"My body, my choice": A qualitative study of women's mastectomy with flat closure experiences

This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women's flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31-72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women's decision-making and mirror-viewing experiences and assist women in adapting to their new body image.

Performance analysis of a contactless nanostructure in solar-powered desalination system

To address the water scarcity problem, solar desalination by using solar still can be one feasible solution to purify the water. Researchers recently developed thermal absorption materials fully and partially submerged in water and floating. These thermal absorption materials transfer their absorbed solar energy to water through thermal conduction. However, direct contact of these thermal absorption materials with water will damage the material, reducing life. Here we developed a novel contactless nanostructure that is not in contact with water. The contactless nanostructure will first absorb the solar energy and then re-radiate the absorbed energy to water, resulting in water heating, evaporation, and condensation. Experimental results showed that the use of a vertical mirror of size 75 × 50 × 0.5 cm could able to enhance the productivity by 79.7% when synthetic saline water (3.5% Wt. NaCl) with 1-cm water depth was used inside the contactless nanostructure solar still (CNSSS) compared to without mirror. The salt deposition is completely prevented owing to the physical de-coupling of the nanostructure from water, resulting in a long lifespan of the nanostructure that can be used for years.

Different symmetries, different mechanisms

Three common symmetries exist in the natural visual world: (i) mirror symmetry, i.e., reflections around a vertical axis, (ii) radial symmetry, i.e., rotations around a point, and (iii) translational symmetry, i.e., shifted repetitions. Are these processed by a common class of visual mechanism? Using stimuli comprising arrays of Gaussian blobs we examined this question using a visual search protocol in which observers located a single symmetric target patch among varying numbers of random-blob distractor patches. The testing protocol used a blocked present/absent task and both search times and accuracy were recorded. Search times for mirror and radial symmetry increased significantly with the number of distractors, as did translational-symmetry patterns containing few repetitions. However translational-symmetry patterns with four repeating sectors produced search slopes close to zero. Fourier analysis revealed that, as with images of natural scenes, the structural information in both mirror- and radial-symmetric patterns is carried by the phase spectrum. However, for translational patterns with four repeating sectors, the amplitude spectrum appears to capture the structure, consistent with previous analyses of texture regularity. Modeling revealed that while the mirror and radial patterns produced an approximately Gaussian-shaped energy response profile as a function of spatial frequency, the translational pattern profiles contained a distinctive spike, the magnitude of which increased with the number of repeating sectors. We propose distinct mechanisms for the detection of different symmetry types: a mechanism that encodes local positional information to detect mirror- and radial-symmetric patterns and a mechanism that computes energy in narrowband filters for the detection of translational symmetry containing many sectors.

Capacitive Sensing for 2-D Electrostatic MEMS Scanner in a Clinical Endomicroscope

A flexible fiber-coupled confocal laser endomicroscope has been developed using an electrostatic micro-electromechanical system (MEMS) scanner located in at distal optics to collect in vivo images in human subjects. Long transmission lines are required that deliver drive and sense signals with limited bandwidth. Phase shifts have been observed between orthogonal X and Y scanner axes from environmental perturbations, which impede image reconstruction. Image processing algorithms used for correction depend on image content and quality, while scanner calibration in the clinic can be limited by potential patient exposure to lasers. We demonstrate a capacitive sensing method to track the motion of the electrostatically driven two-dimensional MEMS scanner and to extract phase information needed for image reconstruction. This circuit uses an amplitude modulation envelope detection method on shared drive and sensing electrodes of the scanner. Circuit parameters were optimized for performance given high scan frequencies, transmission line effects, and substantial parasitic coupling of drive signal to circuit output. Extraction of phase information further leverages nonlinear dynamics of the MEMS scanner. The sensing circuit was verified by comparing with data from a position sensing detector measurement. The phase estimation showed an accuracy of 2.18° and 0.79° in X and Y axes for motion sensing, respectively. The results indicate that the sensing circuit can be implemented with feedback control for pre-calibration of the scanner in clinical MEMS-based imaging systems.

