Face Time: Educating Face Transplant Candidates

Objective: Face transplantation is the innovative application of microsurgery and immunology to restore appearance and function to those with severe facial disfigurements. Our group aims to establish a multidisciplinary education program that can facilitate informed consent and build a strong knowledge base in patients to enhance adherence to medication regimes, recovery, and quality of life. Methods: We analyzed handbooks from our institution's solid organ transplant programs to identify topics applicable to face transplant patients. The team identified unique features of face transplantation that warrant comprehensive patient education. Results: We created a 181-page handbook to provide subjects interested in pursuing transplantation with a written source of information on the process and team members and to address concerns they may have. While the handbook covers a wide range of topics, it is easy to understand and visually appealing. Conclusions: Face transplantation has many unique aspects that must be relayed to the patients pursuing this novel therapy. Since candidates lack third-party support groups and programs, the transplant team must provide an extensive educational component to enhance this complex process. Practice Implications: As face transplantation continues to develop, programs must create sound education programs that address patients’ needs and concerns to facilitate optimal care

Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project

The prescription of strong opioids (SO) for chronic non-cancer pain (CNCP) is steadily increasing. This entails a high risk of adverse effects, a risk that increases with the concomitant prescription of SO with central nervous system depressant drugs and with the use of SO for non-recommended indications. In order to examine this concomitant risk prescription, we designed a descriptive, longitudinal, retrospective population-based study. Patients aged >= 15 years with a continued SO prescription for >= 3 months during 2013-2017 for CNCP were included. Of these, patients who had received concomitant prescriptions of SO and risk drugs (gabapentinoids, benzodiazepines and antidepressants) and those who had received immediate-release fentanyl (IRF) were selected. The study included 22,691 patients; 20,354 (89.7%) patients received concomitant risk prescriptions. Men and subjects with a higher socioeconomic status received fewer concomitant risk prescriptions. Benzodiazepines or Z-drugs were prescribed concomitantly with SO in 15,883 (70%) patients, antidepressants in 14,932 (65%) and gabapentinoids in 11,267 (49%), while 483 (21.32%) patients received IRF (2266 prescriptions in total) without a baseline SO. In conclusion, our study shows that a high percentage of patients prescribed SO for CNCP received concomitant prescriptions with known risks, as well as IRF for unauthorized indications

Trends in the Prescription of Strong Opioids for Chronic Non-Cancer Pain in Primary Care in Catalonia: Opicat-Padris-Project

In chronic non-cancer pain (CNCP), evidence of the effectiveness of strong opioids (SO) is very limited. Despite this, their use is increasingly common. To examine SO prescriptions, we designed a descriptive, longitudinal, retrospective population-based study, including patients aged >= 15 years prescribed SO for >= 3 months continuously in 2013-2017 for CNCP in primary care in Catalonia. Of the 22,691 patients included, 17,509 (77.2%) were women, 10,585 (46.6%) were aged >80 years, and most had incomes of <euro18,000 per year. The most common diagnoses were musculoskeletal diseases and psychiatric disorders. There was a predominance of transdermal fentanyl in the defined daily dose (DDD) per thousand inhabitants/day, with the greatest increase for tapentadol (312% increase). There was an increase of 66.89% in total DDD per thousand inhabitants/day for SO between 2013 (0.737) and 2017 (1.230). The mean daily oral morphine equivalent dose/day dispensed for all drugs was 83.09 mg. Transdermal fentanyl and immediate transmucosal release were the largest cost components. In conclusion, there was a sustained increase in the prescription of SO for CNCP, at high doses, and in mainly elderly patients, predominantly low-income women. The new SO are displacing other drugs

