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Notable Moments in Limb and Face Transplant History

In 2008, surgeons completed two procedures that could forever change transplant surgery. In August, doctors in Munich announced that a farmer was recovering from a double-arm transplant—the first double-arm transplant in the world. In December, the Cleveland Clinic announced they'd replaced about 80 percent of a woman's face. Many surgeons think that arm, hand, and face replacements are the next logical steps in transplants. Is the world ready?

Being first isn't always best

In 1964, physicians around the world were attempting transplants of all kinds when doctors in Ecuador performed the first hand transplant. Unfortunately, like early organ transplants, it didn't work—within two weeks the hand was rejected and doctors had to remove it.

Being second isn't much better

In 1998, doctors performed delicate microsurgery on New Zealander Clint Hallam. For 13 hours at Edouard Herriot Hospital, an international team of scientists led by French surgeon Jean Michel Dubernard stitched a cadaver's forearm and hand to Hallam's upper arm. Completing the hand transplant required microsurgery skills and patience—doctors knitted medial nerve to medial nerve, radial artery to radial artery, radius to radius. Like with other transplants, both donor and recipient must share the same blood type.

After years of studying transplant pioneers and earning a PhD based in xenographs research (he transplanted organs from one species of monkeys to another), Dubernard felt he was prepared to perform a hand transplant on a human. When he was unable to find a suitable French candidate, an Australian colleague recommended Hallam. Fourteen years earlier, Hallam had lost his forearm in a circular saw accident. It was later revealed the accident actually occurred in jail and that Hallam was a longtime con-man.

hands.jpgCritics claimed that Dubernard performed the surgery for the media attention, but the surgeon argued he and his staff did a thorough psychological evaluation of Hallam as well as a background check. (Unsurprisingly, Dubernard had a role in the first partial face transplant, also surrounded by controversy.)

At first, the forearm and hand worked well for Hallam, although he hated that the donor limb was larger than his other arm and a different skin tone. He hid his freak arm as much as he could. Hallam's arm wasn't just grotesque-looking, though; it began itching and flaking, and he was plagued daily by pins and needles. He begged the doctors to remove it, but they refused. Hallam felt emotionally detached from his hand. Finally, a group of British surgeons agreed to remove the limb in 2001. The physicians from France claimed the only reason Hallam's arm rejected is because he failed to take his immunosuppressant drugs and exercise it.

From hands to a face

Frenchwoman Isabella Dinore received the first partial face transplant in 2005.

After taking too many sleeping pills, Dinore had passed out. As she lay unconscious on the floor, her black Lab chewed off her nose, mouth, and lower face. Without lips, muscles, and skin on the bottom half of her jaw, Dinore struggled to speak and eat—she had to eat through a tube. Physicians couldn't help her with traditional plastic surgery and thus felt she would be a good candidate for a face transplant.

Bernard Devauchelle, a French maxillofacial surgeon at Lyon University, saw a picture of a brain-dead woman with a mouth, nose, and lips similar to Dinore's features. He removed a triangle of Maryline St. Aubert's skin with its arteries, nerves, and veins and spent hours graphing the skin onto Dinore's face.

Dinore.jpgIt was rumored St. Aubert was brain-dead because she tried to kill herself. Many people thought Dinore had attempted suicide, too. Dubernard, who had worked alongside Devauchelle in the surgery, argued Dinore accidentally overdosed. Physicians criticized the decision to give a suicidal woman a face transplant. People once again alleged Dubernard had performed the surgery for media attention—Corbis had an exclusive deal for photos—and some urged an ethics investigation.

Dubernard oversaw Dinore's recovery. Shortly after the surgery, he injected some of St. Aubert's stem cells (from her bone marrow) into Dinore in the hopes her body wouldn't reject the transplant, but the stem cell infusion failed. Dinore suffered two bouts of rejection, contracted herpes and a pox virus, and struggled with kidney failure.

A year later, Dinore appeared in the media, showing off her new face. She used her new lips to smoke again.

Full-face transplant

Coler.jpgLaurent Lantieri, head of plastic surgery at Henri-Mondor Hospital in France, spent 16 hours stitching new lips, cheeks, nose, and mouth to Pascal Coler's face. Since Coler was six years old, large masses had been growing on his nerves because of a condition called neurofibromatosis. As the masses increased in size, Coler's face became less recognizable. Strangers pointed at him because of his misshapen visage.

The large masses compressed the nerves, arteries, and fat in Coler's face, causing lasting damage; the transplanted cadaver's face stops the masses from developing. Lantieri didn't alter Coler's bone structure, so Coler looks as he would if he never had the disease.

What the doctors say

When a patient receives a lung or a liver, the body's white blood cells attack the new organ because the body believes it is an invader. That's why immunosuppressant drugs are so important for transplant patients: immunosuppressants mollify the immune system. When a transplant includes so many different tissues, organs, veins, arteries, nerves, fat, and bones, the body targets the limb even more ferociously than it attacks one organ—the white blood cells believe the more transplanted tissue means there are more invaders.

