Confidence: 0.8227872176 00:12:06.530 --> 00:12:06.964 you know, NOTE Confidence: 0.8227872176 00:12:06.964 --> 00:12:08.483 a lot of the things that he NOTE Confidence: 0.8227872176 00:12:08.483 --> 00:12:09.795 was finding Leishmania were NOTE Confidence: 0.8227872176 00:12:09.795 --> 00:12:11.520 very similar to the crusade. NOTE Confidence: 0.8227872176 00:12:11.520 --> 00:12:13.572 So basically like a cross link NOTE Confidence: 0.8227872176 00:12:13.572 --> 00:12:14.940 between the two institutions, NOTE Confidence: 0.83999987625 00:12:14.940 --> 00:12:15.879 the two parasites. NOTE Confidence: 0.83999987625 00:12:15.879 --> 00:12:18.070 And then one day someone said maybe NOTE Confidence: 0.83999987625 00:12:18.130 --> 00:12:20.158 you should look at your leishmania. NOTE Confidence: 0.83999987625 00:12:20.160 --> 00:12:22.779 And in fact he was working with the cruise. NOTE Confidence: 0.83999987625 00:12:22.780 --> 00:12:24.676 That's why he was finding all those things. NOTE Confidence: 0.83999987625 00:12:24.680 --> 00:12:27.497 So if you don't know what you're looking at, NOTE Confidence: 0.83999987625 00:12:27.500 --> 00:12:28.968 you may be completely NOTE Confidence: 0.83999987625 00:12:28.968 --> 00:12:30.436 wrong in your discoveries. NOTE Confidence: 0.83999987625 00:12:30.440 --> 00:12:32.438 So that is extremely important to NOTE Confidence: 0.83999987625 00:12:32.438 --> 00:12:34.258 the quality assurance and quality NOTE Confidence: 0.83999987625 00:12:34.258 --> 00:12:36.378 control of everything you're working, NOTE Confidence: 0.83999987625 00:12:36.380 --> 00:12:40.440 especially, you know, human tissue. NOTE Confidence: 0.83999987625 00:12:40.440 --> 00:12:42.675 So data integration annotation is NOTE Confidence: 0.83999987625 00:12:42.675 --> 00:12:44.910 also very important because you NOTE Confidence: 0.83999987625 00:12:44.987 --> 00:12:47.634 want to be able to offer the the, NOTE Confidence: 0.83999987625 00:12:47.634 --> 00:12:49.622 the investigators very well NOTE Confidence: 0.83999987625 00:12:49.622 --> 00:12:50.616 annotated samples. NOTE Confidence: 0.83999987625 00:12:50.620 --> 00:12:52.916 I'll go more little bit about annotations. NOTE Confidence: 0.83999987625 00:12:52.920 --> 00:12:55.460 It can varies a lot but you need to make NOTE Confidence: 0.83999987625 00:12:55.526 --> 00:12:58.253 sure that what you're saying is what it is, NOTE Confidence: 0.83999987625 00:12:58.260 --> 00:13:00.042 OK and give the basic information NOTE Confidence: 0.83999987625 00:13:00.042 --> 00:13:01.736 and there are also financial NOTE Confidence: 0.83999987625 00:13:01.736 --> 00:13:03.520 considerations for a biobank, NOTE Confidence: 0.83999987625 00:13:03.520 --> 00:13:06.250 it is a very expensive endeavor and NOTE Confidence: 0.83999987625 00:13:06.250 --> 00:13:08.978 also the model that we use at NYU, NOTE Confidence: 0.83999987625 00:13:08.980 --> 00:13:10.220 but it's not the same. NOTE Confidence: 0.83999987625 00:13:10.220 --> 00:13:15.196 That you can see in every single biobank. NOTE Confidence: 0.83999987625 00:13:15.200 --> 00:13:16.716 So specifically for NYU, NOTE Confidence: 0.83999987625 00:13:16.716 --> 00:13:19.494 those are the missions that we have NOTE Confidence: 0.83999987625 00:13:19.494 --> 00:13:22.062 is basically to maintain and expand NOTE Confidence: 0.83999987625 00:13:22.062 --> 00:13:24.078 the human biospecimen repository NOTE Confidence: 0.83999987625 00:13:24.078 --> 00:13:26.726 with clinical pathologic connotation. NOTE Confidence: 0.83999987625 00:13:26.730 --> 00:13:28.836 Of patients that signed universal concern. NOTE Confidence: 0.83999987625 00:13:28.840 --> 00:13:31.084 So we have a universal consent NOTE Confidence: 0.83999987625 00:13:31.084 --> 00:13:32.580 that patients are offered. NOTE Confidence: 0.83999987625 00:13:32.580 --> 00:13:34.596 It doesn't matter where they come from, NOTE Confidence: 0.83999987625 00:13:34.600 --> 00:13:36.200 which disease they have. NOTE Confidence: 0.83999987625 00:13:36.200 --> 00:13:39.555 So they offer that consent and if they allow NOTE Confidence: 0.83999987625 00:13:39.555 --> 00:13:42.600 we can we can collect leftover tissue, NOTE Confidence: 0.83999987625 00:13:42.600 --> 00:13:43.707 OK or blood. NOTE Confidence: 0.83999987625 00:13:43.707 --> 00:13:46.795 So this can be from surgeries or even NOTE Confidence: 0.83999987625 00:13:46.795 --> 00:13:49.735 blood that goes for a clinical test. NOTE Confidence: 0.83999987625 00:13:49.740 --> 00:13:50.568 There is leftover. NOTE Confidence: 0.83999987625 00:13:50.568 --> 00:13:52.500 I can collect that material as long NOTE Confidence: 0.83999987625 00:13:52.552 --> 00:13:54.286 as the patient signed the consent. NOTE Confidence: 0.517689214 00:13:58.730 --> 00:14:00.410 There all the consent. NOTE Confidence: 0.517689214 00:14:00.410 --> 00:14:03.750 So it's like a clinic or hospitals NOTE Confidence: 0.517689214 00:14:03.750 --> 00:14:05.620 everywhere, everywhere. Yeah. NOTE Confidence: 0.8065339 00:14:05.660 --> 00:14:09.620 So originally the consent was. NOTE Confidence: 0.8065339 00:14:09.620 --> 00:14:12.228 We when I started we the most of NOTE Confidence: 0.8065339 00:14:12.228 --> 00:14:15.268 the need was to to collect patient NOTE Confidence: 0.8065339 00:14:15.268 --> 00:14:17.573 to consent patients with cancer. NOTE Confidence: 0.8065339 00:14:17.580 --> 00:14:20.492 So in the cancer centre registration the NOTE Confidence: 0.8065339 00:14:20.492 --> 00:14:23.406 patients would come in and then offer the NOTE Confidence: 0.8065339 00:14:23.406 --> 00:14:26.319 consent as part of their registration then. NOTE Confidence: 0.8065339 00:14:26.320 --> 00:14:29.358 But patients can come from many different NOTE Confidence: 0.8065339 00:14:29.358 --> 00:14:32.955 areas so then we have to adapt and evolve. NOTE Confidence: 0.8065339 00:14:32.960 --> 00:14:35.456 So now we have patients that can be NOTE Confidence: 0.8065339 00:14:35.456 --> 00:14:37.618 concentrated in the registration office, NOTE Confidence: 0.8065339 00:14:37.620 --> 00:14:39.678 they can be consented in the clinical. NOTE Confidence: 0.8065339 00:14:39.680 --> 00:14:42.333 Office by the nurse by the registration NOTE Confidence: 0.8065339 00:14:42.333 --> 00:14:45.367 desk of of the faculty practice and they NOTE Confidence: 0.8065339 00:14:45.367 --> 00:14:48.807 can and I have one person now that is NOTE Confidence: 0.8065339 00:14:48.807 --> 00:14:51.556 located in the pre surgical area and NOTE Confidence: 0.8065339 00:14:51.556 --> 00:14:53.686 he consents everybody before surgery. NOTE Confidence: 0.8065339 00:14:53.690 --> 00:14:55.244 It's not very efficient but it's NOTE Confidence: 0.8065339 00:14:55.244 --> 00:14:57.049 still we still get some patients. NOTE Confidence: 0.8065339 00:14:57.050 --> 00:14:59.274 So it has to be multiple focal unless NOTE Confidence: 0.8065339 00:14:59.274 --> 00:15:01.709 you have one area that everybody comes. NOTE Confidence: 0.777957636190476 00:15:06.740 --> 00:15:09.332 Another thing is to simulate collaborations NOTE Confidence: 0.777957636190476 00:15:09.332 --> 00:15:12.074 with between NYU and outside institutions NOTE Confidence: 0.777957636190476 00:15:12.074 --> 00:15:14.906 and apply high quality standards for NOTE Confidence: 0.777957636190476 00:15:14.906 --> 00:15:16.784 those biased by vice presidents. NOTE Confidence: 0.777957636190476 00:15:16.784 --> 00:15:20.151 So my bar repository as I said is a NOTE Confidence: 0.777957636190476 00:15:20.151 --> 00:15:22.539 biorepository accredited by the the CAP NOTE Confidence: 0.777957636190476 00:15:22.539 --> 00:15:25.399 by College of American Pathologists. NOTE Confidence: 0.777957636190476 00:15:25.400 --> 00:15:28.016 We were inspected every two years and we NOTE Confidence: 0.777957636190476 00:15:28.016 --> 00:15:31.259 hold at the same standards as a clinical lab. NOTE Confidence: 0.777957636190476 00:15:31.260 --> 00:15:33.260 So the CAPS certification NOTE Confidence: 0.777957636190476 00:15:33.260 --> 00:15:35.802 basically gives you a. Clear. NOTE Confidence: 0.777957636190476 00:15:35.802 --> 00:15:37.970 It's not that clear. NOTE Confidence: 0.777957636190476 00:15:37.970 --> 00:15:39.342 We cannot do tests, NOTE Confidence: 0.777957636190476 00:15:39.342 --> 00:15:41.400 but it's a clear equivalent meaning NOTE Confidence: 0.777957636190476 00:15:41.470 --> 00:15:43.395 that if I have a tissue there NOTE Confidence: 0.777957636190476 00:15:43.395 --> 00:15:45.470 that is needed for clinical tests, NOTE Confidence: 0.777957636190476 00:15:45.470 --> 00:15:48.198 that is OK to take my tissue for NOTE Confidence: 0.777957636190476 00:15:48.198 --> 00:15:50.613 the clinical test because it has NOTE Confidence: 0.777957636190476 00:15:50.613 --> 00:15:52.678 hold over the same standards. NOTE Confidence: 0.777957636190476 00:15:52.680 --> 00:15:56.330 So I'll talk about compliance in NOTE Confidence: 0.777957636190476 00:15:56.330 --> 00:15:58.260 IRB and the HIPAA requirements NOTE Confidence: 0.777957636190476 00:15:58.326 --> 00:15:59.870 which is very important. NOTE Confidence: 0.777957636190476 00:15:59.870 --> 00:16:03.488 And so HIPPA is health insurance NOTE Confidence: 0.777957636190476 00:16:03.488 --> 00:16:05.900 portability and Accountability act. NOTE Confidence: 0.777957636190476 00:16:05.900 --> 00:16:07.392 It's a privacy rule. NOTE Confidence: 0.777957636190476 00:16:07.392 --> 00:16:10.400 So privacy rules patients is very important, NOTE Confidence: 0.777957636190476 00:16:10.400 --> 00:16:12.330 setting limits and boundaries and NOTE Confidence: 0.777957636190476 00:16:12.330 --> 00:16:14.260 the release of medical information NOTE Confidence: 0.777957636190476 00:16:14.321 --> 00:16:16.137 and holds violators accountable. NOTE Confidence: 0.777957636190476 00:16:16.140 --> 00:16:18.436 So it is very important that one NOTE Confidence: 0.777957636190476 00:16:18.436 --> 00:16:20.755 to establish it holds true for NOTE Confidence: 0.777957636190476 00:16:20.755 --> 00:16:22.435 all these regulatory issues. NOTE Confidence: 0.777957636190476 00:16:22.440 --> 00:16:24.864 And has direct implication for research NOTE Confidence: 0.777957636190476 00:16:24.864 --> 00:16:28.020 and patient information, of course. NOTE Confidence: 0.777957636190476 00:16:28.020 --> 00:16:28.990 So. NOTE Confidence: 0.777957636190476 00:16:28.990 --> 00:16:31.775 Patient consent is the major NOTE Confidence: 0.777957636190476 00:16:31.775 --> 00:16:33.446 tenant of biorepository. NOTE Confidence: 0.777957636190476 00:16:33.450 --> 00:16:38.168 All samples are collected under an IRB NOTE Confidence: 0.777957636190476 00:16:38.168 --> 00:16:41.689 approved HIPAA compliant consent form. NOTE Confidence: 0.777957636190476 00:16:41.690 --> 00:16:45.173 So our consent form is the way it was NOTE Confidence: 0.777957636190476 00:16:45.173 --> 00:16:48.239 created is mostly for leftover tissue. NOTE Confidence: 0.777957636190476 00:16:48.240 --> 00:16:50.780 There are many variations from NOTE Confidence: 0.777957636190476 00:16:50.780 --> 00:16:51.796 other biobanks. NOTE Confidence: 0.777957636190476 00:16:51.800 --> 00:16:54.491 I can tell you briefly, but for for NOTE Confidence: 0.777957636190476 00:16:54.491 --> 00:16:56.276 us the participation is voluntary. NOTE Confidence: 0.777957636190476 00:16:56.280 --> 00:16:57.460 The patient is approached, NOTE Confidence: 0.777957636190476 00:16:57.460 --> 00:16:58.935 if they want to consent, NOTE Confidence: 0.777957636190476 00:16:58.940 --> 00:17:01.215 they will consent and they can also NOTE Confidence: 0.777957636190476 00:17:01.215 --> 00:17:03.260 choose what they want to consent. NOTE Confidence: 0.777957636190476 00:17:03.260 --> 00:17:05.882 So we can use leftover tissue NOTE Confidence: 0.777957636190476 00:17:05.882 --> 00:17:07.193 and leftover blood. NOTE Confidence: 0.777957636190476 00:17:07.200 --> 00:17:09.293 We cannot use it for biopsies because NOTE Confidence: 0.777957636190476 00:17:09.293 --> 00:17:11.140 biopsies are not leftover tissue. NOTE Confidence: 0.777957636190476 00:17:11.140 --> 00:17:12.253 So I cannot. NOTE Confidence: 0.777957636190476 00:17:12.253 --> 00:17:14.108 Select any biopsy for research. NOTE Confidence: 0.777957636190476 00:17:14.110 --> 00:17:16.190 So if there is a biopsy for research, NOTE Confidence: 0.777957636190476 00:17:16.190 --> 00:17:18.206 the patient needs to sign a NOTE Confidence: 0.777957636190476 00:17:18.206 --> 00:17:20.190 specific consent for that protocol. NOTE Confidence: 0.777957636190476 00:17:20.190 --> 00:17:24.238 OK, the Biorepository will will be able to. NOTE Confidence: 0.777957636190476 00:17:24.240 --> 00:17:26.225 Take that sample process and NOTE Confidence: 0.777957636190476 00:17:26.225 --> 00:17:27.416 distribute as well, NOTE Confidence: 0.777957636190476 00:17:27.420 --> 00:17:30.436 but it's not part of our universal concept. NOTE Confidence: 0.777957636190476 00:17:30.440 --> 00:17:32.435 There is a voluntary donation of blood. NOTE Confidence: 0.777957636190476 00:17:32.440 --> 00:17:35.936 The patients can say one single blood draw, NOTE Confidence: 0.777957636190476 00:17:35.940 --> 00:17:37.179 multiple blood draws. NOTE Confidence: 0.777957636190476 00:17:37.179 --> 00:17:40.184 They can opt which is that they want to NOTE Confidence: 0.777957636190476 00:17:40.184 --> 00:17:44.020 do one thing that is embedded in the. NOTE Confidence: 0.777957636190476 00:17:44.020 --> 00:17:46.020 And and my consent, NOTE Confidence: 0.777957636190476 00:17:46.020 --> 00:17:48.088 we cannot consent children. NOTE Confidence: 0.777957636190476 00:17:48.088 --> 00:17:50.156 So it's only adults. NOTE Confidence: 0.777957636190476 00:17:50.160 --> 00:17:52.344 So the consent allows for linkage NOTE Confidence: 0.777957636190476 00:17:52.344 --> 00:17:53.436 of clinical information. NOTE Confidence: 0.777957636190476 00:17:53.440 --> 00:17:56.480 So everything that the patient's NOTE Confidence: 0.777957636190476 00:17:56.480 --> 00:17:58.426 clinical history, presentations, NOTE Confidence: 0.777957636190476 00:17:58.426 --> 00:18:00.604 radiology, molecular tests, NOTE Confidence: 0.777957636190476 00:18:00.604 --> 00:18:02.056 pathology tests, NOTE Confidence: 0.777957636190476 00:18:02.060 --> 00:18:04.030 anything else is available to NOTE Confidence: 0.777957636190476 00:18:04.030 --> 00:18:05.606 the investigation because the NOTE Confidence: 0.777957636190476 00:18:05.606 --> 00:18:06.998 consent allows for that. NOTE Confidence: 0.777957636190476 00:18:07.000 --> 00:18:09.180 There is no specific project, NOTE Confidence: 0.777957636190476 00:18:09.180 --> 00:18:11.952 so it can be used by many different projects, NOTE Confidence: 0.777957636190476 00:18:11.960 --> 00:18:13.308 according to the investigators. NOTE Confidence: 0.777957636190476 00:18:13.308 --> 00:18:16.019 And if they need to do cell line, NOTE Confidence: 0.777957636190476 00:18:16.020 --> 00:18:18.428 develop xenograft genetic tests, NOTE Confidence: 0.777957636190476 00:18:18.428 --> 00:18:20.234 everything is already. NOTE Confidence: 0.777957636190476 00:18:20.240 --> 00:18:21.420 Written in the consent, NOTE Confidence: 0.777957636190476 00:18:21.420 --> 