Enhancement of behavioral nociceptive responses but not itching responses by viewing mirror images in adult mice

Can mice recognize themselves in a mirror? The answer is unclear. Previous studies have reported that adult mice - when shown itch-like videos - demonstrated itch empathy. However, this was proven to be unreproducible in other studies. In the present study, we wanted to examine whether adult mice were able to recognize their mirror image. In our testing, we found that mice spent more time in the central area in an open field with mirrors surrounding the chamber than those in a normal open field. In a similar open field test with four mice placed in four directions, mice showed similar behavioral responses to those with mirrors. These results indicate that mice are able to recognize images in the mirror, however, they cannot distinguish their own mirror images from the mirror images of other mice. To repeat the experiments of itch empathy, we compared the itch responses of mice in the mirrored environment, to those without. No significant difference in itching responses was detected. Differently, in the case of chemical pain (formalin injection), animals' nociceptive responses to formalin during Phase II were significantly enhanced in the mirrored open field. A new format of heat map was developed to help the analysis of the trace of mice in the open field. Our results suggest that mice do recognize the presence of mice in the mirror, and their nociceptive - but not itch - responses are enhanced.

A low-cost chemical and optical approach to develop latent fingermarks on silver mirror surfaces

The development of fingermarks on reflective surfaces is often a challenge regarding the photography of images with overlapping lines, low contrast and reflections, especially considering that many forensic laboratories are supplied only with basic instrumentation for fingerprint analysis. The present study overviews these difficulties and proposes a combination of chemical and optical procedures, using low-cost products and equipment, to develop fingermarks on silver mirror surfaces. The chemical treatment promotes the delimitation of the substrate, transforming the reflective surface into a transparent surface. The results were statistically analyzed, indicating quality improvement of natural fingermarks pictures taken with standard digital camera on transparent surface. There was good observation of details and minutiae, even for samples recovered several days or weeks after deposition. The suggested method substantially modifies the composition of the substrate without any contact with the fingermark, preserving its characteristics and properties. Like other nondestructive methodologies, this approach could be prioritized over methods that directly change the evidence itself and allows for the photography of the fingermark in unaltered condition. Lastly, it does not impact on the efficiency of subsequent exams.

Experiences of viewing self in the mirror for men and women with dementia as perceived by their caregivers: A phenomenological study

AIM

To explore and discuss the perceptions and experiences of caregivers who rendered care to persons with dementia who viewed themselves in the mirror.

BACKGROUND

Considerations must be given to caring for those with dementia due to the steady rise of adults 65 and older living with dementia. A literature review revealed limited experiential knowledge concerning aspects of mirror-viewing for persons with dementia.

METHODS

This phenomenological hermeneutic study was analyzed using Ricoeur's theory of interpretation. Eighteen participants who cared for individuals with dementia in the home, and long-term care facilities took part in the study. A semi-structured interview guide with open- ended questions facilitated an open dialogue about their experiences while caring for persons with dementia when they view themselves in the mirror. Two questions guiding the study were: 1) What are caregivers' perceptions of what they see and believe when they observe dementia patients whom they care view themselves in a mirror? 2) How do the caregivers' perceptions of that experience change over time as the dementia worsens?

RESULTS

The structural analysis uncovered a considerable difference between the numbers of mirrors available in the homes as compared to the long-term care facilities. Two phenomenological findings were uncovered: 1) decision to look in the mirror and 2) viewing self in the mirror. Six subsequent subthemes; mirror as a tool, wanting to look presentable, self- recognition, self-confirmation seeing another and the latent stage were revealed.

CONCLUSION

A mirror assessment is needed for individuals who have dementia.