In 2007, a study was published with the results of 18 transplants of 24 hands/digits/forearms. (11 folks received one hand, four received two hands, two received two forearms, and one received one thumb.) The good news: limb transplantation has a 100 percent survival rate. (In the early days of organ transplantation, most patients died.) And graph survival is also 100 percent for the first two years. The bad news: 12 patients suffered acute rejection and six Chinese recipients had their hands removed. All patients had enough nerve function in their new limbs that they knew when they were hurt, but few used fine motor skills or had sophisticated nerve function.

Some experts wonder if limb transplants should be conducted when prosthetic limbs are available. Fifteen people in the 2007 study said the limbs improved their quality of life, but many suffer with lingering problems from the immunosuppressant drugs, kidney failure, diabetes, and infections.

One thing is certain, though: Dubernard won't be performing any more limb transplants. He reached the maximum age to practice medicine in France.

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Can You 'Hear' These Silent GIFs?
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GIFs are silent—otherwise they wouldn't be GIFs. But some people claim to hear distinct noises accompanying certain clips. Check out the GIF below as an example: Do you hear a boom every time the structure hits the ground? If so, you may belong to the 20 to 30 percent of people who experience "visual-evoked auditory response," also known as vEAR.

Researchers from City University London recently published a paper online on the phenomenon in the journal Cortex, the British Psychological Society's Research Digest reports. For their study, they recruited more than 4000 volunteers and 126 paid participants and showed them 24 five-second video clips. Each clip lacked audio, but when asked how they rated the auditory sensation for each video on a scale of 0 to 5, 20 percent of the paid participants rated at least half the videos a 3 or more. The percentage was even higher for the volunteer group.

You can try out the researchers' survey yourself. It takes about 10 minutes.

The likelihood of visual-evoked auditory response, according to the researchers, directly relates to what the subject is looking at. "Some people hear what they see: Car indicator lights, flashing neon shop signs, and people's movements as they walk may all trigger an auditory sensation," they write in the study.

Images packed with meaning, like two cars colliding, are more likely to trigger the auditory illusion. But even more abstract images can produce the effect if they have high levels of something called "motion energy." Motion energy is what you see in the video above when the structure bounces and the camera shakes. It's why a video of a race car driving straight down a road might have less of an auditory impact than a clip of a flickering abstract pattern.

The researchers categorize vEAR as a type of synesthesia, a brain condition in which people's senses are combined. Those with synesthesia might "see" patterns when music plays or "taste" certain colors. Most synesthesia is rare, affecting just 4 percent of the population, but this new study suggests that "hearing motion synesthesia" is much more prevalent.

[h/t BPS Research Digest]

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The Surprising Link Between Language and Depression
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Skim through the poems of Sylvia Plath, the lyrics of Kurt Cobain, or posts on an internet forum dedicated to depression, and you'll probably start to see some commonalities. That's because there's a particular way that people with clinical depression communicate, whether they're speaking or writing, and psychologists believe they now understand the link between the two.

According to a recent study published in Clinical Psychological Science, there are certain "markers" in a person's parlance that may point to symptoms of clinical depression. Researchers used automated text analysis methods to comb through large quantities of posts in 63 internet forums with more than 6400 members, searching for certain words and phrases. They also noted average sentence length, grammatical patterns, and other factors.

What researchers found was that a person's use (or overuse) of first-person pronouns can provide some insight into the state of their mental health. People with clinical depression tend to use more first-person singular pronouns, such as "I" and "me," and fewer third-person pronouns, like "they," "he," or "she." As Mohammed Al-Mosaiwi, a Ph.D. candidate in psychology at the University of Reading and the head of the study, writes in a post for IFL Science:

"This pattern of pronoun use suggests people with depression are more focused on themselves, and less connected with others. Researchers have reported that pronouns are actually more reliable in identifying depression than negative emotion words."

What remains unclear, though, is whether people who are more focused on themselves tend to depression, or if depression turns a person's focus on themselves. Perhaps unsurprisingly, people with depression also use more negative descriptors, like "lonely" and "miserable."

But, Al-Mosaiwi notes, it's hardly the most important clue when using language to assess clinical depression. Far better indicators, he says, are the presence of "absolutist words" in a person's speech or writing, such as "always," "constantly," and "completely." When overused, they tend to indicate that someone has a "black-and-white view of the world," Al-Mosaiwi says. An analysis of posts on different internet forums found that absolutist words were 50 percent more prevalent on anxiety and depression forums, and 80 percent more prevalent on suicidal ideation forums.

Researchers hope these types of classifications, supported by computerized methods, will prove more and more beneficial in a clinical setting.

[h/t IFL Science]

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