00:18:23.912 so the patient allowed for all that, OK. NOTE Confidence: 0.777957636190476 00:18:23.912 --> 00:18:26.656 So there is a coronation of risk NOTE Confidence: 0.777957636190476 00:18:26.656 --> 00:18:28.885 and benefits and one thing that NOTE Confidence: 0.777957636190476 00:18:28.885 --> 00:18:31.510 our RB ask is that the results NOTE Confidence: 0.777957636190476 00:18:31.601 --> 00:18:34.184 are not released to the to the. NOTE Confidence: 0.777957636190476 00:18:34.190 --> 00:18:35.408 Patients or anything, NOTE Confidence: 0.777957636190476 00:18:35.408 --> 00:18:37.844 but in fact we don't know. NOTE Confidence: 0.90944382 00:18:37.850 --> 00:18:38.930 What is going to be used. NOTE Confidence: 0.90944382 00:18:38.930 --> 00:18:40.394 So we don't want to say that we're NOTE Confidence: 0.90944382 00:18:40.394 --> 00:18:42.030 going to allow you to see your results NOTE Confidence: 0.90944382 00:18:42.030 --> 00:18:43.642 because we have no idea how it's going NOTE Confidence: 0.90944382 00:18:43.642 --> 00:18:45.240 to be used and what they are going NOTE Confidence: 0.90944382 00:18:45.240 --> 00:18:47.114 to be looking for and protection NOTE Confidence: 0.90944382 00:18:47.114 --> 00:18:49.449 of HIV is extremely important. NOTE Confidence: 0.90944382 00:18:49.450 --> 00:18:51.320 Most of the specimens that NOTE Confidence: 0.90944382 00:18:51.320 --> 00:18:53.190 deidentified and are distributed to NOTE Confidence: 0.90944382 00:18:53.257 --> 00:18:55.189 the investigator the identified. NOTE Confidence: 0.90944382 00:18:55.190 --> 00:18:57.885 So they they have the clinical information NOTE Confidence: 0.90944382 00:18:57.885 --> 00:19:00.827 but they do not know anything about NOTE Confidence: 0.90944382 00:19:00.827 --> 00:19:04.750 that patient apart from. Sex age. NOTE Confidence: 0.90944382 00:19:04.750 --> 00:19:07.340 But I cannot give them the ear. NOTE Confidence: 0.90944382 00:19:07.340 --> 00:19:10.313 The patient was born any date is a PHIK, NOTE Confidence: 0.90944382 00:19:10.313 --> 00:19:13.763 but it's 60 years old. It's OK, OK. NOTE Confidence: 0.90944382 00:19:13.763 --> 00:19:16.529 Patient can withdraw consent at any NOTE Confidence: 0.90944382 00:19:16.529 --> 00:19:20.260 moment and some patients do withdraw consent. NOTE Confidence: 0.90944382 00:19:20.260 --> 00:19:22.857 So how is interaction with the RFP, NOTE Confidence: 0.90944382 00:19:22.860 --> 00:19:25.386 so everything that is a prospective NOTE Confidence: 0.90944382 00:19:25.386 --> 00:19:27.519 collected collection needs to have NOTE Confidence: 0.90944382 00:19:27.519 --> 00:19:29.775 higher be approval which falls under NOTE Confidence: 0.90944382 00:19:29.775 --> 00:19:32.788 our protocol and everybody else that is NOTE Confidence: 0.90944382 00:19:32.788 --> 00:19:35.058 doing intervention like clinical trials. NOTE Confidence: 0.90944382 00:19:35.060 --> 00:19:38.091 So the patient needs to sign consent NOTE Confidence: 0.90944382 00:19:38.091 --> 00:19:40.141 retrospective studies that is what NOTE Confidence: 0.90944382 00:19:40.141 --> 00:19:42.500 our my with the biobank becomes now NOTE Confidence: 0.90944382 00:19:42.500 --> 00:19:44.698 after it has been retrospective. NOTE Confidence: 0.90944382 00:19:44.700 --> 00:19:46.270 The tissue delegates the realization NOTE Confidence: 0.90944382 00:19:46.270 --> 00:19:48.616 is easier to get an IRB approval NOTE Confidence: 0.90944382 00:19:48.616 --> 00:19:50.416 the patient or the investigator. NOTE Confidence: 0.90944382 00:19:50.420 --> 00:19:52.163 They're not need to have a specific NOTE Confidence: 0.90944382 00:19:52.163 --> 00:19:53.581 consent from that patient because NOTE Confidence: 0.90944382 00:19:53.581 --> 00:19:55.126 the material is already there. NOTE Confidence: 0.90944382 00:19:55.130 --> 00:19:57.069 So a waiver of consent from the NOTE Confidence: 0.90944382 00:19:57.069 --> 00:19:58.849 RV is easier to everything. NOTE Confidence: 0.90944382 00:19:58.850 --> 00:20:02.702 You just need to indicate what they can get. NOTE Confidence: 0.90944382 00:20:02.710 --> 00:20:04.310 The clinical information and so NOTE Confidence: 0.90944382 00:20:04.310 --> 00:20:06.449 if that is approved by the IRB, NOTE Confidence: 0.90944382 00:20:06.450 --> 00:20:08.275 I can release that information NOTE Confidence: 0.90944382 00:20:08.275 --> 00:20:09.620 to the investigate, OK. NOTE Confidence: 0.932411975 00:20:12.280 --> 00:20:15.721 So basically. There are three NOTE Confidence: 0.932411975 00:20:15.721 --> 00:20:19.320 levels of RB that we need to follow. NOTE Confidence: 0.932411975 00:20:19.320 --> 00:20:22.545 Some investigators have a NOTE Confidence: 0.932411975 00:20:22.545 --> 00:20:25.155 approved protocol from the RB that NOTE Confidence: 0.932411975 00:20:25.155 --> 00:20:27.800 allows them for identification. NOTE Confidence: 0.932411975 00:20:27.800 --> 00:20:30.310 So an example COVID test, NOTE Confidence: 0.932411975 00:20:30.310 --> 00:20:32.571 there was someone that wants to see NOTE Confidence: 0.932411975 00:20:32.571 --> 00:20:34.908 the the COVID variation and they needed NOTE Confidence: 0.932411975 00:20:34.908 --> 00:20:37.647 to have the ZIP code of the patient NOTE Confidence: 0.932411975 00:20:37.647 --> 00:20:39.825 to see where those strains work. NOTE Confidence: 0.932411975 00:20:39.830 --> 00:20:41.520 So that is a Phi. NOTE Confidence: 0.932411975 00:20:41.520 --> 00:20:44.691 So they need to get a special NOTE Confidence: 0.932411975 00:20:44.691 --> 00:20:47.230 dispensation from this the IRB to NOTE Confidence: 0.932411975 00:20:47.230 --> 00:20:49.072 receive HIV OK or DEIDENTIFIED. NOTE Confidence: 0.932411975 00:20:49.072 --> 00:20:51.704 This is boss majority so it's it's NOTE Confidence: 0.932411975 00:20:51.704 --> 00:20:54.405 an easier process and they they are NOTE Confidence: 0.932411975 00:20:54.405 --> 00:20:56.849 just provide them the samples with NOTE Confidence: 0.932411975 00:20:56.849 --> 00:20:59.024 the clean connotations that they NOTE Confidence: 0.932411975 00:20:59.024 --> 00:21:00.988 need and anonymized especially there NOTE Confidence: 0.932411975 00:21:00.988 --> 00:21:03.280 is no identifier to like someone NOTE Confidence: 0.932411975 00:21:03.347 --> 00:21:05.496 just asked I need them lung cancers, NOTE Confidence: 0.932411975 00:21:05.500 --> 00:21:07.438 so that's it then lung cancers. NOTE Confidence: 0.932411975 00:21:07.440 --> 00:21:10.037 That specimen cannot be traced traced back. NOTE Confidence: 0.932411975 00:21:10.040 --> 00:21:12.302 If the investigator wants to go NOTE Confidence: 0.932411975 00:21:12.302 --> 00:21:13.900 back to see what they are, NOTE Confidence: 0.932411975 00:21:13.900 --> 00:21:16.920 there is no way they can do that, OK. NOTE Confidence: 0.932411975 00:21:16.920 --> 00:21:19.377 And each one of them has different NOTE Confidence: 0.932411975 00:21:19.380 --> 00:21:22.146 level of scrutiny from the art. NOTE Confidence: 0.932411975 00:21:22.150 --> 00:21:23.985 So another important thing is NOTE Confidence: 0.932411975 00:21:23.985 --> 00:21:25.820 no compromise of clinical care NOTE Confidence: 0.932411975 00:21:25.881 --> 00:21:27.897 that's your pathology is come in. NOTE Confidence: 0.932411975 00:21:27.900 --> 00:21:30.188 We are the ones that really know how NOTE Confidence: 0.932411975 00:21:30.188 --> 00:21:32.318 to triage these these samples and. NOTE Confidence: 0.795259281428571 00:21:34.420 --> 00:21:36.597 If if the material comes to pathology, NOTE Confidence: 0.795259281428571 00:21:36.600 --> 00:21:39.870 it's a small tumor I need NOTE Confidence: 0.795259281428571 00:21:39.870 --> 00:21:42.050 that entire tumor for. NOTE Confidence: 0.795259281428571 00:21:42.050 --> 00:21:44.283 For diagnosis, there is going to be NOTE Confidence: 0.795259281428571 00:21:44.283 --> 00:21:46.389 no collection for the biorepository. NOTE Confidence: 0.795259281428571 00:21:46.390 --> 00:21:48.918 OK, so we have that built-in NOTE Confidence: 0.795259281428571 00:21:48.918 --> 00:21:51.246 concerns this one other thing that NOTE Confidence: 0.795259281428571 00:21:51.246 --> 00:21:54.140 we did is that we do not allow NOTE Confidence: 0.795259281428571 00:21:54.140 --> 00:21:56.639 anymore and let's say we with the NOTE Confidence: 0.795259281428571 00:21:56.639 --> 00:21:58.967 institution in general and I had NOTE Confidence: 0.795259281428571 00:21:58.967 --> 00:22:00.899 the support of the institution. NOTE Confidence: 0.897105581666667 00:22:02.920 --> 00:22:06.021 Basically, we do not allow anybody to NOTE Confidence: 0.897105581666667 00:22:06.021 --> 00:22:08.884 collect samples from the OR. But before, NOTE Confidence: 0.897105581666667 00:22:08.884 --> 00:22:11.169 surgeons would do their collection, NOTE Confidence: 0.897105581666667 00:22:11.170 --> 00:22:14.936 and then nobody knows what it was. NOTE Confidence: 0.897105581666667 00:22:14.940 --> 00:22:19.836 Luckily or unluckily, we had a couple of. NOTE Confidence: 0.897105581666667 00:22:19.840 --> 00:22:23.341 Missteps that led to RCA and then was easier NOTE Confidence: 0.897105581666667 00:22:23.341 --> 00:22:27.148 for the institution to say this is not about, NOTE Confidence: 0.897105581666667 00:22:27.150 --> 00:22:29.970 OK, so that is, I say, NOTE Confidence: 0.897105581666667 00:22:29.970 --> 00:22:31.190 very bad for the patient, NOTE Confidence: 0.897105581666667 00:22:31.190 --> 00:22:35.996 but at least I now can control that process. NOTE Confidence: 0.897105581666667 00:22:36.000 --> 00:22:38.996 And a pathologist also can create the NOTE Confidence: 0.897105581666667 00:22:38.996 --> 00:22:41.034 optimal collection technique that is NOTE Confidence: 0.897105581666667 00:22:41.034 --> 00:22:43.080 important for the viral part part. NOTE Confidence: 0.897105581666667 00:22:43.080 --> 00:22:45.656 So the patients go to the ER, NOTE Confidence: 0.897105581666667 00:22:45.660 --> 00:22:47.052 the tissue is resected, NOTE Confidence: 0.897105581666667 00:22:47.052 --> 00:22:49.464 it comes to pathology with process decide NOTE Confidence: 0.897105581666667 00:22:49.464 --> 00:22:52.218 if it can be collected or not and and then NOTE Confidence: 0.897105581666667 00:22:52.218 --> 00:22:54.444 we collect according to the protocol if NOTE Confidence: 0.897105581666667 00:22:54.444 --> 00:22:57.300 there is something that they need fresh. NOTE Confidence: 0.897105581666667 00:22:57.300 --> 00:22:59.068 Sometimes some investigators need NOTE Confidence: 0.897105581666667 00:22:59.068 --> 00:23:01.278 samples in a specific media. NOTE Confidence: 0.897105581666667 00:23:01.280 --> 00:23:04.264 So we do the collection according to what NOTE Confidence: 0.897105581666667 00:23:04.264 --> 00:23:06.816 the investigator needs and we always create. NOTE Confidence: 0.897105581666667 00:23:06.820 --> 00:23:08.962 Control a frozen section control slide NOTE Confidence: 0.897105581666667 00:23:08.962 --> 00:23:11.412 because we need to make sure that NOTE Confidence: 0.897105581666667 00:23:11.412 --> 00:23:13.645 whatever we give into that person to NOTE Confidence: 0.897105581666667 00:23:13.715 --> 00:23:16.410 that investigator is exactly what they say. NOTE Confidence: 0.897105581666667 00:23:16.410 --> 00:23:18.026 So you can take a piece of tissue, NOTE Confidence: 0.897105581666667 00:23:18.030 --> 00:23:20.067 they look, they think there's lung cancer, NOTE Confidence: 0.897105581666667 00:23:20.070 --> 00:23:23.106 but it's just inflammatory very tomorrow. NOTE Confidence: 0.897105581666667 00:23:23.110 --> 00:23:24.643 So I need to make sure that NOTE Confidence: 0.897105581666667 00:23:24.643 --> 00:23:26.538 what I give is what it is, OK. NOTE Confidence: 0.897105581666667 00:23:26.538 --> 00:23:30.030 So I always do a frozen section of every. NOTE Confidence: 0.897105581666667 00:23:30.030 --> 00:23:32.935 So in this protocol need to to NOTE Confidence: 0.897105581666667 00:23:32.935 --> 00:23:34.650 annotate the schematic time. NOTE Confidence: 0.897105581666667 00:23:34.650 --> 00:23:36.874 One of the problems that we have there NOTE Confidence: 0.897105581666667 00:23:36.874 --> 00:23:39.041 is that investigator would say it NOTE Confidence: 0.897105581666667 00:23:39.041 --> 00:23:41.363 needs to be collected like immediately NOTE Confidence: 0.897105581666667 00:23:41.424 --> 00:23:43.706 we cannot go to pathology and then NOTE Confidence: 0.897105581666667 00:23:43.706 --> 00:23:47.030 collect because the RNA will die. NOTE Confidence: 0.897105581666667 00:23:47.030 --> 00:23:49.326 I'm going to be a little bit. NOTE Confidence: 0.897105581666667 00:23:49.330 --> 00:23:49.668 Sarcastic, NOTE Confidence: 0.897105581666667 00:23:49.668 --> 00:23:51.696 but my answer to this investigators NOTE Confidence: 0.897105581666667 00:23:51.696 --> 00:23:54.272 is if you work with something that NOTE Confidence: 0.897105581666667 00:23:54.272 --> 00:23:56.142 needs to be collected immediately NOTE Confidence: 0.897105581666667 00:23:56.142 --> 00:23:58.245 you should not be working with NOTE Confidence: 0.897105581666667 00:23:58.245 --> 00:24:00.190 human tissue because even if the NOTE Confidence: 0.897105581666667 00:24:00.190 --> 00:24:01.870 surgeon collect it is not immediate. NOTE Confidence: 0.897105581666667 00:24:01.870 --> 00:24:02.788 They need to. NOTE Confidence: 0.897105581666667 00:24:02.788 --> 00:24:04.930 The most important thing is the patient. NOTE Confidence: 0.897105581666667 00:24:04.930 --> 00:24:07.450 Well, so it is not they cannot stop NOTE Confidence: 0.897105581666667 00:24:07.450 --> 00:24:09.254 what they're doing, collect everything, NOTE Confidence: 0.897105581666667 00:24:09.254 --> 00:24:10.310 freeze them centrally, NOTE Confidence: 0.897105581666667 00:24:10.310 --> 00:24:10.638 investigate. NOTE Confidence: 0.897105581666667 00:24:10.638 --> 00:24:12.606 The most important thing is impatient. NOTE Confidence: 0.897105581666667 00:24:12.610 --> 00:24:14.812 So there is always the challenge NOTE Confidence: 0.897105581666667 00:24:14.812 --> 00:24:17.302 and a cultural change for the NOTE Confidence: 0.897105581666667 00:24:17.302 --> 00:24:19.592 investigators to understand how this. NOTE Confidence: 0.897105581666667 00:24:19.592 --> 00:24:21.747 Dynamics work and it's just NOTE Confidence: 0.897105581666667 00:24:21.747 --> 00:24:23.739 always a tug of war. NOTE Confidence: 0.897105581666667 00:24:23.740 --> 00:24:26.730 Everybody that has invested doing NOTE Confidence: 0.897105581666667 00:24:26.730 --> 00:24:30.668 anything with humans know how it is so. NOTE Confidence: 0.897105581666667 00:24:30.670 --> 00:24:34.710 How we minimize the the the this process so? NOTE Confidence: 0.897105581666667 00:24:34.710 --> 00:24:37.930 We receive, I'll show later how the NOTE Confidence: 0.897105581666667 00:24:37.930 --> 00:24:39.620 integration is with IT, NOTE Confidence: 0.897105581666667 00:24:39.620 --> 00:24:42.860 but everybody that is consented, NOTE Confidence: 0.897105581666667 00:24:42.860 --> 00:24:44.720 we have a system that will NOTE Confidence: 0.897105581666667 00:24:44.720 --> 00:24:46.680 annotate and and search all the NOTE Confidence: 0.897105581666667 00:24:46.680 --> 00:24:48.320 patients that go for surgery. NOTE