Dataset on fractographic analysis of various SiC-based fibers

This data article reports a systematic fractographic analysis of SiC-based filaments aiming at stress intensity factors assessment. A total of 11 fiber types (as-received or chlorinated Nicalon® and Tyranno® of all three generations) where therefore repeatedly tensile tested to generate the fracture surfaces. The tensile strengths were found to be independent to defect location (surface or internal). The well-known linear square root dependence of strength on mirror, mist or hackle outer radius was reaffirmed. These measurements reveal some residual tensile stresses on Nicalon® fibers, statement however questioned by the broad data scattering. Moreover, it is shown the surface etching treatment didn't affected (generating or releasing) such residual stress. A null y-intercept was consequently adopted to assess the characteristic stress intensity factors (K_IC, mirror, mist or hackle constants). The toughness (K_IC) estimated this way ranges from 1.0 to 1.9 MPa m^1/2 and shows a clear dependency to substrate composition: higher values were extracted on oxygen-free fibers. The A_m/K_IC ratio, estimated to equal 1.8 and independent to substrate type, is a key parameter that would assist further fractographic investigations.

Neural and endocrine responses to social stress differ during actual and virtual aggressive interactions or physiological sign stimuli

Neural and endocrine responses provide quantitative measures that can be used for discriminating behavioral output analyses. Experimental design differences often make it difficult to compare results with respect to the mechanisms producing behavioral actions. We hypothesize that comparisons of distinctive behavioral paradigms or modification of social signals can aid in teasing apart the subtle differences in animal responses to social stress. Eyespots are a unique sympathetically activated sign stimulus of the lizard Anolis carolinensis that influence aggression and social dominance. Eyespot formation along with measurements of central and plasma monoamines enable comparison of paired male aggressive interactions with those provoked by a mirror image. The results suggest that experiments employing artificial application of sign stimuli in dyadic interactions amplify behavioral, neural and endocrine responses, and foreshorten behavioral interactions compared to those that develop among pairs naturally. While the use of mirrors to induce aggressive behavior produces simulated interactions that appear normal, some behavioral, neural, and endocrine responses are amplified in these experiments as well. In contrast, mirror image interactions also limit the level of certain behavioral and neuroendocrine responses. As true social communication does not occur during interaction with mirror images, rank relationships can never be established. Multiple experimental approaches, such as combining naturalistic social interactions with virtual exchanges and/or manipulation of sign stimuli, can often provide added depth to understanding the motivation, context, and mechanisms that produce specific behaviors. The addition of endocrine and neural measurements helps identify the contributions of specific behavioral elements to the social processes proceeding.

Health inequality indices and exogenous risk factors: an illustration on Luxembourgish workers

This paper proposes an aggregable family of multidimensional concentration indices which is characterized in order to be consistent with a property of exogenous risk factors, i.e. health risks for which agents are not responsible for. It is shown that those indices are of interest when individuals face different risk factors, whereas traditional indices fail to deal with heterogeneous agents. In this respect, necessary and suficient conditions are stated in order to rank two health distributions thanks to the generalized concentration curves. An illustration is performed using a sample of individuals living in Luxembourg aged 50 and older.

Walking through the looking glass: Adapting gait patterns with mirror feedback

Clinical locomotor research seeks to facilitate adaptation or retention of new walking patterns by providing feedback. Within a split-belt treadmill paradigm, sagittal plane feedback improves adaptation but does not affect retention. Representation of error in this manner is cognitively demanding. However, it is unknown in this paradigm how frontal plane feedback, which may utilize a unique learning process, impacts locomotor adaptation. Frontal plane movement feedback has been shown to impact retention of novel running mechanics but has yet to be evaluated in gait conditions widely applicable within neurorehabilitation, such as walking. The purpose of this study was to investigate the effects of frontal plane mirror feedback on gait adaptation and retention during split-belt treadmill walking. Forty healthy young adults were divided into two groups: one group received mirror feedback during the first split-belt exposure and the other received no mirror feedback. Individuals in the mirror feedback group were asked to look at their legs in the mirror, but no further instructions were given. Individuals with mirror feedback displayed more symmetric stance time during the first strides of adaptation and maintained this pattern into the second split-belt exposure when no feedback was provided. Individuals with mirror feedback also demonstrated more symmetric double support time upon returning to normal walking. Lastly, the mirror feedback also allowed individuals to walk with smaller gait variability during the final steps of both split-belt exposures. Overall, mirror feedback allowed individuals to reduce their stance time asymmetry and led to a more consistent adapted pattern, suggesting this type of feedback may have utility in gait training that targets symmetry and consistency in movement.

