Ultrasound mapping of lymph node and subcutaneous metastases in patients with cutaneous melanoma: Results of a prospective multicenter study

Background: Ultrasound (sonography, B-mode sonography, ultrasonography) examination improves the sensitivity in more than 25% compared to the clinical palpation, especially after surgery on the regional lymph node area. Objective: To evaluate the distribution of metastases during follow-up in the draining lymph node areas from the scar of primary to regional lymph nodes ( head and neck, supraclavicular, axilla, infraclavicular, groin) in patients with cutaneous melanoma with or without sentinel lymph node biopsy (SLNB) or former elective or consecutive complete lymph node dissection in case of positive sentinel lymph node (CLND). Methods: Prospective multicenter study of the Departments of Dermatology of the Universities of Homburg/Saar, Tubingen and Munich (Germany) in which the distribution of lymph node and subcutaneous metastases were mapped from the scar of primary to the lymphatic drainage region in 53 melanoma patients ( 23 women, 30 men; median age: 64 years; median tumor thickness: 1.99 mm) with known primary, visible lymph nodes or subcutaneous metastases proven by ultrasound and histopathology during the follow-up. Results: Especially in the axilla, infraclavicular region and groin the metastases were not limited to the anatomic lymph node regions. In 5 patients (9.4%) ( 4 of them were in stage IV) lymph node metastases were not located in the corresponding lymph node area. 32 patients without former SLNB had a time range between melanoma excision and lymph node metastases of 31 months ( median), 21 patients with SLNB had 18 months ( p < 0.005). In 11 patients with positive SLNB the time range was 17 months, in 10 patients with negative SLNB 21 months ( p < 0.005); in 32 patients with CLND the time range was 31 m< 0.005). In thinner melanomas lymph node metastases occurred later ( p < 0.05). Conclusions: After surgery of cutaneous melanoma, SLNB and CLND the lymphatic drainage can show significant changes which should be considered in clinical and ultrasound follow-up examinations. Especially for high-risk melanoma patients follow-up examinations should be performed at intervals of 3 months in the first years. Patients at stage IV should be examined in all regional lymph node areas clinically and by ultrasound. Copyright (c) 2006 S. Karger AG, Basel

Diagnosis of inflammatory demyelination in biopsy specimens: a practical approach

Multiple sclerosis is the most frequent demyelinating disease in adults. It is characterized by demyelination, inflammation, gliosis and a variable loss of axons. Clinically and histologically, it shares features with other demyelinating and/or inflammatory CNS diseases. Diagnosis of an inflammatory demyelinating disease can be challenging, especially in small biopsy specimens. Here, we summarize the histological hallmarks and most important neuropathological differential diagnoses of early MS, and provide practical guidelines for the diagnosis of inflammatory demyelinating diseases

The Visit

The Visit is an interactive real-time video installation and Virtual Reality experience, developed from a ground-breaking interdisciplinary research project conducted by artists and psychologists working with women living with dementia. Visitors are invited to sit with Viv, a life-sized, realistic animated character, drawing us into a world of perceptual uncertainty, while at the same time confounding stereotypes and confronting fears about dementia. The characterisation has scientific validity but also the qualities of a rich, emotion-driven film narrative. The point of the work is to draw the viewer into the emotional/perceptual world of Viv.The script is created largely from verbatim interviews, utilising grounded practical theory for unpacking the interview data to connect feelings of loss, attachment and meaning to ideas, events and objects. Like the women who co-created her, Viv experiences various dementia-related symptoms, including hallucinations and confabulation, but she is also insightful and reflective. Viv is living a life and coming to terms with a neurological change.The character is sensitive to the motions of the viewer, she is ‘aware’ of the presence in her home by making eye-contact and directly addressing the visitor. The narrative develops in two parallel streams. Virtual production techniques such as digital human, motion and performance capture and virtual set have been employed to create this non-linear experience. The film is rendered in real-time in a computer game engine.This project investigates the affective potential of immersive technologies and content from in-depth qualitative research with people with lived experience of living with dementia. The ageing population and dementia are key issues facing society in the 21st Century. Biomedical, social science, and neurological perspectives are increasingly well-documented. What is not understood well is the lived experience. The project develops new methodologies for engaging with people living with dementia to understand their experiences and uses immersive technologies to embed the audience as a visitor into Viv’s world.The project contributes to research in three ways. It takes on the issues related to ageism and stigmatisation in relation to dementia. It engages in innovative methodology development for understanding lived experience. It investigates how the audience through the use of technology become immersed in the visit with Viv. In doing so they become aware of their own responses to the character and the condition and, as evaluation has shown, increase empathy, and decrease emotional distance.The Vist VR has been invited to be shown to Dementias Australia CEO and staff in Melbourne and Sydney. Audience members commented on the experience with Viv suggesting “It has definitely opened my eyes to the creative ways we can express or translate mental health research to make it more applicable to the general population.

Mnemoscape: Supporting Older Adults’ Event Memory Using Wearable Camera Photographs on an Immersive Interface

Background: Wearable camera photographs have been shown to be an effective memory aid in people with and without memory impairment. Most studies using wearable cameras as a memory aid have presented photographs on a computer monitor and used a written diary or no review as a comparison. In this pioneering study, we took a new and innovative approach to wearable camera photograph review that embeds the photographs within a virtual landscape. This approach may enhance these benefits by reinstating the original environmental context to increase participants’ sense of re-experiencing the event. Objective: We compare the traditional computer monitor presentation of wearable camera photographs and actively taken digital photographs with the presentation of wearable camera photographs in a new immersive interface that reinstates the spatiotemporal context. Methods: Healthy older adults wore wearable or took digital photographs during a staged event. The next day and 2 weeks later, they viewed wearable camera photographs on a computer monitor or in context on an immersive interface, or digital photographs. Results: Participants who viewed wearable camera photographs in either format recalled more details during photo viewing and subsequent free recall than participants who viewed digital photographs they had taken themselves. Conclusion: Wearable camera photographs are an effective support for event memory, regardless of whether they are presented in context in an experience-near format

The Visit VR. Understanding the experience of living with dementia

The Visit is an interactive 6-dof real-time Virtual Reality experience, developed from a ground-breaking research project conducted by artists and psychologists working with women living with dementia. Visitors are invited to sit with Viv, a life- sized, realistic and responsive character whose dialogue is created largely from verbatim interviews, drawing us into a world of perceptual uncertainty, while at the same time confounding stereotypes and confronting fears about dementia

A visit with Viv: Empathising with a digital human character embodying the lived experiences of dementia.

The Visit, an immersive participatory artwork (viewed on a screen or virtual reality headset), was produced as part of a research programme investigating the subjective experience of dementia and the relational dynamic between people with dementia and others. It invites viewers to engage with a digital human character, 'Viv', as she shares her experiences of living with dementia. The experiences that Viv recounts are based on verbatim accounts from in-depth interviews with four women living with dementia. The artwork was designed with the combined aim of generating insights into the lived experience of dementia and establishing conditions under which viewers might cultivate empathy for the character portrayed. Viewers engaging with Viv were invited to complete pre- and post-engagement measures of state empathy alongside an assessment of emotional distance. State empathy was significantly greater after engaging with The Visit, and correspondingly, there was a significant decrease in emotional distance (aversion), suggesting that the aims were met