Confidence: 0.897105581666667 00:24:48.320 --> 00:24:51.875 So we receive in 24 hours before the surgery. NOTE Confidence: 0.897105581666667 00:24:51.880 --> 00:24:54.856 So these patients ABC will come for surgery. NOTE Confidence: 0.897105581666667 00:24:54.860 --> 00:24:56.540 So the day of surgery someone NOTE Confidence: 0.897105581666667 00:24:56.540 --> 00:24:58.879 in my team will call to the OR NOTE Confidence: 0.897105581666667 00:24:58.879 --> 00:25:00.963 provide them with the lease and say NOTE Confidence: 0.897105581666667 00:25:00.963 --> 00:25:02.757 these are the patients ABC that NOTE Confidence: 0.897105581666667 00:25:02.757 --> 00:25:05.272 we need that material once it is. NOTE Confidence: 0.897105581666667 00:25:05.272 --> 00:25:06.884 Removed from the patient, NOTE Confidence: 0.897105581666667 00:25:06.890 --> 00:25:08.435 it comes to pathology immediately NOTE Confidence: 0.897105581666667 00:25:08.435 --> 00:25:10.706 and we use like the same system NOTE Confidence: 0.897105581666667 00:25:10.706 --> 00:25:12.030 as the frozen section. NOTE Confidence: 0.80165569 00:25:12.030 --> 00:25:14.480 So there is a Courier that brings NOTE Confidence: 0.80165569 00:25:14.480 --> 00:25:16.196 that material directly to pathology NOTE Confidence: 0.80165569 00:25:16.196 --> 00:25:18.289 as if it was a frozen section. NOTE Confidence: 0.80165569 00:25:18.290 --> 00:25:20.747 Then the EPA or if there is a pathologist NOTE Confidence: 0.80165569 00:25:20.747 --> 00:25:22.861 that is involved will collect the NOTE Confidence: 0.80165569 00:25:22.861 --> 00:25:25.059 sample and the biorepository is also NOTE Confidence: 0.80165569 00:25:25.059 --> 00:25:26.839 not notified of the collection. NOTE Confidence: 0.80165569 00:25:26.840 --> 00:25:28.682 They are there, they collect the NOTE Confidence: 0.80165569 00:25:28.682 --> 00:25:29.910 material and they distribute, NOTE Confidence: 0.80165569 00:25:29.910 --> 00:25:31.368 freeze, whatever they need to do. NOTE Confidence: 0.80165569 00:25:31.370 --> 00:25:34.121 So that will minimize the scheming time NOTE Confidence: 0.80165569 00:25:34.121 --> 00:25:36.810 and we annotate when it was removed. NOTE Confidence: 0.80165569 00:25:36.810 --> 00:25:38.987 The war annotates when it was removed, NOTE Confidence: 0.80165569 00:25:38.990 --> 00:25:40.726 and we annotate when it was frozen, NOTE Confidence: 0.80165569 00:25:40.730 --> 00:25:43.800 so we have some control. NOTE Confidence: 0.80165569 00:25:43.800 --> 00:25:45.360 So again the pathology examination NOTE Confidence: 0.80165569 00:25:45.360 --> 00:25:47.333 and we do the quality control NOTE Confidence: 0.80165569 00:25:47.333 --> 00:25:49.098 and assurance of patient care. NOTE Confidence: 0.80165569 00:25:49.100 --> 00:25:51.356 Once again, if you cannot collect, NOTE Confidence: 0.80165569 00:25:51.360 --> 00:25:52.740 it will not be collected. NOTE Confidence: 0.80165569 00:25:52.740 --> 00:25:54.480 It doesn't matter if it's device, NOTE Confidence: 0.80165569 00:25:54.480 --> 00:25:56.958 gene or research that wants that tissue, NOTE Confidence: 0.80165569 00:25:56.960 --> 00:25:59.040 the answer is no, OK. NOTE Confidence: 0.80165569 00:25:59.040 --> 00:26:01.048 And they understand, OK. NOTE Confidence: 0.84256731 00:26:03.330 --> 00:26:07.050 So how the patient is consented? NOTE Confidence: 0.84256731 00:26:07.050 --> 00:26:08.474 As I said briefly, NOTE Confidence: 0.84256731 00:26:08.474 --> 00:26:10.254 we have many different mechanisms. NOTE Confidence: 0.84256731 00:26:10.260 --> 00:26:13.176 The entire consent process is electronic, NOTE Confidence: 0.84256731 00:26:13.180 --> 00:26:18.266 so once they sign the electronic format, NOTE Confidence: 0.84256731 00:26:18.266 --> 00:26:20.532 that material. And go here. NOTE Confidence: 0.84256731 00:26:20.532 --> 00:26:22.988 So there is a lot of things that goes on, NOTE Confidence: 0.84256731 00:26:22.990 --> 00:26:24.846 but there is a system that we use, NOTE Confidence: 0.84256731 00:26:24.850 --> 00:26:26.662 it's called home base. NOTE Confidence: 0.84256731 00:26:26.662 --> 00:26:29.380 It goes through interface with lab NOTE Confidence: 0.84256731 00:26:29.465 --> 00:26:32.774 vantage which is our biorepository data NOTE Confidence: 0.84256731 00:26:32.774 --> 00:26:36.398 manager and interferes with EPIC which NOTE Confidence: 0.84256731 00:26:36.398 --> 00:26:40.268 is our medical records that we use. NOTE Confidence: 0.84256731 00:26:40.268 --> 00:26:41.486 And research Navigator, NOTE Confidence: 0.84256731 00:26:41.490 --> 00:26:43.765 which is all the research that I've NOTE Confidence: 0.84256731 00:26:43.765 --> 00:26:45.509 done are registered in research, NOTE Confidence: 0.84256731 00:26:45.510 --> 00:26:47.246 not paid. So this, NOTE Confidence: 0.84256731 00:26:47.246 --> 00:26:50.390 then once this and this talks constantly. NOTE Confidence: 0.84256731 00:26:50.390 --> 00:26:53.434 Once again, the patient is identified. NOTE Confidence: 0.84256731 00:26:53.434 --> 00:26:55.027 They will send. NOTE Confidence: 0.84256731 00:26:55.030 --> 00:26:56.322 A message to CBD, NOTE Confidence: 0.84256731 00:26:56.322 --> 00:26:59.604 which with the people and they will do what I NOTE Confidence: 0.84256731 00:26:59.604 --> 00:27:02.250 said organized with you are with pathology, NOTE Confidence: 0.84256731 00:27:02.250 --> 00:27:03.056 inform everybody, NOTE Confidence: 0.84256731 00:27:03.056 --> 00:27:05.474 collect the sample and then freeze, NOTE Confidence: 0.84256731 00:27:05.480 --> 00:27:06.804 OK and everything is NOTE Confidence: 0.84256731 00:27:06.804 --> 00:27:08.128 entered in like advantage, NOTE Confidence: 0.84256731 00:27:08.130 --> 00:27:10.890 which is our management system. NOTE Confidence: 0.84256731 00:27:10.890 --> 00:27:12.150 It's a big graphic, NOTE Confidence: 0.84256731 00:27:12.150 --> 00:27:13.410 but it's basically simply, NOTE Confidence: 0.84256731 00:27:13.410 --> 00:27:15.610 simply that's how it works. NOTE Confidence: 0.84256731 00:27:15.610 --> 00:27:17.838 So Dubai's personal process, NOTE Confidence: 0.84256731 00:27:17.838 --> 00:27:19.509 whenever we see, NOTE Confidence: 0.84256731 00:27:19.510 --> 00:27:21.550 when we still look at the NOTE Confidence: 0.84256731 00:27:21.550 --> 00:27:22.230 patient identification, NOTE Confidence: 0.84256731 00:27:22.230 --> 00:27:24.930 make sure that patient is consented. NOTE Confidence: 0.84256731 00:27:24.930 --> 00:27:27.030 There is a notification of excision. NOTE Confidence: 0.84256731 00:27:27.030 --> 00:27:29.530 The collection is is done, NOTE Confidence: 0.84256731 00:27:29.530 --> 00:27:32.632 the tissue is acquired and distributed NOTE Confidence: 0.84256731 00:27:32.632 --> 00:27:35.100 and processed according to the. NOTE Confidence: 0.84256731 00:27:35.100 --> 00:27:38.100 So the tissue management? NOTE Confidence: 0.84256731 00:27:38.100 --> 00:27:38.460 Yes, NOTE Confidence: 0.850620798181818 00:27:38.510 --> 00:27:40.796 you have a sense of what is the fraction NOTE Confidence: 0.850620798181818 00:27:40.796 --> 00:27:43.150 of patients that are you know you're NOTE Confidence: 0.850620798181818 00:27:43.150 --> 00:27:44.710 capturing with this system relative NOTE Confidence: 0.850620798181818 00:27:44.766 --> 00:27:46.380 to the ones that could provide. NOTE Confidence: 0.08383447 00:27:47.900 --> 00:27:52.600 Uh. That's a good question of. NOTE Confidence: 0.08383447 00:27:52.600 --> 00:27:54.724 Let me can say that from the NOTE Confidence: 0.08383447 00:27:54.724 --> 00:27:55.980 patients that signed the consent, NOTE Confidence: 0.08383447 00:27:55.980 --> 00:27:58.507 not everybody goes to surgery. OK. NOTE Confidence: 0.08383447 00:27:58.507 --> 00:28:01.523 So from the patients that signed the consent, NOTE Confidence: 0.08383447 00:28:01.530 --> 00:28:03.922 we have about 40,000 NOTE Confidence: 0.08383447 00:28:03.922 --> 00:28:05.716 people already consented. NOTE Confidence: 0.08383447 00:28:05.720 --> 00:28:07.972 For the entire institution, NOTE Confidence: 0.08383447 00:28:07.972 --> 00:28:10.440 about 10% of them go to surgery NOTE Confidence: 0.08383447 00:28:10.440 --> 00:28:12.460 and we have the tissue collected. NOTE Confidence: 0.08383447 00:28:12.460 --> 00:28:15.980 So that's why we have now one person NOTE Confidence: 0.08383447 00:28:15.980 --> 00:28:18.940 in in the OR that will collect, NOTE Confidence: 0.08383447 00:28:18.940 --> 00:28:22.340 will do target consent. NOTE Confidence: 0.08383447 00:28:22.340 --> 00:28:24.272 The target consent means NOTE Confidence: 0.08383447 00:28:24.272 --> 00:28:26.204 most of our investigators, NOTE Confidence: 0.08383447 00:28:26.210 --> 00:28:28.526 they are working with lung cancer, NOTE Confidence: 0.08383447 00:28:28.530 --> 00:28:30.672 pancreatic cancer, Melanoma, NOTE Confidence: 0.08383447 00:28:30.672 --> 00:28:32.100 colon cancer. NOTE Confidence: 0.08383447 00:28:32.100 --> 00:28:34.770 So if the patient is listed for any of of NOTE Confidence: 0.08383447 00:28:34.835 --> 00:28:37.439 these and they are not consented before, NOTE Confidence: 0.08383447 00:28:37.440 --> 00:28:39.540 so that person will consent. NOTE Confidence: 0.08383447 00:28:39.540 --> 00:28:41.976 So I cannot tell you exactly NOTE Confidence: 0.08383447 00:28:41.976 --> 00:28:44.070 how many patients we skip, NOTE Confidence: 0.08383447 00:28:44.070 --> 00:28:47.922 but up let's let's say like 10% we collect NOTE Confidence: 0.08383447 00:28:47.922 --> 00:28:51.130 about 10% of everybody that goes to the. NOTE Confidence: 0.08383447 00:28:51.130 --> 00:28:52.830 And we also collecting transplant. NOTE Confidence: 0.08383447 00:28:52.830 --> 00:28:53.950 I'm just talking about cancer, NOTE Confidence: 0.08383447 00:28:53.950 --> 00:28:55.606 but he collects for. NOTE Confidence: 0.08383447 00:28:55.606 --> 00:28:57.676 For non cancer as well, NOTE Confidence: 0.08383447 00:28:57.680 --> 00:28:57.990 OK. NOTE Confidence: 0.6028655112 00:28:58.000 --> 00:29:00.968 So Andrew is your follow up that NOTE Confidence: 0.6028655112 00:29:00.968 --> 00:29:03.791 question not gross specimen show up. NOTE Confidence: 0.6028655112 00:29:03.791 --> 00:29:06.734 So do you have separate about NOTE Confidence: 0.6028655112 00:29:06.734 --> 00:29:09.793 specific person to look at the tissue NOTE Confidence: 0.6028655112 00:29:09.793 --> 00:29:12.470 first or you have your a resident NOTE Confidence: 0.7216537075 00:29:12.910 --> 00:29:16.214 is the routine PSA that will grow NOTE Confidence: 0.7216537075 00:29:16.214 --> 00:29:18.840 that will process the specimen NOTE Confidence: 0.7216537075 00:29:18.840 --> 00:29:21.339 and if there is a clinical trial NOTE Confidence: 0.7216537075 00:29:21.339 --> 00:29:23.512 or specific project so then the NOTE Confidence: 0.7216537075 00:29:23.512 --> 00:29:25.913 pathologist on their trial or on that. NOTE Confidence: 0.7216537075 00:29:25.920 --> 00:29:27.672 Protocol is notified and NOTE Confidence: 0.7216537075 00:29:27.672 --> 00:29:29.862 then very often they are. NOTE Confidence: 0.7216537075 00:29:29.870 --> 00:29:33.118 They want to do the collection themselves. NOTE Confidence: 0.7216537075 00:29:33.120 --> 00:29:35.991 But but yes there is it is not a NOTE Confidence: 0.7216537075 00:29:35.991 --> 00:29:38.336 specific person for the viral post NOTE Confidence: 0.7216537075 00:29:38.336 --> 00:29:40.844 story I everybody in the biorepository NOTE Confidence: 0.7216537075 00:29:40.844 --> 00:29:43.736 they they don't have the ability NOTE Confidence: 0.7216537075 00:29:43.736 --> 00:29:46.350 to grow they're not PA so they NOTE Confidence: 0.7216537075 00:29:46.350 --> 00:29:48.474 would I would for patient care I NOTE Confidence: 0.7216537075 00:29:48.474 --> 00:29:50.334 would not allow them to they're NOTE Confidence: 0.7216537075 00:29:50.334 --> 00:29:52.429 not allowed to to cut insurance. NOTE Confidence: 0.58574217625 00:29:52.440 --> 00:29:55.500 So in other words your bowel NOTE Confidence: 0.58574217625 00:29:55.500 --> 00:29:58.490 pastor shares mythology person. NOTE Confidence: 0.80799998 00:29:58.640 --> 00:30:01.640 So it is very much embedded in the NOTE Confidence: 0.80799998 00:30:01.640 --> 00:30:03.799 pathology and what institution. NOTE Confidence: 0.80799998 00:30:03.800 --> 00:30:06.670 Was present. And I said the institution, NOTE Confidence: 0.80799998 00:30:06.670 --> 00:30:09.440 because everything else for the NOTE Confidence: 0.80799998 00:30:09.440 --> 00:30:12.210 biorepository is an institutional resource. NOTE Confidence: 0.80799998 00:30:12.210 --> 00:30:14.510 So the institution pays the NOTE Confidence: 0.80799998 00:30:14.510 --> 00:30:17.092 salary of 1 PA of course, NOTE Confidence: 0.80799998 00:30:17.092 --> 00:30:19.689 if you have 10 PA's and all NOTE Confidence: 0.80799998 00:30:19.689 --> 00:30:21.532 10 PA's will will collect, NOTE Confidence: 0.80799998 00:30:21.532 --> 00:30:23.780 there is one PA that is paid by NOTE Confidence: 0.80799998 00:30:23.845 --> 00:30:25.970 the institution for that function. NOTE Confidence: 0.80799998 00:30:25.970 --> 00:30:29.305 So that's how we we get everybody NOTE Confidence: 0.80799998 00:30:29.305 --> 00:30:31.150 to cooperate, yes. NOTE Confidence: 0.814724817272727 00:30:34.060 --> 00:30:36.736 So. Whenever we we we collect NOTE Confidence: 0.814724817272727 00:30:36.736 --> 00:30:39.440 and we once we collect, NOTE Confidence: 0.814724817272727 00:30:39.440 --> 00:30:42.404 we enter into lab vantage with NOTE Confidence: 0.814724817272727 00:30:42.404 --> 00:30:45.240 diagnostic information I do not have. NOTE Confidence: 0.814724817272727 00:30:45.240 --> 00:30:47.675 The annotation is something a NOTE Confidence: 0.814724817272727 00:30:47.675 --> 00:30:49.623 little bit complicated because. NOTE Confidence: 0.814724817272727 00:30:49.630 --> 00:30:52.588 You can make a very extensive NOTE Confidence: 0.814724817272727 00:30:52.588 --> 00:30:54.067 annotation the investigators. NOTE Confidence: 0.814724817272727 00:30:54.070 --> 00:30:55.700 Are not interested in that NOTE Confidence: 0.814724817272727 00:30:55.700 --> 00:30:57.330 they they want something else. NOTE Confidence: 0.814724817272727 00:30:57.330 --> 00:30:59.250 OK, so that is very common. NOTE Confidence: 0.814724817272727 00:30:59.250 --> 00:31:01.226 So what we do is that we do NOTE Confidence: 0.814724817272727 00:31:01.226 --> 00:31:02.728 a minimal annotation like NOTE Confidence: 0.814724817272727 00:31:02.728 --> 00:31:05.068 diagnosis if there is recurrence, NOTE Confidence: 0.814724817272727 00:31:05.070 --> 00:31:07.166 if the patient has been treated or not, NOTE Confidence: 0.814724817272727 00:31:07.170 --> 00:31:08.496 very simple annotations. NOTE Confidence: 0.814724817272727 00:31:08.496 --> 00:31:11.148 And then if the investigator wants NOTE Confidence: 0.814724817272727 00:31:11.148 --> 00:31:13.510 something with a more extensive NOTE Confidence: 0.814724817272727 00:31:13.510 --> 00:31:15.366 annotation like molecular notations, NOTE Confidence: 0.814724817272727 00:31:15.370 --> 00:31:19.630 then we provide the identifier the. NOTE Confidence: 0.814724817272727 00:31:19.630 --> 00:31:22.120 The the Biorepository identifier which NOTE Confidence: 0.814724817272727 00:31:22.120 --> 00:31:25.012 is not the patient identifier, right. NOTE Confidence: 0.814724817272727 00:31:25.012 --> 00:31:27.424 It's a number that is generated NOTE Confidence: 0.814724817272727 00:31:27.424 --> 00:31:28.630 by the system. NOTE Confidence: 0.814724817272727 00:31:28.630 --> 00:31:30.800 Then we provide that to the data NOTE Confidence: 0.814724817272727 00:31:30.800 --> 00:31:33.608 for and the data core we extract NOTE Confidence: 0.814724817272727 00:31:33.608 --> 00:31:35.863 the clinical information that the NOTE Confidence: 0.814724817272727 00:31:35.863 --> 00:31:38.008 situation the investigator wants. NOTE Confidence: 0.814724817272727 00:31:38.010 --> 00:31:40.145 So in a way we don't have, NOTE Confidence: 0.814724817272727 00:31:40.150 --> 00:31:42.621 I don't need to have someone creating NOTE Confidence: 0.814724817272727 00:31:42.621 --> 00:31:45.148 a lot of annotations because it NOTE Confidence: 0.814724817272727 00:31:45.148 --> 00:31:48.375 varies a lot by every different user. NOTE Confidence: 0.814724817272727 00:31:48.380 --> 00:31:49.756 So we create this, NOTE Confidence: 0.814724817272727 00:31:49.756 --> 00:31:52.975 this system is that we have a way to NOTE Confidence: 0.814724817272727 00:31:52.975 --> 00:31:55.129 get the information that they want NOTE Confidence: 0.814724817272727 00:31:55.129 --> 00:31:57.425 that will follow all the regulatory NOTE Confidence: 0.814724817272727 00:31:57.425 --> 00:31:58.973 issues and patient identifiers NOTE Confidence: 0.814724817272727 00:31:58.973 --> 00:32:01.147 and other which will be released, NOTE Confidence: 0.814724817272727 00:32:01.150 --> 00:32:01.470 OK. NOTE Confidence: 0.93061415 00:32:03.720 --> 00:32:08.386 So the the. The manager the the. NOTE Confidence: 0.93061415 00:32:08.386 --> 00:32:10.806 The program manager also tracks NOTE Confidence: 0.93061415 00:32:10.806 --> 00:32:13.967 all the genealogy of the specimen, NOTE Confidence: 0.93061415 00:32:13.970 --> 00:32:15.070 if there is a split, NOTE Confidence: 0.93061415 00:32:15.070 --> 00:32:16.390 if there are aliquots, NOTE Confidence: 0.93061415 00:32:16.390 --> 00:32:18.040 if you already extracted the NOTE Confidence: 0.93061415 00:32:18.040 --> 00:32:19.690 DNA RNA from that sample, NOTE Confidence: 0.93061415 00:32:19.690 --> 00:32:20.280 everything enters, NOTE Confidence: 0.93061415 00:32:20.280 --> 00:32:21.755 so we know exactly what NOTE Confidence: 0.93061415 00:32:21.755 --> 00:32:23.140 happened to that material. NOTE Confidence: 0.813679534166667 00:32:27.590 --> 00:32:30.272 So as I said, clean connotation NOTE Confidence: 0.813679534166667 00:32:30.272 --> 00:32:32.609 is very variable depending a lot. NOTE Confidence: 0.813679534166667 00:32:32.610 --> 00:32:35.395 We do very limited annotation NOTE Confidence: 0.813679534166667 00:32:35.395 --> 00:32:37.623 and extensive annotation requires NOTE Confidence: 0.813679534166667 00:32:37.623 --> 00:32:40.154 personal to mine the data and NOTE Confidence: 0.813679534166667 00:32:40.154 --> 00:32:42.049 enter the clinical data set. NOTE Confidence: 0.813679534166667 00:32:42.050 --> 00:32:43.989 I don't have one person to do NOTE Confidence: 0.813679534166667 00:32:43.989 --> 00:32:45.928 that because it is a lot of work. NOTE Confidence: 0.813679534166667 00:32:45.930 --> 00:32:48.702 So we basically refer to people NOTE Confidence: 0.813679534166667 00:32:48.702 --> 00:32:50.445 that for the resource of the NOTE Confidence: 0.813679534166667 00:32:50.445 --> 00:32:51.720 institution that already do that. NOTE Confidence: 0.752490907083333 00:32:54.840 --> 00:32:56.508 But a minimal notation is important NOTE Confidence: 0.752490907083333 00:32:56.508 --> 00:32:58.367 if patients want if an investigator NOTE Confidence: 0.752490907083333 00:32:58.367 --> 00:33:00.455 wants someone that has never received NOTE Confidence: 0.752490907083333 00:33:00.455 --> 00:33:02.094 chemotherapy or someone that NOTE Confidence: 0.752490907083333 00:33:02.094 --> 00:33:03.649 received chemotherapy, so we cannot. NOTE Confidence: 0.86357601 00:33:05.770 --> 00:33:08.232 How do you manage to maintain this NOTE Confidence: 0.86357601 00:33:08.232 --> 00:33:09.942 update, you know like patients NOTE Confidence: 0.86357601 00:33:09.942 --> 00:33:12.424 that died or patient had follow up NOTE Confidence: 0.86357601 00:33:12.424 --> 00:33:14.179 or surgeries or other treatments NOTE Confidence: 0.856601941111111 00:33:14.510 --> 00:33:17.340 because the the the program NOTE Confidence: 0.856601941111111 00:33:17.340 --> 00:33:19.604 is integrated with EPIC. NOTE Confidence: 0.856601941111111 00:33:19.610 --> 00:33:21.550 And that information is fed NOTE Confidence: 0.856601941111111 00:33:21.550 --> 00:33:23.102 directly into the program, NOTE Confidence: 0.856601941111111 00:33:23.110 --> 00:33:25.118 so the diagnosis that. NOTE Confidence: 0.856601941111111 00:33:25.118 --> 00:33:28.130 That comes from pathology is integrated NOTE Confidence: 0.856601941111111 00:33:28.220 --> 00:33:30.943 this staging we use the the CAP NOTE Confidence: 0.856601941111111 00:33:30.943 --> 00:33:33.409 template so that can be uploaded NOTE Confidence: 0.856601941111111 00:33:33.409 --> 00:33:36.244 into the into lab vantage as well. NOTE Confidence: 0.856601941111111 00:33:36.250 --> 00:33:38.470 So then that data is extracted. NOTE Confidence: 0.856601941111111 00:33:38.470 --> 00:33:40.384 If the recurrence is a little NOTE Confidence: 0.856601941111111 00:33:40.384 --> 00:33:42.878 bit more tough to get because it NOTE Confidence: 0.856601941111111 00:33:42.878 --> 00:33:44.788 is very often sometimes emote. NOTE Confidence: 0.856601941111111 00:33:44.790 --> 00:33:47.380 They don't have a biopsy or something NOTE Confidence: 0.856601941111111 00:33:47.380 --> 00:33:49.729 that tells it is a recurrence, NOTE Confidence: 0.856601941111111 00:33:49.730 --> 00:33:52.268 but date of death is annotated NOTE Confidence: 0.856601941111111 00:33:52.268 --> 00:33:54.810 because it goes straight into epic. NOTE Confidence: 0.856601941111111 00:33:54.810 --> 00:33:56.798 The problem is if the patient dies. NOTE Confidence: 0.856601941111111 00:33:56.800 --> 00:33:57.780 Outside of the system then NOTE Confidence: 0.856601941111111 00:33:57.780 --> 00:33:59.210 there is no way I can tell, NOTE Confidence: 0.856601941111111 00:33:59.210 --> 00:34:00.815 so they'll say the annotation NOTE Confidence: 0.856601941111111 00:34:00.815 --> 00:34:02.420 is very minimal and not. NOTE Confidence: 0.91476312 00:34:05.100 --> 00:34:08.028 Very extensive. Because of all these NOTE Confidence: 0.91476312 00:34:08.028 --> 00:34:09.840 variations, one thing that we need NOTE Confidence: 0.91476312 00:34:09.840 --> 00:34:12.588 to do is to make sure that we have a. NOTE Confidence: 0.843626304 00:34:16.100 --> 00:34:18.260 What's the word look like? NOTE Confidence: 0.843626304 00:34:18.260 --> 00:34:21.653 An inquiry or a quality control of the data? NOTE Confidence: 0.843626304 00:34:21.660 --> 00:34:24.644 So once a year we need to reselect. NOTE Confidence: 0.843626304 00:34:24.650 --> 00:34:26.449 Once a year, twice a year we NOTE Confidence: 0.843626304 00:34:26.449 --> 00:34:28.379 select a few cases and make NOTE Confidence: 0.843626304 00:34:28.379 --> 00:34:30.199 sure that the diagnosis that NOTE Confidence: 0.843626304 00:34:30.199 --> 00:34:32.060 collected from Epic is accurate. NOTE Confidence: 0.843626304 00:34:32.060 --> 00:34:34.244 So we sort of need to do NOTE Confidence: 0.843626304 00:34:34.244 --> 00:34:36.510 a QA of the data, OK. NOTE Confidence: 0.36893207 00:34:39.410 --> 00:34:43.930 Uh. So the investigators can request NOTE Confidence: 0.36893207 00:34:43.930 --> 00:34:46.690 that material funded by repository. NOTE Confidence: 0.36893207 00:34:46.690 --> 00:34:48.410 Again we have two system, NOTE Confidence: 0.36893207 00:34:48.410 --> 00:34:50.811 one that does not allow for patient NOTE Confidence: 0.36893207 00:34:50.811 --> 00:34:52.990 identifier and another one that allows NOTE Confidence: 0.36893207 00:34:52.990 --> 00:34:54.434 for patient identifier depending NOTE Confidence: 0.36893207 00:34:54.434 --> 00:34:56.530 again on the level of the RV. NOTE Confidence: 0.36893207 00:34:56.530 --> 00:34:59.610 So then they explained if they want NOTE Confidence: 0.36893207 00:34:59.610 --> 00:35:02.190 fresh frozen part of embedded tissue, NOTE Confidence: 0.36893207 00:35:02.190 --> 00:35:03.526 whatever it is, blood, NOTE Confidence: 0.36893207 00:35:03.526 --> 00:35:05.937 whatever it is that they put in NOTE Confidence: 0.36893207 00:35:05.937 --> 00:35:07.959 the order and then we'll process. NOTE Confidence: 0.36893207 00:35:07.960 --> 00:35:10.385 Ever before any distribution disease NOTE Confidence: 0.36893207 00:35:10.385 --> 00:35:12.810 should be some quality assurance NOTE Confidence: 0.36893207 00:35:12.881 --> 00:35:15.197 that again that what I'm given NOTE Confidence: 0.36893207 00:35:15.197 --> 00:35:17.240 the investigator is what it is. NOTE Confidence: 0.36893207 00:35:17.240 --> 00:35:18.428 Unfortunately I'm the one NOTE Confidence: 0.36893207 00:35:18.428 --> 00:35:19.913 that does most of this, NOTE Confidence: 0.36893207 00:35:19.920 --> 00:35:22.200 but other pathologists are helping. NOTE Confidence: 0.36893207 00:35:22.200 --> 00:35:24.505 But sometimes as I said NOTE Confidence: 0.36893207 00:35:24.505 --> 00:35:26.640 lung and is a big group, NOTE Confidence: 0.36893207 00:35:26.640 --> 00:35:29.718 so I have to do all the lung quality NOTE Confidence: 0.36893207 00:35:29.718 --> 00:35:33.040 control and we also assessed the NOTE Confidence: 0.36893207 00:35:33.040 --> 00:35:36.980 patient consent form and assess the IRB. NOTE Confidence: 0.36893207 00:35:36.980 --> 00:35:38.744 Four things that we're going to NOTE Confidence: 0.36893207 00:35:38.744 --> 00:35:40.872 encounter as well with people that want NOTE Confidence: 0.36893207 00:35:40.872 --> 00:35:42.965 to do things out of the biorepository, NOTE Confidence: 0.36893207 00:35:42.970 --> 00:35:45.140 but they do not have an RP or the RB NOTE Confidence: 0.36893207 00:35:45.209 --> 00:35:47.689 doesn't say that that's what they can do. NOTE Confidence: 0.36893207 00:35:47.690 --> 00:35:49.378 So we have to do a little bit NOTE Confidence: 0.36893207 00:35:49.378 --> 00:35:50.683 of regulatory and they'll go NOTE Confidence: 0.36893207 00:35:50.683 --> 00:35:52.063 back to the investigator said. NOTE Confidence: 0.36893207 00:35:52.070 --> 00:35:55.622 Your RP does not say anything about using NOTE Confidence: 0.36893207 00:35:55.622 --> 00:35:58.407 bio specimen or using human tissue. NOTE Confidence: 0.36893207 00:35:58.410 --> 00:36:00.102 So they need to go back to the IRB, NOTE Confidence: 0.36893207 00:36:00.110 --> 00:36:03.080 amend the protocol and then we NOTE Confidence: 0.36893207 00:36:03.080 --> 00:36:04.565 can distribute material. NOTE Confidence: 0.36893207 00:36:04.570 --> 00:36:06.358 So the service that we do. NOTE Confidence: 0.84740308 00:36:07.780 --> 00:36:10.220 How do you prioritize distribution? NOTE Confidence: 0.84740308 00:36:10.220 --> 00:36:12.738 Let's say if you have like a ordinance, NOTE Confidence: 0.84740308 00:36:12.738 --> 00:36:15.922 who decides who gets what and what priority? NOTE Confidence: 0.600457793333333 00:36:16.440 --> 00:36:21.524 So do the. It is not much NOTE Confidence: 0.600457793333333 00:36:21.524 --> 00:36:23.688 of a problem because. NOTE Confidence: 0.600457793333333 00:36:23.690 --> 00:36:25.374 Very often, for instance, NOTE Confidence: 0.600457793333333 00:36:25.374 --> 00:36:27.058 the pancreatic team that's NOTE Confidence: 0.600457793333333 00:36:27.058 --> 00:36:28.730 assuming it's very active, NOTE Confidence: 0.600457793333333 00:36:28.730 --> 00:36:30.508 so there is the head of pancreatic. NOTE Confidence: 0.600457793333333 00:36:30.510 --> 00:36:32.562 If there is, if two investigators NOTE Confidence: 0.600457793333333 00:36:32.562 --> 00:36:34.450 asking for the same sample, NOTE Confidence: 0.600457793333333 00:36:34.450 --> 00:36:37.303 I can go to the head of the pancreatic NOTE Confidence: 0.600457793333333 00:36:37.303 --> 00:36:39.595 program and say which one is more NOTE Confidence: 0.600457793333333 00:36:39.595 --> 00:36:41.832 important here or we cannot find NOTE Confidence: 0.600457793333333 00:36:41.832 --> 00:36:44.820 something else in general if the patient NOTE Confidence: 0.600457793333333 00:36:44.820 --> 00:36:47.799 if one investigator has an NIH grant. NOTE Confidence: 0.600457793333333 00:36:47.800 --> 00:36:49.714 That takes priority of someone that NOTE Confidence: 0.600457793333333 00:36:49.714 --> 00:36:52.439 does not have an age grant or or NOTE Confidence: 0.600457793333333 00:36:52.439 --> 00:36:54.174 doesn't have a funding institution. NOTE Confidence: 0.600457793333333 00:36:54.180 --> 00:36:55.380 It's more important than NIH. NOTE Confidence: 0.600457793333333 00:36:55.380 --> 00:37:01.510 But so we we we prioritized by the NOTE Confidence: 0.600457793333333 00:37:01.510 --> 00:37:03.960 sourcing the fund of source and also NOTE Confidence: 0.600457793333333 00:37:03.960 --> 00:37:06.234 if there is more more dispute we NOTE Confidence: 0.600457793333333 00:37:06.234 --> 00:37:08.879 can go to the head of the program. NOTE Confidence: 0.600457793333333 00:37:08.880 --> 00:37:11.076 If there is no way then NOTE Confidence: 0.600457793333333 00:37:11.080 --> 00:37:13.180 I can make that decision. NOTE Confidence: 0.600457793333333 00:37:13.180 --> 00:37:15.365 We have a government body NOTE Confidence: 0.600457793333333 00:37:15.365 --> 00:37:18.030 that is I respond to the. NOTE Confidence: 0.600457793333333 00:37:18.030 --> 00:37:20.278 Associating or translational research. NOTE Confidence: 0.600457793333333 00:37:20.278 --> 00:37:24.294 So the bar repository is under the NOTE Confidence: 0.600457793333333 00:37:24.294 --> 00:37:27.079 administration of the associate team. NOTE Confidence: 0.600457793333333 00:37:27.080 --> 00:37:29.810 So that is the liaison building institution. NOTE Confidence: 0.600457793333333 00:37:29.810 --> 00:37:31.525 So basically if there is a conflict NOTE Confidence: 0.600457793333333 00:37:31.525 --> 00:37:33.595 that we need to then I can go to NOTE Confidence: 0.600457793333333 00:37:33.595 --> 00:37:35.162 the associate Dean and said this is NOTE Confidence: 0.600457793333333 00:37:35.162 --> 00:37:36.744 what I tried to receive a conflict, NOTE Confidence: 0.600457793333333 00:37:36.750 --> 00:37:37.906 what can we do? NOTE Confidence: 0.600457793333333 00:37:37.906 --> 00:37:40.648 And and then it is resolved in that sense. NOTE Confidence: 0.600457793333333 00:37:40.650 --> 00:37:42.694 But there is a line of escalation NOTE Confidence: 0.600457793333333 00:37:42.694 --> 00:37:43.570 that we can. NOTE Confidence: 0.600457793333333 00:37:43.570 --> 00:37:44.698 But as I said, NOTE Confidence: 0.600457793333333 00:37:44.698 --> 00:37:46.813 it is not very common because we NOTE Confidence: 0.600457793333333 00:37:46.813 --> 00:37:48.578 can always offer another case. NOTE Confidence: 0.600457793333333 00:37:48.580 --> 00:37:51.064 It it's very rare that someone NOTE Confidence: 0.600457793333333 