Human gait symmetry assessment using a depth camera and mirrors

It is proposed in this paper a reliable approach for human gait symmetry assessment using a Time-of-Flight (ToF) depth camera and two mirrors. The setup formed from these devices provides a sequence of 3D point clouds that is the input of our system. A cylindrical histogram is estimated for describing the posture in each point cloud. The sequence of such histograms is then separated into two sequences of sub-histograms representing two half-bodies. A cross-correlation technique is finally applied to provide values describing gait symmetry indices. The evaluation was performed on 9 different gait types to demonstrate the ability of our approach in assessing gait symmetry. A comparison between our system and related methods, that employ different input data types, is also provided.

Circulating microRNAs as biomarkers in traumatic brain injury

Preclinical and clinical studies can be greatly improved through the inclusion of diagnostic, prognostic, predictive or pharmacodynamics biomarkers. Circulating microRNAs (miRNAs) represent highly stable targets that respond to physiological and pathological changes. MicroRNA biomarkers can be detected by highly sensitive and absolutely quantitative methods currently available in most clinical laboratories. Here we review preclinical and clinical studies that have examined circulating miRNAs as potential diagnostic and prognostic biomarkers. We also present data that suggests pharmacodynamics biomarkers can be identified that are associated with neuroprotection in general. Although circulating miRNA can serve as useful tools, it is clear their expression profiles are highly sensitive to changing conditions and are influenced by a broad range of parameters including age, sex, body mass index, injury severity, time of collection, as well as methods of processing, purification and detection. Thus, considerable effort will be required to standardize methods and experimental design conditions before circulating miRNAs can prove useful in a heterologous injury like TBI. This article is part of the Special Issue entitled "Novel Treatments for Traumatic Brain Injury".

Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options

Objective

Mirror aneurysms are generally considered as a subset of multiple aneurysms, defined as aneurysms occurring bilaterally and symmetrically on the same-named vessels. Although not infrequent, the characteristics of mirror aneurysms are not well studied. This investigation was conducted to elucidate the anatomic features of such lesions and examine treatment options.

Materials and Methods

A retrospective review was conducted, aimed at 172 patients treated for 344 mirror aneurysms between January 2007 and December 2015. Aneurysms of similar nature but in asymmetric locations on the same-named vessels were excluded. All available records were examined and lesion characteristics, as well as treatment outcomes were assessed.

Results

In study subjects (n = 172), mirror aneurysms most often involved middle cerebral artery bifurcation (n = 83), followed by a paraclinoid internal carotid artery (n = 50) and posterior communicating artery (n = 21). Most of the lesions (95.3%) measured ≤ 10 mm, and in 126 patients (74.6%), the size ratios were > 50%. Of the 344 aneurysms studied, coil embolization was undertaken in 217, surgical clipping in 62, and observation alone (no treatment) in 65. Coil embolization and surgical clipping were done bilaterally in 83 and 12 patients, respectively. In 12 patients, combined coiling and clipping were implemented on each side. Single-stage coil embolization of both the aneurysms was performed in 73 patients, with excellent post-procedural (85.6%) and follow-up (86.8%) occlusive results. There was no procedure-related morbidity or mortality.

Conclusion

By adopting different treatment strategies to different configurations and vascular sources, mirror aneurysms can be safely and effectively treated. If feasible, single-stage coil embolization should be considered as a reasonable treatment option for mirror aneurysms.

