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Multiplicity of Heads in Indian Mythology. J Craniofac Surg 2020; 31:6-8. [DOI: 10.1097/scs.0000000000005831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ausman JI. Is it time to perform the first human head transplant? Comment on the CSA (CephaloSomatic Ansatomisis) paper by Ren, Canavero, and colleagues. Surg Neurol Int 2018; 9:28. [PMID: 29492328 PMCID: PMC5820846 DOI: 10.4103/sni.sni_472_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- James I Ausman
- Emeritus Editor-in-Chief and Publisher, SNI Publications, Professor, Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA and Harbor-UCLA Medical Center, Torrance, CA, USA
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Ren X, Li M, Zhao X, Liu Z, Ren S, Zhang Y, Zhang S, Canavero S. First cephalosomatic anastomosis in a human model. Surg Neurol Int 2017; 8:276. [PMID: 29279793 PMCID: PMC5705925 DOI: 10.4103/sni.sni_415_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Cephalosomatic anastomosis (CSA) has never been attempted before in man as the transected spinal cords of the body donor and body recipient could not be “fused” back together. Recent advances made this possible. Here, we report on the surgical steps necessary to reconnect a head to a body at the cervical level. Methods: Full rehearsal of a CSA on two recently deceased human cadavers was performed at Harbin Medical University, Harbin, China. Results: The surgery took 18 hours to complete within the time frame planned for this surgery. Several advances resulted from this rehearsal, including optimization of the surgical steps, sparing of the main nerves (phrenics, recurrent laryngeal nerves), and assessment of vertebral stabilization. Conclusion: Several specialties are involved in a full-scale CSA, including neck surgery, vascular surgery, orthopedic surgery, plastic surgery, gastrointestinal surgery, and neurosurgery, as well as the operating staff. This rehearsal confirmed the surgical feasibility of a human CSA and further validated the surgical plan. Education and coordination of all the operating teams and coordination of the operative staff was achieved in preparation for the live human CSA.
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Affiliation(s)
- Xiaoping Ren
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China.,Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University, Chicago, Illinois, USA
| | - Ming Li
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Xin Zhao
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Zehan Liu
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Shuai Ren
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Yafang Zhang
- Department of Anatomy, Harbin Medical University, Harbin, China
| | - Shide Zhang
- Department of Radiology, 2 Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Sergio Canavero
- Turin Advanced Neuromodulation Group, Turin, Italy, Harbin Medical University, Harbin, China
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Miller LF. Transplanting the Body: Preliminary Ethical Considerations. New Bioeth 2017; 23:219-235. [PMID: 29058535 DOI: 10.1080/20502877.2017.1385919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A dissociated area of medical research warrants bioethical consideration: a proposed transplantation of a donor's entire body, except head, to a patient with a fatal degenerative disease. The seeming improbability of such an operation can only underscore the need for thorough bioethical assessment: Not assessing a case of such potential ethical import, by showing neglect instead of facing the issue, can only compound the ethical predicament, perhaps eroding public trust in ethical medicine. This article discusses the historical background of full-body transplantation, documents the seriousness of its current pursuit, and builds an argument for why prima facie this type of transplant is bioethically distinct. Certainly, this examination can only be preliminary, indicating what should be a wide and vigorous discussion among practitioners and ethicists. It concludes with practical suggestions for how the medical and bioethics community may proceed with ethical assessment.
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Zhang J, Zhang Y, Xu T, Pan SJ, Nie G, Miao XY, Qiu JY, Yu WQ, Zhang SY, Liang TB. Severe traumatic hemorrhagic shock induces compromised immune barrier function of the mesenteric lymph node leading to an increase in intestinal bacterial translocation. Am J Transl Res 2017; 9:2363-2373. [PMID: 28559986 PMCID: PMC5446518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
Critically ill patients have increased susceptibility to translocation of gut bacteria. However, the mechanisms are complicated and remain unclear, and the aim of this study was to explore these mechanisms. Rats exposed to different levels of shock were orally administrated with bioluminescent Citrobacter. We found that severe shock caused an increase in bacterial translocation to the visceral organs, such as liver, spleen and blood, compared with mild shock. Surprisingly, bacterial translocation to mesenteric lymph node (MLN) was unchanged between the two shock groups. Various methods, including flow cytometry, a co-culture model and western blots, were used to evaluate MLN-associated immune function. Specifically, we focused on mesenteric lymph node dendritic cells (MLN-DCs), the critical antigen presenting cells involved in the construction of the immune barrier in MLN. We also found that severe shock impaired the phenotypic maturation of MLN-DCs and induced a tolerogenic phenotype. Furthermore, co-culture assays of DCs with naive CD4+ T cells showed that DCs subject to severe shock were more inclined to polarize native CD4+ T cells into Th2 and Treg cells. This study successfully reproduced the clinical phenomenon of severe shock resulting in increased bacterial translocation to extraintestinal tissues, and this may be related to the compromised immune barrier function of MLN, as maturation and function of MLN-DC's were badly impaired.