00:37:51.064 --> 00:37:53.440 needs a very specific patient. NOTE Confidence: 0.600457793333333 00:37:53.440 --> 00:37:55.580 Correct for that specific protocol. NOTE Confidence: 0.600457793333333 00:37:55.580 --> 00:37:58.028 But of course if someone has a specific NOTE Confidence: 0.600457793333333 00:37:58.028 --> 00:38:00.188 protocol in that patient sign also NOTE Confidence: 0.600457793333333 00:38:00.188 --> 00:38:02.048 consent but that specific protocol NOTE Confidence: 0.600457793333333 00:38:02.048 --> 00:38:04.696 that is the one that goes not the patient, NOTE Confidence: 0.600457793333333 00:38:04.700 --> 00:38:05.836 the other investigator that NOTE Confidence: 0.600457793333333 00:38:05.836 --> 00:38:07.256 does not have that protocol. NOTE Confidence: 0.600457793333333 00:38:07.260 --> 00:38:09.102 So there are different levels of NOTE Confidence: 0.600457793333333 00:38:09.102 --> 00:38:11.240 of telling what is the government NOTE Confidence: 0.600457793333333 00:38:11.240 --> 00:38:12.269 for that expense. NOTE Confidence: 0.922564034 00:38:14.580 --> 00:38:17.160 So we have a fully. NOTE Confidence: 0.922564034 00:38:17.160 --> 00:38:18.474 Histologist service that NOTE Confidence: 0.922564034 00:38:18.474 --> 00:38:20.226 is mostly for research. NOTE Confidence: 0.922564034 00:38:20.230 --> 00:38:22.894 We don't do any clear any NOTE Confidence: 0.922564034 00:38:22.894 --> 00:38:25.080 tests there and we do. NOTE Confidence: 0.922564034 00:38:25.080 --> 00:38:26.700 We can do everything embedding, NOTE Confidence: 0.922564034 00:38:26.700 --> 00:38:28.560 cutting, frozen sections, NOTE Confidence: 0.922564034 00:38:28.560 --> 00:38:30.420 HNE, immune Histology, NOTE Confidence: 0.922564034 00:38:30.420 --> 00:38:32.253 immunohistochemical stains and NOTE Confidence: 0.922564034 00:38:32.253 --> 00:38:34.697 TMA's for the investigators. NOTE Confidence: 0.922564034 00:38:34.700 --> 00:38:37.570 We have a group that does nuclear NOTE Confidence: 0.922564034 00:38:37.570 --> 00:38:39.340 gas extractions from blood, NOTE Confidence: 0.922564034 00:38:39.340 --> 00:38:40.216 tissue frozen, NOTE Confidence: 0.922564034 00:38:40.216 --> 00:38:42.844 whatever it is saliva and they NOTE Confidence: 0.922564034 00:38:42.844 --> 00:38:45.917 can do RNA and DNA and this NOTE Confidence: 0.922564034 00:38:45.917 --> 00:38:48.022 is also an automated process. NOTE Confidence: 0.922564034 00:38:48.030 --> 00:38:49.590 Every single image that NOTE Confidence: 0.922564034 00:38:49.590 --> 00:38:51.150 is distributed we scan, NOTE Confidence: 0.922564034 00:38:51.150 --> 00:38:54.894 so there is also a virtual image of NOTE Confidence: 0.922564034 00:38:54.894 --> 00:38:57.937 that material that can be used for. NOTE Confidence: 0.922564034 00:38:57.940 --> 00:39:00.844 It is very a lot of AI or NOTE Confidence: 0.922564034 00:39:00.844 --> 00:39:02.171 artificial intelligence and NOTE Confidence: 0.922564034 00:39:02.171 --> 00:39:04.247 and digital pathology projects. NOTE Confidence: 0.922564034 00:39:04.250 --> 00:39:06.189 So they can be used for that NOTE Confidence: 0.922564034 00:39:06.189 --> 00:39:07.870 process and clinical trial support. NOTE Confidence: 0.922564034 00:39:07.870 --> 00:39:10.480 Clinical trial support is mostly NOTE Confidence: 0.922564034 00:39:10.480 --> 00:39:13.346 they need a archival biopsy to NOTE Confidence: 0.922564034 00:39:13.346 --> 00:39:16.070 make sure the patient can enroll. NOTE Confidence: 0.922564034 00:39:16.070 --> 00:39:18.688 So my team will go to pathology NOTE Confidence: 0.922564034 00:39:18.688 --> 00:39:21.225 find that block process the block NOTE Confidence: 0.922564034 00:39:21.225 --> 00:39:23.450 according to the the protocol NOTE Confidence: 0.922564034 00:39:23.450 --> 00:39:25.966 and then send it to the directly NOTE Confidence: 0.922564034 00:39:25.966 --> 00:39:28.096 to to the central lab. NOTE Confidence: 0.922564034 00:39:28.100 --> 00:39:29.510 That is during the clinical NOTE Confidence: 0.922564034 00:39:29.510 --> 00:39:31.820 trial or we go to collect a NOTE Confidence: 0.922564034 00:39:31.820 --> 00:39:33.915 specific biopsy for that clinical NOTE Confidence: 0.922564034 00:39:33.915 --> 00:39:35.960 trial process according to the NOTE Confidence: 0.922564034 00:39:35.960 --> 00:39:37.750 protocol and do the distribution. NOTE Confidence: 0.922564034 00:39:37.750 --> 00:39:40.495 So we sort of take care of all the NOTE Confidence: 0.922564034 00:39:40.495 --> 00:39:42.817 tissue and blood before research. NOTE Confidence: 0.905298655555556 00:39:46.110 --> 00:39:48.405 So this is a little bit of the distribution. NOTE Confidence: 0.905298655555556 00:39:48.410 --> 00:39:51.186 So blood is the one that is mostly NOTE Confidence: 0.905298655555556 00:39:51.186 --> 00:39:53.090 used because everybody. Yeah. NOTE Confidence: 0.905298655555556 00:39:53.090 --> 00:39:55.040 Not everybody works with tissue. NOTE Confidence: 0.905298655555556 00:39:55.040 --> 00:39:56.960 So percent of distribute, NOTE Confidence: 0.905298655555556 00:39:56.960 --> 00:39:59.200 these numbers are already outdated, NOTE Confidence: 0.905298655555556 00:39:59.200 --> 00:40:01.200 but I kept them anyway. NOTE Confidence: 0.905298655555556 00:40:01.200 --> 00:40:03.818 But the distribution is sort of stable. NOTE Confidence: 0.905298655555556 00:40:03.820 --> 00:40:05.885 So the blood is about NOTE Confidence: 0.905298655555556 00:40:05.885 --> 00:40:07.860 80% or 90% distribution. NOTE Confidence: 0.905298655555556 00:40:07.860 --> 00:40:10.716 The tissue is about 8020% distribution, NOTE Confidence: 0.905298655555556 00:40:10.716 --> 00:40:13.554 which is good, but it means that we have NOTE Confidence: 0.905298655555556 00:40:13.554 --> 00:40:15.864 a lot more tissue than we distribute NOTE Confidence: 0.905298655555556 00:40:15.864 --> 00:40:18.496 and other fluids is is low utilization, NOTE Confidence: 0.905298655555556 00:40:18.500 --> 00:40:20.456 but we don't collect a lot NOTE Confidence: 0.905298655555556 00:40:20.456 --> 00:40:21.760 of other fluids anyway. NOTE Confidence: 0.905298655555556 00:40:21.760 --> 00:40:24.770 So the. The the tissue. NOTE Confidence: 0.905298655555556 00:40:24.770 --> 00:40:26.234 Another thing that I've I did NOTE Confidence: 0.905298655555556 00:40:26.234 --> 00:40:29.510 not say is that, for instance. NOTE Confidence: 0.905298655555556 00:40:29.510 --> 00:40:32.282 We had a surplus of thyroid NOTE Confidence: 0.905298655555556 00:40:32.282 --> 00:40:35.190 and a surplus of prostate. NOTE Confidence: 0.905298655555556 00:40:35.190 --> 00:40:37.130 Utilization of those two NOTE Confidence: 0.905298655555556 00:40:37.130 --> 00:40:40.040 specimens at NYU is very low. NOTE Confidence: 0.905298655555556 00:40:40.040 --> 00:40:42.040 So we've reached the plateau, NOTE Confidence: 0.905298655555556 00:40:42.040 --> 00:40:43.111 no more collection. NOTE Confidence: 0.905298655555556 00:40:43.111 --> 00:40:45.253 So even if the patient consent, NOTE Confidence: 0.905298655555556 00:40:45.260 --> 00:40:47.600 we do not collect because we have a lot, NOTE Confidence: 0.905298655555556 00:40:47.600 --> 00:40:49.130 unless there is a specific NOTE Confidence: 0.905298655555556 00:40:49.130 --> 00:40:50.354 order for that patient, NOTE Confidence: 0.905298655555556 00:40:50.360 --> 00:40:50.723 OK. NOTE Confidence: 0.905298655555556 00:40:50.723 --> 00:40:53.264 So we can also decide when to NOTE Confidence: 0.905298655555556 00:40:53.264 --> 00:40:55.593 stop collecting if you have enough NOTE Confidence: 0.905298655555556 00:40:55.593 --> 00:40:56.736 of that material. NOTE Confidence: 0.905298655555556 00:40:56.740 --> 00:40:58.670 So this is just the NOTE Confidence: 0.452052446 00:40:59.790 --> 00:41:02.820 storage, you know like particularly NOTE Confidence: 0.452052446 00:41:02.820 --> 00:41:04.689 30,000 block is a lot so are NOTE Confidence: 0.452052446 00:41:04.689 --> 00:41:06.429 you are you handling that NOTE Confidence: 0.83435292125 00:41:06.440 --> 00:41:08.720 very good. I forgot to mention that too. NOTE Confidence: 0.83435292125 00:41:08.720 --> 00:41:12.704 So we have in house a few freezers. NOTE Confidence: 0.83435292125 00:41:12.710 --> 00:41:15.260 And then NYU contracted another NOTE Confidence: 0.83435292125 00:41:15.260 --> 00:41:17.810 outside vendor that we transferred NOTE Confidence: 0.83435292125 00:41:17.889 --> 00:41:20.129 the freezer to that facility. NOTE Confidence: 0.83435292125 00:41:20.130 --> 00:41:22.069 So they would do all the maintenance, NOTE Confidence: 0.83435292125 00:41:22.070 --> 00:41:24.620 the temperature maintenance of that material NOTE Confidence: 0.83435292125 00:41:24.620 --> 00:41:27.922 and once we need we just request that NOTE Confidence: 0.83435292125 00:41:27.922 --> 00:41:30.570 material should be brought back to NYU. NOTE Confidence: 0.83435292125 00:41:30.570 --> 00:41:33.138 So there is a freezer farm, NOTE Confidence: 0.83435292125 00:41:33.140 --> 00:41:35.726 there are many commercial entities that NOTE Confidence: 0.83435292125 00:41:35.730 --> 00:41:38.628 have that and you know you has a contract NOTE Confidence: 0.83435292125 00:41:38.628 --> 00:41:41.120 with one that is now in New Jersey. NOTE Confidence: 0.83435292125 00:41:41.120 --> 00:41:43.311 Of course this is expensive and that NOTE Confidence: 0.83435292125 00:41:43.311 --> 00:41:45.963 is that's why we try to use as much NOTE Confidence: 0.83435292125 00:41:45.963 --> 00:41:48.069 tissue as possible and link to the NOTE Confidence: 0.83435292125 00:41:48.069 --> 00:41:50.260 collection of cases that are not used, NOTE Confidence: 0.83435292125 00:41:50.260 --> 00:41:52.423 because it's a waste of resource to NOTE Confidence: 0.83435292125 00:41:52.423 --> 00:41:54.777 have all these material and pay for NOTE Confidence: 0.83435292125 00:41:54.777 --> 00:41:56.588 that without having any utilization. NOTE Confidence: 0.83435292125 00:41:56.588 --> 00:41:59.220 Yeah, but that is what I mean NOTE Confidence: 0.83435292125 00:41:59.295 --> 00:42:00.999 especially in Manhattan. NOTE Confidence: 0.83435292125 00:42:01.000 --> 00:42:03.840 It's not very space is a little bit, NOTE Confidence: 0.83435292125 00:42:03.840 --> 00:42:05.742 I don't know any other facilities NOTE Confidence: 0.83435292125 00:42:05.742 --> 00:42:09.088 I have been I I have a. NOTE Confidence: 0.83435292125 00:42:09.090 --> 00:42:10.731 Inspected other biorepositories NOTE Confidence: 0.83435292125 00:42:10.731 --> 00:42:14.560 through the CIP program and they have. NOTE Confidence: 0.83435292125 00:42:14.560 --> 00:42:15.940 A room full of freezes, NOTE Confidence: 0.83435292125 00:42:15.940 --> 00:42:17.000 but they have the space. NOTE Confidence: 0.83435292125 00:42:17.000 --> 00:42:19.190 That doesn't happen in New York. NOTE Confidence: 0.896633425454546 00:42:22.180 --> 00:42:23.848 So just to illustrate the the NOTE Confidence: 0.896633425454546 00:42:23.848 --> 00:42:25.560 nucleic acids we have automated, NOTE Confidence: 0.896633425454546 00:42:25.560 --> 00:42:28.080 we have two automated machines that can do NOTE Confidence: 0.896633425454546 00:42:28.080 --> 00:42:30.916 DNA and RNA extraction from large volumes. NOTE Confidence: 0.896633425454546 00:42:30.920 --> 00:42:32.505 So the investigators really take NOTE Confidence: 0.896633425454546 00:42:32.505 --> 00:42:34.090 advantage of that instead if NOTE Confidence: 0.896633425454546 00:42:34.147 --> 00:42:35.755 they're doing one or two cases, NOTE Confidence: 0.896633425454546 00:42:35.760 --> 00:42:36.948 they do it themselves, NOTE Confidence: 0.896633425454546 00:42:36.948 --> 00:42:39.114 but they're doing 100 cases, 200 cases. NOTE Confidence: 0.896633425454546 00:42:39.114 --> 00:42:41.473 It's easier to give it to us NOTE Confidence: 0.896633425454546 00:42:41.473 --> 00:42:43.699 and we provide the DNA RNA, NOTE Confidence: 0.896633425454546 00:42:43.700 --> 00:42:45.982 we do quality control and then we NOTE Confidence: 0.896633425454546 00:42:45.982 --> 00:42:47.805 shift the entire material directly NOTE Confidence: 0.896633425454546 00:42:47.805 --> 00:42:50.500 to the genomic center that will do. NOTE Confidence: 0.896633425454546 00:42:50.500 --> 00:42:51.748 The sequencing for them. NOTE Confidence: 0.885891190625 00:42:53.990 --> 00:42:56.306 Just an example of how much NOTE Confidence: 0.885891190625 00:42:56.306 --> 00:42:58.314 clinical trials is increasing and NOTE Confidence: 0.885891190625 00:42:58.314 --> 00:43:00.289 we also increasing our support. NOTE Confidence: 0.885891190625 00:43:00.290 --> 00:43:03.107 This 2015 was before my time I came in NOTE Confidence: 0.885891190625 00:43:03.107 --> 00:43:06.385 16 and this is really always a growing NOTE Confidence: 0.885891190625 00:43:06.385 --> 00:43:09.573 number of clinical trials that we are NOTE Confidence: 0.885891190625 00:43:09.573 --> 00:43:11.908 involved in supporting these trials. NOTE Confidence: 0.885891190625 00:43:11.910 --> 00:43:14.568 So this is very quick workflow, NOTE Confidence: 0.885891190625 00:43:14.570 --> 00:43:17.818 the tissue comes or the blood comes. NOTE Confidence: 0.885891190625 00:43:17.820 --> 00:43:19.840 It goes to the biorepository. NOTE Confidence: 0.885891190625 00:43:19.840 --> 00:43:21.436 If there is an order for NOTE Confidence: 0.885891190625 00:43:21.436 --> 00:43:22.500 DNA or any extraction, NOTE Confidence: 0.885891190625 00:43:22.500 --> 00:43:26.260 we extract and then send it to distribution. NOTE Confidence: 0.885891190625 00:43:26.260 --> 00:43:27.910 If there is a fresh tissue, NOTE Confidence: 0.885891190625 00:43:27.910 --> 00:43:29.642 goes straight to distribution NOTE Confidence: 0.885891190625 00:43:29.642 --> 00:43:31.807 or stays in the biorepository NOTE Confidence: 0.885891190625 00:43:31.807 --> 00:43:34.097 and then it goes to Histology, NOTE Confidence: 0.885891190625 00:43:34.100 --> 00:43:36.620 then a process and then distribute. NOTE Confidence: 0.885891190625 00:43:36.620 --> 00:43:38.620 So everything is integrated and NOTE Confidence: 0.885891190625 00:43:38.620 --> 00:43:40.620 every single project is different. NOTE Confidence: 0.885891190625 00:43:40.620 --> 00:43:44.380 So it's not exactly the same for everybody. NOTE Confidence: 0.885891190625 00:43:44.380 --> 00:43:47.747 So why it's important to have certifications? NOTE Confidence: 0.885891190625 00:43:47.750 --> 00:43:49.773 Because that's an assurance of in the NOTE Confidence: 0.885891190625 00:43:49.773 --> 00:43:51.740 investigator that we are doing everything. NOTE Confidence: 0.885891190625 00:43:51.740 --> 00:43:53.420 So we are clap certified. NOTE Confidence: 0.885891190625 00:43:53.420 --> 00:43:55.787 We have a license by the the New York NOTE Confidence: 0.885891190625 00:43:55.787 --> 00:43:58.314 State and we also do proficiency tests NOTE Confidence: 0.885891190625 00:43:58.314 --> 00:44:00.700 from the integrated biobank of Luxembourg, NOTE Confidence: 0.885891190625 00:44:00.700 --> 00:44:05.260 which is supported by the International NOTE Confidence: 0.885891190625 00:44:05.260 --> 00:44:07.966 Society of Biorepository IDL. NOTE Confidence: 0.885891190625 00:44:07.966 --> 00:44:10.522 So we hold 11 certificates of NOTE Confidence: 0.885891190625 