Blind readers break mirror invariance as sighted do

Mirror invariance refers to a predisposition of humans, including infants and animals, which urge them to consider mirrored images as corresponding to the same object. Yet in order to learn to read a written system that incorporates mirrored letters (e.g., <b> vs. <d> in the Latin alphabet), humans learn to break this perceptual bias. Here we examined the role visual experience and input modality play in the emergence of this bias. To this end, we tested congenital blind (CB) participants in two same-different tactile comparison tasks including pairs of mirrored and non-mirrored Braille letters as well as embossed unfamiliar geometric shapes and Latin letters, and compared their results to those of age-matched sighted participants involved in similar but visually-presented tasks. Sighted participants showed a classical pattern of results for their material of expertise, Latin letters. CB's results signed for their expertise with the Braille script compared to the other two materials that they processed according to an internal frame of reference. They also evidenced that they automatically break mirror invariance for different materials explored through the tactile modality, including Braille letters. Altogether, these results demonstrate that learning to read Braille through the tactile modality allows breaking mirror invariance in a comparable way to what is observed in sighted individuals for the mirrored letters of the Latin alphabet.

Searching for Radial Symmetry

Symmetry is ubiquitous in the natural world. Numerous investigations, dating back over one hundred years, have explored the visual processing of symmetry. However, these studies have been concerned with mirror symmetry, overlooking radial (or rotational) symmetry, which is also prevalent in nature. Using a visual search paradigm, which approximates the everyday task of searching for an object embedded in background clutter, we have measured how quickly and how accurately human observers detect radially symmetric dot patterns. Performance was compared with mirror symmetry. We found that with orders of radial symmetry greater than 5, radial symmetry can be detected more easily than mirror symmetry, revealing for the first time that radial symmetry is a salient property of objects for human vision.

CB Database: A change blindness database for objects in natural indoor scenes

Change blindness has been a topic of interest in cognitive sciences for decades. Change detection experiments are frequently used for studying various research topics such as attention and perception. However, creating change detection stimuli is tedious and there is no open repository of such stimuli using natural scenes. We introduce the Change Blindness (CB) Database with object changes in 130 colored images of natural indoor scenes. The size and eccentricity are provided for all the changes as well as reaction time data from a baseline experiment. In addition, we have two specialized satellite databases that are subsets of the 130 images. In one set, changes are seen in rooms or in mirrors in those rooms (Mirror Change Database). In the other, changes occur in a room or out a window (Window Change Database). Both the sets have controlled background, change size, and eccentricity. The CB Database is intended to provide researchers with a stimulus set of natural scenes with defined stimulus parameters that can be used for a wide range of experiments. The CB Database can be found at http://search.bwh.harvard.edu/new/CBDatabase.html .

The "social" facilitation of eating without the presence of others: Self-reflection on eating makes food taste better and people eat more

Food tastes better and people eat more of it when eaten with company than alone. Although several explanations have been proposed for this social facilitation of eating, they share the basic assumption that this phenomenon is achieved by the existence of co-eating others. Here, we demonstrate a similar "social" facilitation of eating in the absence of other individuals. Elderly participants tasted a piece of popcorn alone while in front of a mirror (which reflects the participant themselves eating popcorn) or in front of a wall-reflecting monitor, and were found to eat more popcorn and rate it better tasting in the self-reflecting condition than in the monitor condition. Similar results were found for younger adults. The results suggest that the social facilitation of eating does not necessarily require the presence of another individual. Furthermore, we observed a similar "social" facilitation of eating even when participants ate a piece of popcorn in front of a static picture of themselves eating, suggesting that static visual information of "someone" eating food is sufficient to produce the "social" facilitation of eating.