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Affiliation(s)
- Jian Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
| | - Yun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
| | - Tao Xu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
| | - Sheng-Jing Pan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
| | - Gang Nie
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
| | - Xiao-Yan Miao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
| | - Jun-Yu Qiu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
| | - Wen-Qiao Yu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
| | - Shao-Yang Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseChina
- Zhejiang University, Collaborative Innovation Center for Cancer MedicineGuangzhou, China
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Furr A, Hardy MA, Barret JP, Barker JH. Surgical, ethical, and psychosocial considerations in human head transplantation. Int J Surg 2017; 41:190-195. [PMID: 28110028 PMCID: PMC5490488 DOI: 10.1016/j.ijsu.2017.01.077] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/11/2017] [Accepted: 01/14/2017] [Indexed: 12/14/2022]
Abstract
Transplanting a head and brain is perhaps the final frontier of organ transplantation. The goal of body-to-head transplantation (BHT) is to sustain the life of individuals who suffer from terminal disease, but whose head and brain are healthy. Ideally BHT could provide a lifesaving treatment for several conditions where none currently exists. BHT is no ordinary experiment, to transfer a head to another body involves extraordinarily complex medical challenges as well as ethical and existential dilemmas that were previously confined to the imagination of writers of fiction. The possibility of replacing an incurably ill body with a healthy one tests not only our surgical limits, but also the social and psychological boundaries of physical life and alters what we recognize life to be. The purpose of this target article, the complementary manuscript focused on immunological issues in BHT, and the accompanying Commentaries by scholars and practitioners in medicine, immunology, and bioethics is to review major surgical and psychosocial-ethical and immunological considerations surrounding body-to-head transplantation. We hope that together these ideas will provide readers with a comprehensive overview of the possibilities and challenges associated with BHT and initiate professional discussion and debate through which this new frontier in medicine is considered and approached.
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Affiliation(s)
- Allen Furr
- Haley Center 7018, Auburn University, Auburn, AL, 36849, USA.
| | - Mark A Hardy
- Department of Surgery, Columbia University College of Physicians and Surgeons, 161 Fort, Washington Ave., Herbert Irving Pavilion 5-549, New York, NY, 10032, USA.
| | - Juan P Barret
- University Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - John H Barker
- Frankfurt Initiative for Regenerative Medicine, Experimental Orthopedics & Trauma Surgery, J.W. Goethe-University, Friedrichsheim Orthopedic Hospital, Haus 97 B, 1OG, Marienburgstr. 2, 60528, Frankfurt/Main, Germany.
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Li PW, Zhao X, Zhao YL, Wang BJ, Song Y, Shen ZL, Jiang HJ, Jin H, Canavero S, Ren XP. A cross-circulated bicephalic model of head transplantation. CNS Neurosci Ther 2017; 23:535-541. [PMID: 28429535 DOI: 10.1111/cns.12700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 11/30/2022] Open
Abstract
AIMS A successful cephalosomatic anastomosis ("head transplant") requires, among others, the ability to control long-term immune rejection and avoidance of ischemic events during the head transference phase. We developed a bicephalic model of head transplantation to study these aspects. METHODS AND RESULTS The thoracic aorta and superior vena cava of a donor rat were anastomosed with the carotid artery and extracorporeal veins of a recipient rat by vascular grafts. Before thoracotomy in the donor rat, the axillary artery and vein of the donor were connected to the carotid and the extracranial vein of the third rat through a silicone tube. The silicone tube was passed through a peristaltic pump to ensure donor brain tissue blood supply. There is no ischemia reperfusion injury in donor brain tissue analyzed by electroencephalogram. Postoperative donor has pain reflex and corneal reflex. CONCLUSIONS Peristaltic pump application can guarantee the blood supply of donor brain tissue per unit time, while the application of temperature change device to the silicone tube can protect the brain tissue hypothermia, postoperative experimental data show that there is no brain tissue ischemia during the whole operation. The application of vascular grafting can also provide the possibility of long-term survival of the model.