00:44:10.522 --> 00:44:12.384 proficiency that includes nucleic NOTE Confidence: 0.885891190625 00:44:12.384 --> 00:44:14.929 acid Histology and everything else. NOTE Confidence: 0.885891190625 00:44:14.930 --> 00:44:17.282 So you know something we do every two NOTE Confidence: 0.885891190625 00:44:17.282 --> 00:44:19.462 years to maintain to make sure that NOTE Confidence: 0.885891190625 00:44:19.462 --> 00:44:21.466 we're doing the right things and it NOTE Confidence: 0.885891190625 00:44:21.466 --> 00:44:24.042 increases the value and I have heard, NOTE Confidence: 0.885891190625 00:44:24.050 --> 00:44:26.156 I've heard, I have seen comments NOTE Confidence: 0.885891190625 00:44:26.156 --> 00:44:27.890 in grants that people say, NOTE Confidence: 0.885891190625 00:44:27.890 --> 00:44:31.370 you know this patient, this, this. NOTE Confidence: 0.885891190625 00:44:31.370 --> 00:44:33.870 Institution has a CAP accredited NOTE Confidence: 0.885891190625 00:44:33.870 --> 00:44:35.370 by a repository, NOTE Confidence: 0.885891190625 00:44:35.370 --> 00:44:38.154 so that's a plus for the NOTE Confidence: 0.885891190625 00:44:38.154 --> 00:44:40.590 grant support that they have. NOTE Confidence: 0.885891190625 00:44:40.590 --> 00:44:44.286 So this is basically our finances mostly. NOTE Confidence: 0.885891190625 00:44:44.290 --> 00:44:47.866 So 19% is supported by Grant, NOTE Confidence: 0.885891190625 00:44:47.870 --> 00:44:51.374 Grant based mostly the, NOTE Confidence: 0.885891190625 00:44:51.374 --> 00:44:52.902 the, the personnel. NOTE Confidence: 0.885891190625 00:44:52.902 --> 00:44:55.184 So we have some personnel that is NOTE Confidence: 0.885891190625 00:44:55.184 --> 00:44:57.230 highly specific for certain grants. NOTE Confidence: 0.885891190625 00:44:57.230 --> 00:44:59.900 Our biggest grants is the NOTE Confidence: 0.885891190625 00:44:59.900 --> 00:45:02.570 Cancer Center grant and also. NOTE Confidence: 0.885891190625 00:45:02.570 --> 00:45:04.850 Ischemic epic net and I'll NOTE Confidence: 0.885891190625 00:45:04.850 --> 00:45:07.130 show you some breakdown later. NOTE Confidence: 0.885891190625 00:45:07.130 --> 00:45:09.154 And this institutional support NOTE Confidence: 0.885891190625 00:45:09.154 --> 00:45:12.190 is still about 30 to 40%. NOTE Confidence: 0.885891190625 00:45:12.190 --> 00:45:13.870 It varies from year to year. NOTE Confidence: 0.885891190625 00:45:13.870 --> 00:45:16.480 So these are we don't make NOTE Confidence: 0.885891190625 00:45:16.480 --> 00:45:17.785 money by repository, NOTE Confidence: 0.885891190625 00:45:17.790 --> 00:45:19.596 we can just reduce the amount NOTE Confidence: 0.885891190625 00:45:19.596 --> 00:45:21.896 of loss from the institution or NOTE Confidence: 0.885891190625 00:45:21.896 --> 00:45:23.948 investment from the institution. NOTE Confidence: 0.885891190625 00:45:23.950 --> 00:45:25.590 But a lot of them, NOTE Confidence: 0.885891190625 00:45:25.590 --> 00:45:27.245 they still have some significant NOTE Confidence: 0.885891190625 00:45:27.245 --> 00:45:29.438 support and most of our resource NOTE Confidence: 0.885891190625 00:45:29.438 --> 00:45:30.857 comes from chargebacks. NOTE Confidence: 0.885891190625 00:45:30.860 --> 00:45:32.116 So every single process. NOTE Confidence: 0.885891190625 00:45:32.116 --> 00:45:33.058 What we do, NOTE Confidence: 0.885891190625 00:45:33.060 --> 00:45:34.998 we have to charge to investigate NOTE Confidence: 0.885891190625 00:45:35.000 --> 00:45:36.690 again cultural change because not NOTE Confidence: 0.885891190625 00:45:36.690 --> 00:45:38.380 everybody is interested in paying NOTE Confidence: 0.885891190625 00:45:38.432 --> 00:45:40.399 something that they could get for free. NOTE Confidence: 0.885891190625 00:45:40.400 --> 00:45:42.220 They think they can get for free, NOTE Confidence: 0.885891190625 00:45:42.220 --> 00:45:44.452 but they are not getting the quality in NOTE Confidence: 0.885891190625 00:45:44.452 --> 00:45:46.519 the material that they they have before. NOTE Confidence: 0.89918133375 00:45:48.660 --> 00:45:51.252 This is mostly the breakdown of NOTE Confidence: 0.89918133375 00:45:51.252 --> 00:45:53.114 the services or collections, NOTE Confidence: 0.89918133375 00:45:53.114 --> 00:45:56.096 how much will recover clinical trials. NOTE Confidence: 0.89918133375 00:45:56.100 --> 00:45:58.284 So this is all grant money from NOTE Confidence: 0.89918133375 00:45:58.284 --> 00:46:00.350 everything that we get and research. NOTE Confidence: 0.89918133375 00:46:00.350 --> 00:46:04.256 Archival is mostly recovering from the NOTE Confidence: 0.89918133375 00:46:04.256 --> 00:46:07.409 pathology archival material tissue that NOTE Confidence: 0.89918133375 00:46:07.409 --> 00:46:10.608 is used for research or for glucose. NOTE Confidence: 0.89918133375 00:46:10.610 --> 00:46:12.146 So why pathologists? NOTE Confidence: 0.89918133375 00:46:12.146 --> 00:46:15.218 We are the most qualified medical NOTE Confidence: 0.89918133375 00:46:15.218 --> 00:46:17.766 professionals to do this by banking job. NOTE Confidence: 0.89918133375 00:46:17.770 --> 00:46:20.014 We are very familiar with this NOTE Confidence: 0.89918133375 00:46:20.014 --> 00:46:21.510 requisition with the clinical NOTE Confidence: 0.89918133375 00:46:21.581 --> 00:46:23.277 implications and characterization of NOTE Confidence: 0.89918133375 00:46:23.277 --> 00:46:26.330 these organs of these tumors or tissue. NOTE Confidence: 0.89918133375 00:46:26.330 --> 00:46:28.325 And we are also very much familiar NOTE Confidence: 0.89918133375 00:46:28.325 --> 00:46:29.977 with the quality assurance process NOTE Confidence: 0.89918133375 00:46:29.977 --> 00:46:32.197 and quality standards for all this. NOTE Confidence: 0.89918133375 00:46:32.200 --> 00:46:35.350 So we are already practicing this. NOTE Confidence: 0.89918133375 00:46:35.350 --> 00:46:37.969 So that's why it is very important to have NOTE Confidence: 0.89918133375 00:46:37.969 --> 00:46:41.045 a pathologist involved and in my situation. NOTE Confidence: 0.89918133375 00:46:41.050 --> 00:46:44.122 As I said, it is very much associated NOTE Confidence: 0.89918133375 00:46:44.122 --> 00:46:46.979 with the Department of Pathology. NOTE Confidence: 0.89918133375 00:46:46.980 --> 00:46:48.145 So the challenge is with NOTE Confidence: 0.89918133375 00:46:48.145 --> 00:46:49.310 difficult to predict the future, NOTE Confidence: 0.89918133375 00:46:49.310 --> 00:46:50.984 we'll never know what you're collecting NOTE Confidence: 0.89918133375 00:46:50.984 --> 00:46:52.639 if that's going to be needed. NOTE Confidence: 0.89918133375 00:46:52.640 --> 00:46:56.136 So we need to be always flexible and NOTE Confidence: 0.89918133375 00:46:56.136 --> 00:46:59.275 adaptable to what comes during the COVID, NOTE Confidence: 0.89918133375 00:46:59.275 --> 00:47:01.400 the investigators in the center, NOTE Confidence: 0.89918133375 00:47:01.400 --> 00:47:04.320 they wanted PBMC, some COVID. NOTE Confidence: 0.89918133375 00:47:04.320 --> 00:47:06.460 So we collected the samples, NOTE Confidence: 0.89918133375 00:47:06.460 --> 00:47:08.730 processed PBMC and utilization 0 NOTE Confidence: 0.89918133375 00:47:08.730 --> 00:47:12.039 because by the time they wanted this, NOTE Confidence: 0.89918133375 00:47:12.040 --> 00:47:13.560 they already wanted something else. NOTE Confidence: 0.89918133375 00:47:13.560 --> 00:47:15.768 So there is always a risk NOTE Confidence: 0.89918133375 00:47:15.768 --> 00:47:17.240 that what you collecting. NOTE Confidence: 0.89918133375 00:47:17.240 --> 00:47:19.144 Is not going to be used because NOTE Confidence: 0.89918133375 00:47:19.144 --> 00:47:20.610 it's very difficult to predict. NOTE Confidence: 0.89918133375 00:47:20.610 --> 00:47:21.684 As I said, NOTE Confidence: 0.89918133375 00:47:21.684 --> 00:47:24.190 basically in connotation we need to have NOTE Confidence: 0.89918133375 00:47:24.266 --> 00:47:27.018 support from a data core or someone that NOTE Confidence: 0.89918133375 00:47:27.018 --> 00:47:29.746 can mine epic to get more annotation. NOTE Confidence: 0.89918133375 00:47:29.750 --> 00:47:32.062 What's simple to collect NOTE Confidence: 0.89918133375 00:47:32.062 --> 00:47:34.374 we already went over. NOTE Confidence: 0.89918133375 00:47:34.380 --> 00:47:37.593 What is the technique that we need to invest? NOTE Confidence: 0.89918133375 00:47:37.600 --> 00:47:39.536 And it needs a lot of IT support NOTE Confidence: 0.89918133375 00:47:39.536 --> 00:47:41.109 for the data integration. NOTE Confidence: 0.89918133375 00:47:41.110 --> 00:47:42.349 Without institutional support, NOTE Confidence: 0.89918133375 00:47:42.349 --> 00:47:45.240 it's very difficult to have that IT NOTE Confidence: 0.89918133375 00:47:45.309 --> 00:47:47.784 integration and again institutional support NOTE Confidence: 0.89918133375 00:47:47.784 --> 00:47:50.259 and more important cultural change, NOTE Confidence: 0.89918133375 00:47:50.260 --> 00:47:52.528 because it will require a cultural NOTE Confidence: 0.89918133375 00:47:52.528 --> 00:47:54.040 change for the investigators, NOTE Confidence: 0.89918133375 00:47:54.040 --> 00:47:55.990 from the clinicians and everybody NOTE Confidence: 0.89918133375 00:47:55.990 --> 00:47:57.940 else involved in the process, NOTE Confidence: 0.89918133375 00:47:57.940 --> 00:47:59.848 which is not impossible. NOTE Confidence: 0.89918133375 00:47:59.848 --> 00:48:01.279 It is possible. NOTE Confidence: 0.89918133375 00:48:01.280 --> 00:48:02.855 It creates a little bit of headache, NOTE Confidence: 0.89918133375 00:48:02.860 --> 00:48:05.716 but it changes, which is true for everything. NOTE Confidence: 0.89918133375 00:48:05.720 --> 00:48:07.621 It's not on for this so. NOTE Confidence: 0.89918133375 00:48:07.621 --> 00:48:08.944 Just institutional resource. NOTE Confidence: 0.89918133375 00:48:08.944 --> 00:48:12.910 I want to say that these are grants that. NOTE Confidence: 0.89918133375 00:48:12.910 --> 00:48:15.598 We have supported and you know has been NOTE Confidence: 0.89918133375 00:48:15.598 --> 00:48:17.990 very good in getting those grants. NOTE Confidence: 0.89918133375 00:48:17.990 --> 00:48:19.898 I'm not saying that it's only NOTE Confidence: 0.89918133375 00:48:19.898 --> 00:48:21.170 because of our repository. NOTE Confidence: 0.89918133375 00:48:21.170 --> 00:48:23.389 Of course there is science behind it, NOTE Confidence: 0.89918133375 00:48:23.390 --> 00:48:25.742 but the fact that there is a NOTE Confidence: 0.89918133375 00:48:25.742 --> 00:48:27.829 biorepository that is well annotated, NOTE Confidence: 0.89918133375 00:48:27.830 --> 00:48:30.678 it has been a plus for all these NOTE Confidence: 0.89918133375 00:48:30.678 --> 00:48:34.060 grams that that NYU has received. NOTE Confidence: 0.776301782857143 00:48:34.920 --> 00:48:37.120 I have a question about NOTE Confidence: 0.776301782857143 00:48:37.120 --> 00:48:38.762 the support relationship. NOTE Confidence: 0.776301782857143 00:48:38.762 --> 00:48:42.572 So this four names your NOTE Confidence: 0.776301782857143 00:48:42.572 --> 00:48:45.205 repository therefore facility or NOTE Confidence: 0.776301782857143 00:48:45.205 --> 00:48:46.930 you have an independent group. NOTE Confidence: 0.79182476 00:48:46.970 --> 00:48:48.236 It is, it is very good. NOTE Confidence: 0.79182476 00:48:48.240 --> 00:48:50.284 What happened is a lot of the NOTE Confidence: 0.79182476 00:48:50.284 --> 00:48:51.570 applications for this sport, NOTE Confidence: 0.79182476 00:48:51.570 --> 00:48:52.954 they have the requirement NOTE Confidence: 0.79182476 00:48:52.954 --> 00:48:54.338 to have a pathology. NOTE Confidence: 0.79182476 00:48:54.340 --> 00:48:56.315 So very often there is NOTE Confidence: 0.79182476 00:48:56.315 --> 00:48:57.500 a pathologist involved. NOTE Confidence: 0.79182476 00:48:57.500 --> 00:48:59.596 There are two mechanisms that we can do. NOTE Confidence: 0.79182476 00:48:59.600 --> 00:49:01.706 We can keep everything in the NOTE Confidence: 0.79182476 00:49:01.706 --> 00:49:03.110 biorepository and then the NOTE Confidence: 0.79182476 00:49:03.177 --> 00:49:05.057 investigators take from there. NOTE Confidence: 0.79182476 00:49:05.060 --> 00:49:08.119 Or we do that for the Melanoma NOTE Confidence: 0.79182476 00:49:08.120 --> 00:49:10.334 spore that all these samples are NOTE Confidence: 0.79182476 00:49:10.334 --> 00:49:13.542 procured for us by abide the CBD and NOTE Confidence: 0.79182476 00:49:13.542 --> 00:49:15.607 then we release immediately that NOTE Confidence: 0.79182476 00:49:15.607 --> 00:49:17.979 sample to develop normally sport. NOTE Confidence: 0.79182476 00:49:17.980 --> 00:49:19.876 So they have their own annotations NOTE Confidence: 0.79182476 00:49:19.876 --> 00:49:21.860 and they're all by repository. NOTE Confidence: 0.79182476 00:49:21.860 --> 00:49:23.720 So you can do both. NOTE Confidence: 0.79182476 00:49:23.720 --> 00:49:25.953 You can keep everything in your central NOTE Confidence: 0.79182476 00:49:25.953 --> 00:49:27.937 repository or you can procure the NOTE Confidence: 0.79182476 00:49:27.937 --> 00:49:29.875 samples and then distribute to them. NOTE Confidence: 0.79182476 00:49:29.880 --> 00:49:33.156 And of course they have the financial, NOTE Confidence: 0.79182476 00:49:33.160 --> 00:49:35.275 you can do the charge back because they have. NOTE Confidence: 0.79182476 00:49:35.280 --> 00:49:37.050 The financial support to give NOTE Confidence: 0.79182476 00:49:37.050 --> 00:49:38.466 to the buyer repository. NOTE Confidence: 0.79182476 00:49:38.470 --> 00:49:40.350 So there are just two models that we can do. NOTE Confidence: 0.79182476 00:49:40.350 --> 00:49:41.148 Thanks for asking. NOTE Confidence: 0.79182476 00:49:41.148 --> 00:49:42.744 I forgot to mention that and NOTE Confidence: 0.79182476 00:49:42.744 --> 00:49:44.179 we do the same question. NOTE Confidence: 0.79182476 00:49:44.180 --> 00:49:46.380 How do you handle investigators NOTE Confidence: 0.819673263461538 00:49:46.390 --> 00:49:48.854 that are not there anymore or projects NOTE Confidence: 0.819673263461538 00:49:48.854 --> 00:49:50.925 that started acquired samples or you NOTE Confidence: 0.819673263461538 00:49:50.925 --> 00:49:53.144 made a distribution and then they leave NOTE Confidence: 0.819673263461538 00:49:53.205 --> 00:49:55.317 the institution or the project ends, NOTE Confidence: 0.788342790625 00:49:55.410 --> 00:49:58.722 big problem. So this is a big problem NOTE Confidence: 0.788342790625 00:49:58.722 --> 00:50:01.673 for the institution and we have NOTE Confidence: 0.788342790625 00:50:01.673 --> 00:50:04.486 created a biospecimen policy for NYU. NOTE Confidence: 0.788342790625 00:50:04.486 --> 00:50:07.180 So basically now requires that every NOTE Confidence: 0.788342790625 00:50:07.258 --> 00:50:09.858 investigator that is collecting sample NOTE Confidence: 0.788342790625 00:50:09.858 --> 00:50:12.969 independent of the viral repository to NOTE Confidence: 0.788342790625 00:50:12.969 --> 00:50:15.615 have everything annotated in lab vantage. NOTE Confidence: 0.788342790625 00:50:15.620 --> 00:50:17.020 I'm I'm saying lab vantage, NOTE Confidence: 0.788342790625 00:50:17.020 --> 00:50:19.155 not a propaganda, anyone can use different, NOTE Confidence: 