Oxygen reduction reaction kinetics on a Pt thin layer electrode in AEMFC

The study of the catalytic activity in a fuel cell is challenging, as mass transport, gas crossover and the counter electrode are generally interfering. In this study, a Pt electrode consisting of a thin film deposited on the gas diffusion layer was employed to study the oxygen reduction reaction (ORR) in an operating Anion Exchange Membrane Fuel Cell (AEMFC). The 2D Pt electrode was assembled together with a conventional porous Pt/C counter electrode and an extra Pt/C layer and membrane to reduce the H2 crossover. Polarization curves at different O2 partial pressures were recorded and the resulting reproducible ORR activities were normalized with respect to the active surface area (ECSA), obtained by CO stripping. As expected, decreasing the O2 partial pressure results in a negative shift in open circuit voltage (OCV), cell voltage and maximum attainable current density. For cell voltages above 0.8 V a fairly constant Tafel slope of 60 mV dec−1 was recorded but at lower voltages the slope increases rapidly. The observed Tafel slope can be explained by a theoretical model with an associative mechanism where charge- and proton-transfer steps are decoupled, and the proton transfer is the rate-determining step. A reaction order of 1 with respect to O2 was obtained at 0.65 V which corresponds well with the mechanism suggested above. Based on the obtained catalyst activities, the electrode performance is comparable to good porous electrodes found in the field. The methodology presented in this study is expected to be useful in future kinetic studies of other catalysts for AEMFC

Enhanced oxygen reduction activity with rare earth metal alloy catalysts in proton exchange membrane fuel cells

Alloying platinum is an approach to increase the oxygen reduction reaction (ORR) activity and at the same time reduce the amount of precious platinum catalyst in proton exchange membrane fuel cells (PEMFC). In this work the cathode activity of thin films of rare earth metals (REM) alloys, Pt Y, Pt Gd and Pt Tb, produced by sputter deposition onto gas diffusion layers, are evaluated in a fuel cell by means of polarization curves in O /H , and cyclic- and CO-stripping voltammetry in N /5% H . Prior to evaluation, the model electrodes were acid-treated to obtain a Pt skin covering the PtREM alloy bulk, as was revealed by energy-dispersive X-ray spectroscopy (EDX) and X-ray photoelectron spectroscopy (XPS). The core shell alloys of Pt Y and Pt Gd catalysts show a specific activity enhancement at 0.9 V of 2.5 times compared to pure Pt. The slightly lower enhancement factor of 2.0 for Pt Tb is concluded to be due to leaching of the REM, that resulted in a thicker, and subsequently less strained, Pt overlayer. The high activity, combined with the minor changes in surface composition, achieved in the fuel cell environment shows that PtREM core shell catalysts are promising for the cathode reaction in PEMFC

Nefropatia brucel·lar

L'afectació renal en el curs de la Brucel·losi ha estat citada de fa anys per alguns autors. Però entre els parènquimes que es poden veure envoltats en el curs d'aquesta malaltia, la localització renal no era, sovint, descoberta. Fins fa pocs anys els informes sobre aquest aspecte procedien bé de peces de nefrectomia, bé de necròpsies. ..

Pathogenesis of scrapie in ARQ/ARQ sheep after subcutaneous infection: effect of lymphadenectomy and immune cell subset changes in relation to prion protein accumulation.

Although it is well established that the infectious agent can replicate in the lymphoreticular system (LRS) early after inoculation, the information on pathways or cells involved in the dissemination of scrapie from the point of inoculation is limited. In order to gain a better understanding on these mechanisms 16 ARQ/ARQ, polymorphic or non polymorphic Suffolk or Romney lambs were inoculated subcutaneously with a Suffolk scrapie brain homogenate in the drainage area of the prefemoral lymph node. Fourteen lambs were then either subjected to early or late surgical removal of the prefemoral lymph nodes or not subjected to lymphadectomy and used as positive controls. Eleven animals were culled at a preclinical stage of the disease, and only 5, including 2 positive controls, were killed after reaching clinical end point. Of 5 polymorphic animals killed at preclinical stages of infection, two did not show any evidence of infection, two showed little involvement of LRS tissues and little or none in brain, and one showed widespread LRS involvement but mild PrPd accumulation in the CNS. This was in contrast with the findings in non-polymorphic sheep which, at comparable dpi, showed a complete attack rate with widespread PrPd accumulation in LRS tissues and many of them also in the CNS. The only polymorphic sheep left to develop clinical signs reached enpoint with a more protracted incubation period than the non-polymorphic sheep, but with similar PrPd magnitudes in the LRS or brain. The only change that appears to be related to PrPd accumulation in the LNs is the increase in CD21+ cells indistinctly in polymorphic or polymorphic animals