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Affiliation(s)
- Peng-Wei Li
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Xin Zhao
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Yun-Long Zhao
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Bing-Jian Wang
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Yang Song
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Zi-Long Shen
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Hong-Jun Jiang
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Hai Jin
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Sergio Canavero
- HEAVEN/GEMINI International Collaborative Group, Turin, Italy
| | - Xiao-Ping Ren
- Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Nangang District, Harbin, China.,Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University, Maywood, IL, USA
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Abstract
Background Since the turn of the last century, the prospect of head transplantation has captured the imagination of scientists and the general public. Recently, head transplant has regained attention in popular media, as neurosurgeons have proposed performing this procedure in 2017. Given the potential impact of such a procedure, we were interested in learning the history of the technical hurdles that need to be overcome, and determine if it is even technically possible to perform such a procedure on humans today. Method We conducted a historical review of available literature on the technical challenges and developments of head transplantation. The many social, psychological, ethical, religious, cultural, and legal questions of head transplantation were beyond the scope of this review. Results Our historical review identified the following important technical considerations related to performing a head transplant: maintenance of blood flow to an isolated brain via vessel anastomosis; availability of immunosuppressive agents; spinal anastomosis and fusion following cord transfection; pain control in the recipient. Several animal studies have demonstrated success in maintaining recipient cerebral perfusion and achieving immunosuppression. However, there is currently sparse evidence in favor of successful spinal anastomosis and fusion after transection. While recent publications by an Italian group offer novel approaches to this challenge, research on this topic has been sparse and hinges on procedures performed in animal models in the 1970s. How transferrable these older methods are to the human nervous system is unclear and warrants further exploration. Conclusions Our review identified several important considerations related to performing a viable head transplantation. Besides the technical challenges that remain, there are important ethical issues to consider, such as exploitation of vulnerable patients and informed consent. Thus, besides the remaining technical challenges, these ethical issues will also need to be addressed before moving these studies to the clinic.
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Kim CY. PEG-assisted reconstruction of the cervical spinal cord in rats: effects on motor conduction at 1 h. Spinal Cord 2016; 54:910-912. [PMID: 27215738 PMCID: PMC5399165 DOI: 10.1038/sc.2016.72] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- C-Y Kim
- Department of Bioengineering, College of Life Science, CHA University, Seoul, Korea.,Department of Laboratory Animal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Korea
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Affiliation(s)
- Xiao-Ping Ren
- Hand and Microsurgical Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Department of Molecular Pharmacology & Therapeutics, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
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Ren X, Canavero S. Human head transplantation. Where do we stand and a call to arms. Surg Neurol Int 2016; 7:11. [PMID: 26862450 PMCID: PMC4743270 DOI: 10.4103/2152-7806.175074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 11/27/2015] [Indexed: 11/04/2022] Open
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12
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Ren XP, Ye YJ, Li PW, Shen ZL, Han KC, Song Y. Head Transplantation in Mouse Model. CNS Neurosci Ther 2015; 21:615-8. [PMID: 26096690 DOI: 10.1111/cns.12422] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/17/2015] [Accepted: 05/22/2015] [Indexed: 01/24/2023] Open
Abstract
AIMS The mouse model of allo-head and body reconstruction (AHBR) has recently been established to further the clinical development of this strategy for patients who are suffering from mortal bodily trauma or disease, yet whose mind remains healthy. Animal model studies are indispensable for developing such novel surgical practices. The goal of this work was to establish head transplant mouse model, then the next step through the feasible biological model to investigate immune rejection and brain function in next step, thereby promoting the goal of translation of AHBR to the clinic in the future. METHODS AND RESULTS Our approach involves retaining adequate blood perfusion in the transplanted head throughout the surgical procedure by establishing donor-to-recipient cross-circulation by cannulating and anastomosing the carotid artery on one side of the body and the jugular vein on the other side. Neurological function was preserved by this strategy as indicated by electroencephalogram and intact cranial nerve reflexes. CONCLUSIONS The results of this study support the feasibility of this method for avoiding brain ischemia during transplantation, thereby allowing for the possibility of long-term studies of head transplantation.
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Affiliation(s)
- Xiao-Ping Ren
- Hand and Microsurgical Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Department of Molecular Pharmacology & Therapeutics, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Yi-Jie Ye
- Hand and Microsurgical Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China
| | - Peng-Wei Li
- Hand and Microsurgical Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China
| | - Zi-Long Shen
- Hand and Microsurgical Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China
| | - Ke-Cheng Han
- Hand and Microsurgical Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China
| | - Yang Song
- Hand and Microsurgical Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China
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