0.788342790625 00:50:19.160 --> 00:50:20.714 but that's the one and why NOTE Confidence: 0.788342790625 00:50:20.714 --> 00:50:22.599 you use this and I'm familiar. NOTE Confidence: 0.788342790625 00:50:22.600 --> 00:50:25.048 So everybody needs to enter all NOTE Confidence: 0.788342790625 00:50:25.048 --> 00:50:26.680 their specimens in advantage. NOTE Confidence: 0.788342790625 00:50:26.680 --> 00:50:29.460 So once the investigator leaves, NOTE Confidence: 0.788342790625 00:50:29.460 --> 00:50:31.700 that material comes to the viral repository. NOTE Confidence: 0.788342790625 00:50:31.700 --> 00:50:33.715 So then I'll be responsible NOTE Confidence: 0.788342790625 00:50:33.715 --> 00:50:34.924 for that material. NOTE Confidence: 0.788342790625 00:50:34.930 --> 00:50:37.681 And this is a major challenge because NOTE Confidence: 0.788342790625 00:50:37.681 --> 00:50:40.315 not everybody is making good annotations NOTE Confidence: 0.788342790625 00:50:40.315 --> 00:50:43.528 and good good keeping of that material. NOTE Confidence: 0.788342790625 00:50:43.530 --> 00:50:45.558 So that's part of the cultural NOTE Confidence: 0.788342790625 00:50:45.558 --> 00:50:48.359 change that I think that is has to NOTE Confidence: 0.788342790625 00:50:48.359 --> 00:50:50.084 come and it's slowly improving. NOTE Confidence: 0.788342790625 00:50:50.090 --> 00:50:52.953 But that was something that is still NOTE Confidence: 0.788342790625 00:50:52.953 --> 00:50:55.872 happening and it is always a problem NOTE Confidence: 0.788342790625 00:50:55.872 --> 00:50:58.426 with someone who has leaves and then NOTE Confidence: 0.788342790625 00:50:58.426 --> 00:51:00.302 they cannot take the samples and then NOTE Confidence: 0.788342790625 00:51:00.302 --> 00:51:02.330 the samples are useless because there NOTE Confidence: 0.788342790625 00:51:02.330 --> 00:51:05.320 is no annotation, don't know what it is. NOTE Confidence: 0.788342790625 00:51:05.320 --> 00:51:07.720 And so it. NOTE Confidence: 0.788342790625 00:51:07.720 --> 00:51:10.163 In a good way that it reinforced NOTE Confidence: 0.788342790625 00:51:10.163 --> 00:51:12.597 to the institution the need for NOTE Confidence: 0.788342790625 00:51:12.597 --> 00:51:14.349 a centralized biorepository that NOTE Confidence: 0.788342790625 00:51:14.349 --> 00:51:16.490 can be responsible for others. NOTE Confidence: 0.788342790625 00:51:16.490 --> 00:51:20.306 So you know what all these mishaps has been? NOTE Confidence: 0.788342790625 00:51:20.310 --> 00:51:22.975 Very good for the central NOTE Confidence: 0.788342790625 00:51:22.975 --> 00:51:25.107 Biorepository because basically yes. NOTE Confidence: 0.788342790625 00:51:25.110 --> 00:51:27.917 And very fortunate that we have the NOTE Confidence: 0.788342790625 00:51:27.917 --> 00:51:29.800 support of institutions says yes, NOTE Confidence: 0.788342790625 00:51:29.800 --> 00:51:30.826 you're the ones that need to NOTE Confidence: 0.788342790625 00:51:30.826 --> 00:51:31.510 take care of this. NOTE Confidence: 0.693545425714286 00:51:32.550 --> 00:51:35.455 Well, another word, do you have like? NOTE Confidence: 0.693545425714286 00:51:35.460 --> 00:51:37.360 Living in the institutional support, NOTE Confidence: 0.693545425714286 00:51:37.360 --> 00:51:38.788 let's say, you know, NOTE Confidence: 0.693545425714286 00:51:38.788 --> 00:51:41.240 during COVID or whatever reason you're not. NOTE Confidence: 0.693545425714286 00:51:41.240 --> 00:51:42.828 Getting, you know, distribution NOTE Confidence: 0.693545425714286 00:51:42.828 --> 00:51:44.813 events to to support yourself, NOTE Confidence: 0.693545425714286 00:51:44.820 --> 00:51:46.680 you know, being able to charge. NOTE Confidence: 0.693545425714286 00:51:46.680 --> 00:51:48.921 Do you have like a limit in the amount NOTE Confidence: 0.693545425714286 00:51:48.921 --> 00:51:50.920 that the institution will support? NOTE Confidence: 0.881864396 00:51:52.250 --> 00:51:55.010 I haven't encountered that even. NOTE Confidence: 0.881864396 00:51:55.010 --> 00:51:57.502 Yeah, it works even during the COVID NOTE Confidence: 0.881864396 00:51:57.502 --> 00:52:00.688 because a lot of the investigators, they. NOTE Confidence: 0.881864396 00:52:00.688 --> 00:52:03.950 The labs were closed, so they switched NOTE Confidence: 0.881864396 00:52:03.950 --> 00:52:06.540 a lot of their efforts into COVID, NOTE Confidence: 0.881864396 00:52:06.540 --> 00:52:08.320 so everything that we're collecting, NOTE Confidence: 0.881864396 00:52:08.320 --> 00:52:10.933 they would use. NOTE Confidence: 0.881864396 00:52:10.933 --> 00:52:14.417 So for COVID specifically, NOTE Confidence: 0.881864396 00:52:14.420 --> 00:52:17.440 the institution created a grant. NOTE Confidence: 0.881864396 00:52:17.440 --> 00:52:19.617 That they were provided to the investigators, NOTE Confidence: 0.881864396 00:52:19.620 --> 00:52:21.392 not outside the Grantwood NOTE Confidence: 0.881864396 00:52:21.392 --> 00:52:22.730 institutional grant, so. NOTE Confidence: 0.881864396 00:52:22.730 --> 00:52:25.880 Yes, I think the institution will take, NOTE Confidence: 0.881864396 00:52:25.880 --> 00:52:28.088 I don't know what is their NOTE Confidence: 0.881864396 00:52:28.088 --> 00:52:30.280 limit but they will do that. NOTE Confidence: 0.881864396 00:52:30.280 --> 00:52:32.984 And I also know there is now an NOTE Confidence: 0.881864396 00:52:32.984 --> 00:52:35.287 investigator a very big on genetics. NOTE Confidence: 0.881864396 00:52:35.290 --> 00:52:38.170 So he's trying to get to create the NOTE Confidence: 0.881864396 00:52:38.170 --> 00:52:40.733 genetic center at NYU and he's using a NOTE Confidence: 0.881864396 00:52:40.733 --> 00:52:43.499 lot of he doesn't have specific grants NOTE Confidence: 0.881864396 00:52:43.499 --> 00:52:46.019 for that generate preliminary data. NOTE Confidence: 0.881864396 00:52:46.020 --> 00:52:48.450 So the institution is provide him NOTE Confidence: 0.881864396 00:52:48.450 --> 00:52:51.080 with a grant to do that process NOTE Confidence: 0.881864396 00:52:51.080 --> 00:52:52.980 and that includes by repository. NOTE Confidence: 0.881864396 00:52:52.980 --> 00:52:54.652 So again it is. NOTE Confidence: 0.881864396 00:52:54.652 --> 00:52:56.846 Of course, there's nothing to do with me. NOTE Confidence: 0.881864396 00:52:56.850 --> 00:52:58.404 I'm not the one making those decisions, NOTE Confidence: 0.881864396 00:52:58.410 --> 00:53:01.105 but the institution make the decisions to NOTE Confidence: 0.881864396 00:53:01.105 --> 00:53:02.869 support investigators during that time. NOTE Confidence: 0.881864396 00:53:02.870 --> 00:53:03.408 So again, NOTE Confidence: 0.881864396 00:53:03.408 --> 00:53:05.291 that's that's what it is and that's NOTE Confidence: 0.881864396 00:53:05.291 --> 00:53:07.207 the model that I've been working. NOTE Confidence: 0.697383511428572 00:53:08.400 --> 00:53:11.634 So I can follow the question about NOTE Confidence: 0.697383511428572 00:53:11.640 --> 00:53:13.236 the party, the investigator. NOTE Confidence: 0.697383511428572 00:53:13.236 --> 00:53:16.726 Do you guys you know have an institutional NOTE Confidence: 0.697383511428572 00:53:16.726 --> 00:53:19.774 or like a formal institutional policy, NOTE Confidence: 0.697383511428572 00:53:19.780 --> 00:53:22.450 how you either allow certain investigator NOTE Confidence: 0.697383511428572 00:53:22.450 --> 00:53:25.370 to carry some of these with them? NOTE Confidence: 0.7184196975 00:53:25.800 --> 00:53:29.314 There is a policy in general, NOTE Confidence: 0.7184196975 00:53:29.314 --> 00:53:31.516 I'm not aware that they allow NOTE Confidence: 0.7184196975 00:53:31.516 --> 00:53:33.746 investigators to take their samples NOTE Confidence: 0.7184196975 00:53:33.746 --> 00:53:36.121 with them because everything is NOTE Confidence: 0.7184196975 00:53:36.121 --> 00:53:37.710 considered institutional resource. NOTE Confidence: 0.7184196975 00:53:37.710 --> 00:53:40.769 If there is a situation like that. NOTE Confidence: 0.7184196975 00:53:40.770 --> 00:53:42.084 They're probably discussed NOTE Confidence: 0.7184196975 00:53:42.084 --> 00:53:44.712 with the Dean or the the, NOTE Confidence: 0.7184196975 00:53:44.720 --> 00:53:45.820 the, you know, I, I, NOTE Confidence: 0.7184196975 00:53:45.820 --> 00:53:47.098 I'm not part of that discussion, NOTE Confidence: 0.7184196975 00:53:47.100 --> 00:53:49.879 but there is a policy that institutes NOTE Confidence: 0.7184196975 00:53:49.879 --> 00:53:52.214 that everything needs to be cataloged NOTE Confidence: 0.7184196975 00:53:52.214 --> 00:53:54.356 in that specific system and that NOTE Confidence: 0.7184196975 00:53:54.356 --> 00:53:56.866 they cannot take their material out. NOTE Confidence: 0.545304837142857 00:53:58.490 --> 00:54:01.269 Relations with the rest of the annotation. NOTE Confidence: 0.545304837142857 00:54:01.270 --> 00:54:03.148 So it wasn't a PC system. NOTE Confidence: 0.545304837142857 00:54:03.150 --> 00:54:05.390 Do you use the APR or is it NOTE Confidence: 0.611859878 00:54:06.070 --> 00:54:07.820 we we was epic beaker? NOTE Confidence: 0.631509605714286 00:54:09.310 --> 00:54:12.022 Think of that. I actually will NOTE Confidence: 0.631509605714286 00:54:12.022 --> 00:54:14.248 see either waiting on it. NOTE Confidence: 0.817736759333333 00:54:14.440 --> 00:54:17.986 Yes and no because we just had a transition NOTE Confidence: 0.817736759333333 00:54:17.986 --> 00:54:20.477 between power path to epic beaker, NOTE Confidence: 0.817736759333333 00:54:20.480 --> 00:54:23.905 so the whole system was created NOTE Confidence: 0.817736759333333 00:54:23.905 --> 00:54:26.630 to interface with power pad. NOTE Confidence: 0.817736759333333 00:54:26.630 --> 00:54:28.853 So now we bicker, we have to get again NOTE Confidence: 0.817736759333333 00:54:28.853 --> 00:54:31.550 the IT support to change that material and NOTE Confidence: 0.817736759333333 00:54:31.550 --> 00:54:34.738 then integrate with speaker. So it is a. NOTE Confidence: 0.817736759333333 00:54:34.738 --> 00:54:36.773 We're now integrated with weaker, NOTE Confidence: 0.817736759333333 00:54:36.780 --> 00:54:38.604 but there was that transition in the middle. NOTE Confidence: 0.427627625 00:54:40.110 --> 00:54:44.710 Another talk talking about that you're OK. NOTE Confidence: 0.725649156666667 00:54:44.710 --> 00:54:47.879 It is a. If you're going NOTE Confidence: 0.725649156666667 00:54:47.879 --> 00:54:49.244 traffic because I'm I'm now, NOTE Confidence: 0.725649156666667 00:54:49.250 --> 00:54:51.566 I'm used to it, it's fine, NOTE Confidence: 0.725649156666667 00:54:51.570 --> 00:54:53.397 I'm very used to it and I've NOTE Confidence: 0.725649156666667 00:54:53.397 --> 00:54:54.470 already forgot everything else. NOTE Confidence: 0.725649156666667 00:54:54.470 --> 00:54:57.026 But it is a learning curve. NOTE Confidence: 0.725649156666667 00:54:57.030 --> 00:54:59.574 It is a learning. Especially for NOTE Confidence: 0.725649156666667 00:54:59.574 --> 00:55:01.004 the for the pathologist notebook, NOTE Confidence: 0.725649156666667 00:55:01.004 --> 00:55:03.380 for the labs, it's more learning. NOTE Confidence: 0.725649156666667 00:55:03.380 --> 00:55:05.540 I think that's all. NOTE Confidence: 0.725649156666667 00:55:05.540 --> 00:55:08.095 Oh, just a just another example of NOTE Confidence: 0.725649156666667 00:55:08.095 --> 00:55:11.477 a paper that used material from the NOTE Confidence: 0.725649156666667 00:55:11.477 --> 00:55:14.237 biorepository that is published recently. NOTE Confidence: 0.725649156666667 00:55:14.240 --> 00:55:14.862 But no. NOTE Confidence: 0.725649156666667 00:55:14.862 --> 00:55:17.039 So just to conclude the bank can NOTE Confidence: 0.725649156666667 00:55:17.039 --> 00:55:19.082 deliver quality specimens and a NOTE Confidence: 0.725649156666667 00:55:19.082 --> 00:55:21.157 critical resource of the medical NOTE Confidence: 0.725649156666667 00:55:21.157 --> 00:55:23.095 science is an invaluable resource NOTE Confidence: 0.725649156666667 00:55:23.095 --> 00:55:25.273 to the increased needs of high NOTE Confidence: 0.725649156666667 00:55:25.280 --> 00:55:27.180 throughput technologies and accuracy NOTE Confidence: 0.725649156666667 00:55:27.180 --> 00:55:29.555 of data generated depending on NOTE Confidence: 0.725649156666667 00:55:29.555 --> 00:55:32.039 the quality of the vice specimen, NOTE Confidence: 0.725649156666667 00:55:32.040 --> 00:55:34.020 which is very, very important. NOTE Confidence: 0.725649156666667 00:55:34.020 --> 00:55:35.710 So this is the team. NOTE Confidence: 0.725649156666667 00:55:35.710 --> 00:55:37.240 We started with six people. NOTE Confidence: 0.725649156666667 00:55:37.240 --> 00:55:41.368 We are now 24 excluding me, NOTE Confidence: 0.725649156666667 00:55:41.370 --> 00:55:44.970 25 with me and we. NOTE Confidence: 0.725649156666667 00:55:44.970 --> 00:55:48.960 That is the the team that we have right now. NOTE Confidence: 0.725649156666667 00:55:48.960 --> 00:55:49.620 Thank you. NOTE Confidence: 0.624856642 00:55:52.740 --> 00:55:56.700 Yeah, so something more important. NOTE Confidence: 0.624856642 00:55:56.700 --> 00:55:59.342 I am just. Right now, NOTE Confidence: 0.624856642 00:55:59.342 --> 00:56:00.990 I don't need to be there every day. NOTE Confidence: 0.624856642 00:56:00.990 --> 00:56:02.838 Everything goes without me. NOTE Confidence: 0.624856642 00:56:02.838 --> 00:56:05.610 But Sandra Mendoza is the manager NOTE Confidence: 0.624856642 00:56:05.685 --> 00:56:07.729 and the assistant director, NOTE Confidence: 0.624856642 00:56:07.730 --> 00:56:09.730 and she's really the person NOTE Confidence: 0.624856642 00:56:09.730 --> 00:56:10.930 that maintains that, NOTE Confidence: 0.624856642 00:56:10.930 --> 00:56:12.298 the whole structure functioning. NOTE Confidence: 0.624856642 00:56:12.298 --> 00:56:14.008 So you need someone that NOTE Confidence: 0.624856642 00:56:14.008 --> 00:56:15.649 has to be there every day. NOTE Confidence: 0.624856642 00:56:15.650 --> 00:56:17.108 If you can have a pathologist, NOTE Confidence: 0.624856642 00:56:17.110 --> 00:56:19.542 great, but not always easy to get a NOTE Confidence: 0.624856642 00:56:19.542 --> 00:56:21.390 pathology should be that exclusively. NOTE Confidence: 0.624856642 00:56:21.390 --> 00:56:23.862 But you know, once someone is NOTE Confidence: 0.624856642 00:56:23.862 --> 00:56:25.810 trained and organized that is, NOTE Confidence: 0.624856642 00:56:25.810 --> 00:56:27.950 it works extremely well. NOTE Confidence: 0.624856642 00:56:27.950 --> 00:56:28.460 Thank you. NOTE Confidence: 0.581376693333333 00:56:31.400 --> 00:56:32.879 Question. Yes please. NOTE Confidence: 0.7604606375 00:56:35.230 --> 00:56:37.449 And it was striking that you distribute NOTE Confidence: 0.7604606375 00:56:37.449 --> 00:56:40.116 20% of your tissue samples but it NOTE Confidence: 0.7604606375 00:56:40.116 --> 00:56:42.423 wasn't clearly how you decide what NOTE Confidence: 0.7604606375 00:56:42.423 --> 00:56:45.071 to to that is no ones working on NOTE Confidence: 0.7604606375 00:56:45.149 --> 00:56:47.482 sarcoma YouTube every what if I come NOTE Confidence: 0.7604606375 00:56:47.482 --> 00:56:51.628 to you and I play on 110 that Jason's. NOTE Confidence: 0.7604606375 00:56:51.630 --> 00:56:53.628 