International consensus recommendations on face transplantation: A 2-step Delphi study

Face transplantation is a viable reconstructive approach for severe craniofacial defects. Despite the evolution witnessed in the field, ethical aspects, clinical and psychosocial implications, public perception, and economic sustainability remain the subject of debate and unanswered questions. Furthermore, poor data reporting and sharing, the absence of standardized metrics for outcome evaluation, and the lack of consensus definitions of success and failure have hampered the development of a “transplantation culture” on a global scale. We completed a 2-round online modified Delphi process with 35 international face transplant stakeholders, including surgeons, clinicians, psychologists, psychiatrists, ethicists, policymakers, and researchers, with a representation of 10 of the 19 face transplant teams that had already performed the procedure and 73% of face transplants. Themes addressed included patient assessment and selection, indications, social support networks, clinical framework, surgical considerations, data on patient progress and outcomes, definitions of success and failure, public image and perception, and financial sustainability. The presented recommendations are the product of a shared commitment of face transplant teams to foster the development of face transplantation and are aimed at providing a gold standard of practice and policy

Lawson criterion for ignition exceeded in an inertial fusion experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion

36. Facial expression after face transplant: the first international face transplant cohort comparison

PURPOSE: Assessment of motor function restoration following face transplant (FT) is difficult as standardized, bilateral tests are lacking. This study aims to bolster support for software-based analysis through international collaboration.METHODS: FaceReader (Noldus, Wageningen, Netherlands), a facial expression analysis software, was used to analyze 77 post-transplant videos of 8 FT patients from Boston, USA (range, 1-9 years), 2 FT patients from Helsinki, FIN (range, 3-4 years), and 3 FT patients from Antalya, TUR (range, 6.5-8.5 years). Age-matched healthy controls from respective countries had no history of prior facial procedures. Videos contained patients and controls performing facial expressions evaluated by software analysis using the Facial Action Coding System. Facial movements were assigned intensity score values between 0 (absent) and 1 (fully present). Maximum values were compared to respective healthy controls to calculate percent restoration.RESULTS: Out of 13 FT patients, 8 were full FT, 5 were partial FT and 2 patients were female. Compared to healthy controls, the median restoration of motor function was 40.4% (IQR 30.8%-52.9%) for patients with full FT, 32.0% (IQR 28.2%-52.8%) for patients with partial FT and 36.9% (IQR 28.8%-52.9%) for all patients with FT. When facial nerve coaptation was performed at branch level, average motor function restoration was 42.7% ± 11.4% compared to 27.9% ± 11.6% at trunk coaptation level (p=0.032). Use of interpositional nerve grafts had no influence on motor outcomes.CONCLUSION: Software-based analysis is suitable to assess motor function after FT. International collaboration strengthens outcome data for FT