All clinically-relevant blood components transmit prion disease following a single blood transfusion: a sheep model of vCJD

Variant CJD (vCJD) is an incurable, infectious human disease, likely arising from the consumption of BSE-contaminated meat products. Whilst the epidemic appears to be waning, there is much concern that vCJD infection may be perpetuated in humans by the transfusion of contaminated blood products. Since 2004, several cases of transfusion-associated vCJD transmission have been reported and linked to blood collected from pre-clinically affected donors. Using an animal model in which the disease manifested resembles that of humans affected with vCJD, we examined which blood components used in human medicine are likely to pose the greatest risk of transmitting vCJD via transfusion. We collected two full units of blood from BSE-infected donor animals during the pre-clinical phase of infection. Using methods employed by transfusion services we prepared red cell concentrates, plasma and platelets units (including leucoreduced equivalents). Following transfusion, we showed that all components contain sufficient levels of infectivity to cause disease following only a single transfusion and also that leucoreduction did not prevent disease transmission. These data suggest that all blood components are vectors for prion disease transmission, and highlight the importance of multiple control measures to minimise the risk of human to human transmission of vCJD by blood transfusion

A renewed rise in global HCFC-141b emissions between 2017???2021

Global emissions of the ozone-depleting gas HCFC-141b (1,1-dichloro-1-fluoroethane, CH3CCl2F) derived from measurements of atmospheric mole fractions increased between 2017 and 2021 despite a fall in reported production and consumption of HCFC-141b for dispersive uses. HCFC-141b is a controlled substance under the Montreal Protocol, and its phase-out is currently underway, after a peak in reported consumption and production in developing (Article 5) countries in 2013. If reported production and consumption are correct, our study suggests that the 2017–2021 rise is due to an increase in emissions from the bank when appliances containing HCFC-141b reach the end of their life, or from production of HCFC-141b not reported for dispersive uses. Regional emissions have been estimated between 2017–2020 for all regions where measurements have sufficient sensitivity to emissions. This includes the regions of northwestern Europe, east Asia, the United States and Australia, where emissions decreased by a total of 2.3 ± 4.6 Gg yr−1, compared to a mean global increase of 3.0 ± 1.2 Gg yr−1 over the same period. Collectively these regions only account for around 30 % of global emissions in 2020. We are not able to pinpoint the source regions or specific activities responsible for the recent global emission rise

Noninvasive Vascular Images for Face Transplant Surgical Planning

Objective: Face transplantation replaces substantial defects with anatomically identical donor tissues; preoperative vascular assessment relies on noninvasive imaging to separate and characterize the external carotid vessels and branches. The objective is to describe and illustrate vascular considerations for face transplantation candidates. Methods: Novel noninvasive imaging using computed tomography and magnetic resonance imaging over 3 spatial dimensions plus time was developed and tested in 4 face transplant candidates. Precontrast images assessed bones and underlying metal. Contrast media was used to delineate and separate arteries from veins. For computed tomography, acquisition over multiple time points enabled the computation of tissue perfusion metrics. Time-resolved magnetic resonance angiography was performed to separate arterial and venous phases. Results: The range of circulation times for the external carotid system was 6 to 14 seconds from arterial blush to loss of venous enhancement. Precontrast imaging provided a roadmap of bones and metal. Among the 4 patients, 3 had surgical clips, metal implants, or both within 1 cm of major vessels considered for surgery. Contrast-enhanced wide area detector computed tomographic data acquired in the axial mode separated these structures and provided arterial and venous images for planning the surgical anastomoses. Magnetic resonance imaging was able to distinguish between the large vessels from the external carotid systems. Conclusions: Vascular imaging maps are challenging in face transplantation because of the rapid circulation times and artifact from the initial injury, prior reconstructive attempts, or both. Nevertheless, face transplant candidates require high spatial and temporal resolution vascular imaging to determine those vessels appropriate for surgical anastomoses