Simultaneous intrinsic and extrinsic calibration of a laser deflecting tilting mirror in the projective voltage space

PURPOSE  : During the past five decades, laser technology emerged and is nowadays part of a great number of scientific and industrial applications. In the medical field, the integration of laser technology is on the rise and has already been widely adopted in contemporary medical applications. However, it is new to use a laser to cut bone and perform general osteotomy surgical tasks with it. In this paper, we describe a method to calibrate a laser deflecting tilting mirror and integrate it into a sophisticated laser osteotome, involving next generation robots and optical tracking. METHODS  : A mathematical model was derived, which describes a controllable deflection mirror by the general projective transformation. This makes the application of well-known camera calibration methods possible. In particular, the direct linear transformation algorithm is applied to calibrate and integrate a laser deflecting tilting mirror into the affine transformation chain of a surgical system. RESULTS  : Experiments were performed on synthetic generated calibration input, and the calibration was tested with real data. The determined target registration errors in a working distance of 150 mm for both simulated input and real data agree at the declared noise level of the applied optical 3D tracking system: The evaluation of the synthetic input showed an error of 0.4 mm, and the error with the real data was 0.3 mm.

A Multi-Component Pheromone in the Urine of Dominant Male Tilapia (Oreochromis mossambicus) Reduces Aggression in Rivals

Males often use scent to communicate their dominance, and to mediate aggressive and breeding behaviors. In teleost fish, however, the chemical composition of male pheromones is poorly understood. Male Mozambique tilapia, Oreochromis mossambicus, use urine that signals social status and primes females to spawn. The urinary sex pheromone directed at females consists of 5β-pregnane-3α,17α,20β-triol 3-glucuronate and its 20α-epimer. The concentration of these is positively correlated with male social rank. This study tested whether dominant male urine reduces aggression in receiver males, and whether the pregnanetriol 3-glucuronates also reduce male-male aggression. Males were allowed to fight their mirror image when exposed to either: i) water control or a chemical stimulus; ii) dominant male urine (DMU); iii) C18-solid phase (C18-SPE) DMU eluate; iv) C18-SPE DMU eluate plus filtrate; v) the two pregnanetriol 3-glucuronates (P3Gs); or vi) P3Gs plus DMU filtrate. Control males mounted an increasingly aggressive fight against their image over time. However, DMU significantly reduced this aggressive response. The two urinary P3Gs did not replicate the effect of whole DMU. Neither did the C18-SPE DMU eluate, containing the P3Gs, alone, nor the C18-SPE DMU filtrate to which the two P3Gs were added. Only exposure to reconstituted DMU (C18-SPE eluate plus filtrate) restored the aggression-reducing effect of whole DMU. Olfactory activity was present in the eluate and the polar filtrate in electro-olfactogram studies. We conclude that P3Gs alone have no reducing effect on aggression and that the urinary signal driving off male competition is likely to be a multi-component pheromone, with components present in both the polar and non-polar urine fractions.

Clar, clarified

BACKGROUND

The origin of Dr. Clar's forehead mirror remains a mystery. The aim of this study is to track the roots of this eponym anew to find a definitive answer.

METHODS

Historical, notably by the analysis of the reports of medical meetings and the content of instrument trade catalogs of the corresponding epoch.

RESULTS

Konrad or Conrad Clar (1844-1904) was an Austrian balneologist and geologist particularly interested in laryngological examination. He notably invented a lighting apparatus in 1874, his famous forehead mirror in 1886, and a handgrip for laryngological instruments in 1901.

CONCLUSIONS

Konrad Clar is the man behind the eponymous Dr. Clar's mirror. This study allowed to definitively confirm this statement.

Mirror Meningioma at Foramen Magnum: A Management Challenge

BACKGROUND

Meningiomas of the foramen magnum are among the most challenging of all skull base lesions. Controversies continue regarding the most appropriate approach to this critical anatomic region. The authors report a first case in English literature about twin meningiomas arising from both sides of the ventrolateral dura at the foramen magnum.

CASE DESCRIPTION

Preoperative imaging showed a solitary mass engulfing the lower medulla. However, intraoperatively a twin mass was discovered. It encased the right side vertebral artery (VA) and abutted the left side. The unilateral far lateral transcondylar approach is not enough to resect both tumors at the same time. However, the far lateral transcondylar approach in both sides may compromise the stability and increase the risk of injury to either side of the neurovascular structures.