If you have that or how do you decide NOTE Confidence: 0.7604606375 00:56:53.628 --> 00:56:55.755 what you collect and what you described? NOTE Confidence: 0.72771407 00:56:55.800 --> 00:56:58.340 So we collect everything from NOTE Confidence: 0.72771407 00:56:58.340 --> 00:57:00.880 patients that signed the consent. NOTE Confidence: 0.72771407 00:57:00.880 --> 00:57:02.260 So if there is a sarcoma, NOTE Confidence: 0.72771407 00:57:02.260 --> 00:57:04.136 will collect the sarcoma if there is, NOTE Confidence: 0.72771407 00:57:04.140 --> 00:57:05.766 even if there is nobody working NOTE Confidence: 0.72771407 00:57:05.766 --> 00:57:07.969 on it or there is no need for it. NOTE Confidence: 0.72771407 00:57:07.970 --> 00:57:09.830 What I stopped collectively is when NOTE Confidence: 0.72771407 00:57:09.830 --> 00:57:12.820 I have like I think I have like 1000 NOTE Confidence: 0.72771407 00:57:12.820 --> 00:57:15.339 thyroids and thousands or more than 1000 NOTE Confidence: 0.72771407 00:57:15.339 --> 00:57:17.667 prostate cancer and nobody requests it. NOTE Confidence: 0.72771407 00:57:17.670 --> 00:57:20.937 So I'm not going to order to get anymore. NOTE Confidence: 0.72771407 00:57:20.940 --> 00:57:25.340 But for other cases like head and neck, NOTE Confidence: 0.72771407 00:57:25.340 --> 00:57:27.720 head and neck is difficult to collect NOTE Confidence: 0.72771407 00:57:27.785 --> 00:57:30.059 because nowadays most patients it's a NOTE Confidence: 0.72771407 00:57:30.059 --> 00:57:32.719 tiny biopsy and then the patients get NOTE Confidence: 0.72771407 00:57:32.719 --> 00:57:35.100 therapy and then they take it out. NOTE Confidence: 0.72771407 00:57:35.100 --> 00:57:36.400 What is that over? NOTE Confidence: 0.72771407 00:57:36.400 --> 00:57:38.717 Not always there is viable tumor there, NOTE Confidence: 0.72771407 00:57:38.720 --> 00:57:40.776 but we collect from the head and neck. NOTE Confidence: 0.72771407 00:57:40.780 --> 00:57:43.160 We have some salivary glands, NOTE Confidence: 0.72771407 00:57:43.160 --> 00:57:47.176 we have sarcomas, we have a lot of. NOTE Confidence: 0.72771407 00:57:47.180 --> 00:57:48.416 We have trust funds, NOTE Confidence: 0.72771407 00:57:48.416 --> 00:57:50.859 we also collect the heart and lung NOTE Confidence: 0.72771407 00:57:50.859 --> 00:57:52.939 transplant material liver transplant. NOTE Confidence: 0.72771407 00:57:52.940 --> 00:57:55.166 So if the patient consent to recollect. NOTE Confidence: 0.730797045 00:57:56.080 --> 00:57:57.900 Then when you do it like so we NOTE Confidence: 0.730797045 00:57:57.900 --> 00:58:00.495 just keep it unless we have 1000 NOTE Confidence: 0.730797045 00:58:00.495 --> 00:58:02.195 prostates they're getting old. NOTE Confidence: 0.730797045 00:58:02.200 --> 00:58:03.260 Are they still valuable. NOTE Confidence: 0.785474666 00:58:03.270 --> 00:58:05.148 They're still valid with as long NOTE Confidence: 0.785474666 00:58:05.148 --> 00:58:07.379 as they are annotated and we do NOTE Confidence: 0.785474666 00:58:07.379 --> 00:58:08.607 periodic quality assurance and NOTE Confidence: 0.785474666 00:58:08.607 --> 00:58:10.833 then if they if there is a problem NOTE Confidence: 0.785474666 00:58:10.833 --> 00:58:12.852 then we have to throw them out. NOTE Confidence: 0.785474666 00:58:12.852 --> 00:58:14.782 But in general they they NOTE Confidence: 0.785474666 00:58:14.782 --> 00:58:15.940 maintained very well. NOTE Confidence: 0.785474666 00:58:15.940 --> 00:58:18.550 They should if if you keep them in minus 80 NOTE Confidence: 0.785474666 00:58:18.620 --> 00:58:21.300 or liquid nitrogen they they stay very well. NOTE Confidence: 0.785474666 00:58:21.300 --> 00:58:24.004 I did a A for a small project NOTE Confidence: 0.785474666 00:58:24.004 --> 00:58:26.060 we note remember that. NOTE Confidence: 0.785474666 00:58:26.060 --> 00:58:31.184 NYU had a sandy hurricane that came NOTE Confidence: 0.785474666 00:58:31.190 --> 00:58:34.032 and basically destroyed and why you you NOTE Confidence: 0.785474666 00:58:34.032 --> 00:58:36.906 were like almost one year without function. NOTE Confidence: 0.785474666 00:58:36.906 --> 00:58:38.986 So there was already sample. NOTE Confidence: 0.785474666 00:58:38.990 --> 00:58:40.985 This was before the Biorepository but there NOTE Confidence: 0.785474666 00:58:40.985 --> 00:58:43.029 was some samples there already collected. NOTE Confidence: 0.785474666 00:58:43.030 --> 00:58:45.690 So I wanted to see that material NOTE Confidence: 0.785474666 00:58:45.690 --> 00:58:47.769 was still viable and useful. NOTE Confidence: 0.785474666 00:58:47.770 --> 00:58:49.698 So we did a little project and we NOTE Confidence: 0.785474666 00:58:49.698 --> 00:58:50.879 published in the BIOREPOSITORY NOTE Confidence: 0.785474666 00:58:50.879 --> 00:58:52.489 during or whatever it is, NOTE Confidence: 0.785474666 00:58:52.490 --> 00:58:53.802 but basically saying that NOTE Confidence: 0.785474666 00:58:53.802 --> 00:58:55.442 it is good for Histology, NOTE Confidence: 0.785474666 00:58:55.450 --> 00:58:55.967 immunohistology. NOTE Confidence: 0.785474666 00:58:55.967 --> 00:58:57.518 RNA DNA extraction, NOTE Confidence: 0.785474666 00:58:57.518 --> 00:59:00.103 everything that we need that NOTE Confidence: 0.785474666 00:59:00.103 --> 00:59:01.859 issue is still useful. NOTE Confidence: 0.785474666 00:59:01.860 --> 00:59:05.310 So it it is quite resistant this issue. NOTE Confidence: 0.71546069 00:59:08.130 --> 00:59:11.546 So long you talk about whether you NOTE Confidence: 0.71546069 00:59:11.546 --> 00:59:14.299 connect any tissue or PEX or PO. NOTE Confidence: 0.885259488 00:59:18.230 --> 00:59:21.320 So basically the investigator will NOTE Confidence: 0.885259488 00:59:21.320 --> 00:59:23.196 place an order so like they want. NOTE Confidence: 0.718618642666667 00:59:27.170 --> 00:59:29.185 Small squamous cell carcinoma let's NOTE Confidence: 0.718618642666667 00:59:29.185 --> 00:59:32.573 just OK and then when I have a case NOTE Confidence: 0.718618642666667 00:59:32.573 --> 00:59:34.988 then we inform the the clinician the NOTE Confidence: 0.718618642666667 00:59:34.988 --> 00:59:37.322 this the investigator we have today NOTE Confidence: 0.718618642666667 00:59:37.322 --> 00:59:41.230 someone that is supposed to come for for. NOTE Confidence: 0.718618642666667 00:59:41.230 --> 00:59:43.198 For excision that has squamous cell NOTE Confidence: 0.718618642666667 00:59:43.198 --> 00:59:45.340 carcinoma, do you want the tissue? NOTE Confidence: 0.718618642666667 00:59:45.340 --> 00:59:47.335 So they will say yes or no. NOTE Confidence: 0.718618642666667 00:59:47.340 --> 00:59:49.300 Sometimes what investigates is tell NOTE Confidence: 0.718618642666667 00:59:49.300 --> 00:59:51.910 me because these two processes say if NOTE Confidence: 0.718618642666667 00:59:51.910 --> 00:59:53.656 the tissue comes until 3:00 o'clock NOTE Confidence: 0.718618642666667 00:59:53.656 --> 00:59:55.671 in the afternoon, I'll take it. NOTE Confidence: 0.718618642666667 00:59:55.671 --> 00:59:57.213 If the tissue comes 7:00 o'clock NOTE Confidence: 0.718618642666667 00:59:57.213 --> 00:59:59.268 in the evening, I don't want it. NOTE Confidence: 0.718618642666667 00:59:59.268 --> 01:00:01.356 I mean of course they need to NOTE Confidence: 0.718618642666667 01:00:01.356 --> 01:00:02.796 also work their workflow, NOTE Confidence: 0.718618642666667 01:00:02.800 --> 01:00:05.320 but that's how the the discussion NOTE Confidence: 0.718618642666667 01:00:05.320 --> 01:00:08.070 is done for every single order that NOTE Confidence: 0.718618642666667 01:00:08.070 --> 01:00:10.707 they displace and then once it comes NOTE Confidence: 0.718618642666667 01:00:10.707 --> 01:00:12.989 we they give the protocol so they NOTE Confidence: 0.718618642666667 01:00:12.989 --> 01:00:15.409 want to collect the tissue in RMI. NOTE Confidence: 0.718618642666667 01:00:15.410 --> 01:00:16.850 We give them an RMI, NOTE Confidence: 0.718618642666667 01:00:16.850 --> 01:00:19.142 each collect another sample, NOTE Confidence: 0.718618642666667 01:00:19.142 --> 01:00:21.172 another fluid, another vehicle. NOTE Confidence: 0.718618642666667 01:00:21.172 --> 01:00:23.818 We we doing that with you. NOTE Confidence: 0.718618642666667 01:00:23.820 --> 01:00:26.816 So we we adapt to whatever the NOTE Confidence: 0.718618642666667 01:00:26.816 --> 01:00:29.650 protocol of that investigator is. NOTE Confidence: 0.718618642666667 01:00:29.650 --> 01:00:31.708 But that's how we we've been NOTE Confidence: 0.718618642666667 01:00:31.710 --> 01:00:32.846 sending material. NOTE Confidence: 0.718618642666667 01:00:32.846 --> 01:00:37.390 Most of the PDX that people are xenografts, NOTE Confidence: 0.718618642666667 01:00:37.390 --> 01:00:39.558 that people working are NOTE Confidence: 0.718618642666667 01:00:39.558 --> 01:00:41.726 again long and ponderous. NOTE Confidence: 0.718618642666667 01:00:41.730 --> 01:00:45.090 So these are my biggest customers. NOTE Confidence: 0.684495473333333 01:00:47.290 --> 01:00:50.188 So Andreas, this is another situation, NOTE Confidence: 0.684495473333333 01:00:50.190 --> 01:00:53.390 I don't just pass it to CPR experience. NOTE Confidence: 0.684495473333333 01:00:53.390 --> 01:00:57.182 So what what happens if someone NOTE Confidence: 0.684495473333333 01:00:57.182 --> 01:00:59.078 investigator asking some? NOTE Confidence: 0.684495473333333 01:00:59.080 --> 01:01:01.036 A solid material. NOTE Confidence: 0.684495473333333 01:01:01.036 --> 01:01:03.644 Which started the organization, NOTE Confidence: 0.684495473333333 01:01:03.650 --> 01:01:05.002 not the your bank, NOTE Confidence: 0.684495473333333 01:01:05.002 --> 01:01:07.470 but it's part of the current case. NOTE Confidence: 0.684495473333333 01:01:07.470 --> 01:01:08.418 In other words, NOTE Confidence: 0.684495473333333 01:01:08.418 --> 01:01:10.218 it's like year or two years. NOTE Confidence: 0.741513368 01:01:10.890 --> 01:01:15.266 So yeah, so that's why our system is NOTE Confidence: 0.741513368 01:01:15.266 --> 01:01:17.426 integrated with the pathology system. NOTE Confidence: 0.741513368 01:01:17.430 --> 01:01:19.590 So everything this was a decision NOTE Confidence: 0.741513368 01:01:19.590 --> 01:01:22.514 of the Chair of pathology that every NOTE Confidence: 0.741513368 01:01:22.514 --> 01:01:24.746 single specimen that is in the NOTE Confidence: 0.741513368 01:01:24.746 --> 01:01:27.178 archival is available for research. NOTE Confidence: 0.721492375 01:01:27.490 --> 01:01:29.320 So is there any time limit? Like NOTE Confidence: 0.84883068 01:01:29.330 --> 01:01:30.590 there is no time limit, NOTE Confidence: 0.84883068 01:01:30.590 --> 01:01:32.294 the only thing is that. Uh. NOTE Confidence: 0.84883068 01:01:32.294 --> 01:01:35.138 In general, I make that determination, NOTE Confidence: 0.84883068 01:01:35.140 --> 01:01:37.602 see if there is a biopsy and NOTE Confidence: 0.84883068 01:01:37.602 --> 01:01:39.414 there is not enough material for NOTE Confidence: 0.84883068 01:01:39.414 --> 01:01:40.680 what that investigator wants. NOTE Confidence: 0.84883068 01:01:40.680 --> 01:01:42.760 I'll tell them this patient is not good. NOTE Confidence: 0.84883068 01:01:42.760 --> 01:01:45.084 Maybe you have to find another one. NOTE Confidence: 0.84883068 01:01:45.090 --> 01:01:46.830 If they just want an H&E, NOTE Confidence: 0.84883068 01:01:46.830 --> 01:01:49.620 which is easy, NOTE Confidence: 0.84883068 01:01:49.620 --> 01:01:51.732 but I haven't encountered, NOTE Confidence: 0.84883068 01:01:51.732 --> 01:01:54.096 I have encountered only one situation NOTE Confidence: 0.84883068 01:01:54.096 --> 01:01:56.539 that it was a patient in a clinical NOTE Confidence: 0.84883068 01:01:56.539 --> 01:01:58.549 trial for breast that they needed NOTE Confidence: 0.84883068 01:01:58.549 --> 01:02:00.364 the material from the archival. NOTE Confidence: 0.84883068 01:02:00.370 --> 01:02:02.920 So that material was given through NOTE Confidence: 0.84883068 01:02:02.920 --> 01:02:05.853 the central lab and then another NOTE Confidence: 0.84883068 01:02:05.853 --> 01:02:08.045 clinician that was not aware that NOTE Confidence: 0.84883068 01:02:08.045 --> 01:02:10.600 that patient was in a clinical trial NOTE Confidence: 0.84883068 01:02:10.600 --> 01:02:13.186 requested the test in that block. NOTE Confidence: 0.84883068 01:02:13.190 --> 01:02:15.526 So, but again it has really nothing to NOTE Confidence: 0.84883068 01:02:15.526 --> 01:02:18.339 do with me is basically saying informing NOTE Confidence: 0.84883068 01:02:18.339 --> 01:02:20.886 putting the two clinicians together say NOTE Confidence: 0.84883068 01:02:20.886 --> 01:02:23.430 this patient is part of a clinical trial, NOTE Confidence: 0.84883068 01:02:23.430 --> 01:02:25.376 the material has been central clinical trial. NOTE Confidence: 0.84883068 01:02:25.380 --> 01:02:28.026 So what we can do is to NOTE Confidence: 0.84883068 01:02:28.026 --> 01:02:29.720 request the block back. NOTE Confidence: 0.84883068 01:02:29.720 --> 01:02:31.628 We don't distribute blocks, NOTE Confidence: 0.84883068 01:02:31.628 --> 01:02:35.090 we just do IC like a scan. NOTE Confidence: 0.84883068 01:02:35.090 --> 01:02:37.154 But sometimes for clinical trials if NOTE Confidence: 0.84883068 01:02:37.154 --> 01:02:39.751 there is only one block that's very NOTE Confidence: 0.84883068 01:02:39.751 --> 01:02:42.049 important then we release the block. NOTE Confidence: 0.84883068 01:02:42.050 --> 01:02:43.650 But then we can request a block back NOTE Confidence: 0.84883068 01:02:43.650 --> 01:02:45.168 if there is a clinical situation, NOTE Confidence: 0.84883068 01:02:45.170 --> 01:02:47.920 but that it's not very common but NOTE Confidence: 0.84883068 01:02:47.920 --> 01:02:50.370 if the case is not signed out. NOTE Confidence: 0.84883068 01:02:50.370 --> 01:02:53.464 We will not release the I have. NOTE Confidence: 0.84883068 01:02:53.470 --> 01:02:57.678 We had one last week someone asked for. NOTE Confidence: 0.84883068 01:02:57.680 --> 01:02:59.864 20 unstained slides from a case that NOTE Confidence: 0.84883068 01:02:59.864 --> 01:03:01.792 was not signed either, said no, NOTE Confidence: 0.84883068 01:03:01.792 --> 01:03:03.268 because I don't know what's going. NOTE Confidence: 0.84883068 01:03:03.270 --> 01:03:04.260 You know, NOTE Confidence: 0.84883068 01:03:04.260 --> 01:03:07.230 clinical care is the most important. NOTE Confidence: 0.84883068 01:03:07.230 --> 01:03:09.547 After it is done, everything is done. NOTE Confidence: 0.84883068 01:03:09.550 --> 01:03:10.456 If they order, NOTE Confidence: 0.84883068 01:03:10.456 --> 01:03:12.268 all lung cancers go from molecular. NOTE Confidence: 0.84883068 01:03:12.270 --> 01:03:14.750 After they've done everything and. NOTE Confidence: 0.84883068 01:03:14.750 --> 01:03:17.483 If there is tissue left, you can use, NOTE Confidence: 0.84883068 01:03:17.483 --> 01:03:19.838 otherwise so it's a daily. NOTE Confidence: 0.84883068 01:03:19.840 --> 01:03:21.080 Case by case decision. NOTE Confidence: 0.90746193 01:03:22.510 --> 01:03:22.830 Thank you. NOTE Confidence: 0.798381696 01:03:24.890 --> 01:03:25.682 Thank you very much, NOTE Confidence: 0.798381696 01:03:25.682 --> 01:03:26.970 Andrew. Again, thank you.