CONCLUSIONS

We suggest that resection can be safely achieved via the unilateral far lateral transcondylar approach followed by Gamma Knife radiosurgery (GKRS) or a staged bilateral approach.

New reflections on agency and body ownership: The moving rubber hand illusion in the mirror

No previous study has simultaneously examined body ownership and agency in healthy subjects during mirror self-observation. We used a moving rubber hand illusion to examine how both body ownership and agency are affected by seeing (i) the body moving in a mirror, compared with (ii) directly viewing the moving hand, and (iii) seeing a visually identical hand rotated by 180°. We elicited ownership of the hand using direct visual feedback, finding this effect was further enhanced when looking at the hand in a mirror, whereas rotating the hand 180° abolished ownership. Agency was similarly elicited using direct visual feedback, and equally so in the mirror, but again reduced for the 180° hand. We conclude that the reflected body in a mirror is treated as 'special' in the mind, and distinct from other external objects. This enables bodies and actions viewed in a mirror to be directly related to the self.

Contralateral interictal spikes are related to tapetum damage in left temporal lobe epilepsy

OBJECTIVE

In temporal lobe epilepsy (TLE), the epileptogenic focus is focal and unilateral in the majority of patients. A key characteristic of focal TLE is the presence of subclinical epileptiform activity in both the ictal and contralateral "healthy" hemisphere. Such interictal activity is clinically important, as it may reflect the spread of pathology, potentially leading to secondary epileptogenesis. The role played by white matter pathways in this process is unknown.

METHODS

We compared three interhemispheric white matter tracts (anterior commissure, fornix, and tapetum) to determine the pathway most associated with the presence of contralateral interictal spikes. Forty patients with unilateral left or right TLE were categorized based on the presence or absence of contralateral interictal spikes. Analyses of variance (ANOVAs) were run on diffusion properties from each tract.

RESULTS

The analyses revealed that patients with left TLE and with bilateral interictal spikes had lower fractional anisotropy (FA) and higher mean diffusivity (MD) in the tapetum. Patients with right TLE did not show this effect. No significant associations with bilateral activity were observed for the other tracts. Blood oxygen level-dependent (BOLD) functional connectivity data revealed that homotopic lateral, not mesial, temporal areas were reliably correlated in bilateral patients, independent of ictal side.

SIGNIFICANCE

Our results indicate that, among the tracts investigated, only the tapetum was associated with contralateral epileptiform activity, implicating this structure in seizures and possible secondary epileptogenesis. We describe two mechanisms that might explain this association (the interruption of inhibitory signals or the toxic effect of carrying epileptiform signals toward the healthy hemisphere), but also acknowledge other rival factors that may be at work. We also report that patients with TLE with bilateral spikes had increased lateral bitemporal lobe connectivity. Our current results can be seen as bringing together important functional and structural data to elucidate the basis of contralateral interictal activity in focal, unilateral epilepsy. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

Helping burn patients to look at their injuries: how confident are burn care staff and how often do they help?

Patients vary in their feelings about looking at their injuries and burn care staff play an important role in helping patients. This study explored confidence among burn care staff in helping patients to look at their injuries and how often help was typically offered. Burn care professionals (n=33) completed a questionnaire exploring confidence and practice in this area. Eighty-five percent (n=28) believed it was important for patients to look at their injuries but a significant proportion lacked confidence in preparing patients for what they might see (18%; n=6) and having the necessary practical skills required (24%; n=8). Fifty-five percent (n=18) worried about upsetting patients and 48% (n=16) worried about saying/doing the wrong thing. Practice varied significantly. Only 21% (n=7) regularly (most or all of the time) informed patients where mirrors were situated within the ward area. Eighteen percent (n=6) of staff reported never or only occasionally asking patients if they had seen their injuries, 27% (n=9) of staff never or only occasionally asked patients if they would like to see their injuries and 30% (n=10) of staff never or only occasionally asked patients if they wanted any help looking at their injuries. Training in this area may be useful to enhance staff confidence so patients can be offered appropriate support.