Ventricular strain changes in monochorionic twins with and without twin-to-twin transfusion syndrome.

OBJECTIVE: The objective of the study was to investigate whether vector velocity imaging (VVI), a non-Doppler speckle tracking ultrasound technology, is feasible in twin pregnancies and can aid management of twin-twin transfusion syndrome (TTTS). STUDY DESIGN: Twenty-seven women pregnant with monochorionic diamniotic twins affected by TTTS and 28 monochorionic pregnancies that did not develop TTTS were included in a prospective case-control study at a fetal medicine center. Fetal echocardiograms were recorded with dummy electrocardiography to retain original frame rates when exported for offline speckle tracking analysis using Syngo-VVI software (Siemens Corp, Munich, Germany). Right and left ventricular (LV) free wall Lagrangian strain was measured from the original coordinates. Within-twin pair ventricular strain differences including relationship to Quintero staging and response to laser therapy for TTTS were analyzed by Wilcoxon signed-rank test. RESULTS: The VVI strain measurements could be analyzed in 182 of 200 TTTS and 96 of 112 non-TTTS control ventricles. Within-pair strain was concordant in non-TTTS controls. Recipient LV strain was reduced at all Quintero stages compared with donors (P < .01). Recipient right ventricular strain was reduced only in stages 3 and 4 (P < .01). Strain improved at a median of 2 weeks following successful laser therapy. Intertwin differences in strain were independent of weight discordance. CONCLUSION: Recipient LV strain is reduced in stages 1 and 2 TTTS. Within-pair strain discordance may distinguish early TTTS from growth discordance and guide timing of and management following treatment.

The brain's fingers and hands.

The brain keeps track of the changing positions of body parts in space using a spatial body schema. When subjects localise a tactile stimulus on the skin, they might either use a somatotopic body map, or use a body schema to identify the location of the stimulation in external space. Healthy subjects were touched on the fingertips, with the hands in one of two postures: either the right hand was vertically above the left, or the fingers of both hands were interwoven. Subjects made speeded verbal responses to identify either the finger or the hand that was touched. Interweaving the fingers significantly impaired hand identification across several experiments, but had no effect on finger identification. Our results suggest that identification of fingers occurs in a somatotopic representation or finger schema. Identification of hands uses a general body schema, and is influenced by external spatial location. This dissociation implies that touches on the finger can only be identified with a particular hand after a process of assigning fingers to hands. This assignment is based on external spatial location. Our results suggest a role of the body schema in the identification of structural body parts from touch.

Facilitated processing of visual stimuli associated with the body.

Recent work on tactile perception has revealed enhanced tactile acuity and speeded spatial-choice reaction times (RTs) when viewing the stimulated body site as opposed to viewing a neutral object. Here we examine whether this body-view enhancement effect extends to visual targets. Participants performed a speeded spatial discrimination between two lights attached either to their own left index finger or to a wooden finger-shaped object, making a simple distal--proximal decision. We filmed either the finger-mounted or the object-mounted lights in separate experimental blocks and the live scene was projected onto a screen in front of the participants. Thus, participants responded to identical visual targets varying only in their context: on the body or not. Results revealed a large performance advantage for the finger-mounted stimuli: reaction times were substantially reduced, while discrimination accuracy was unaffected. With this finding we address concerns associated with previous work on the processing of stimuli attributed to the self and extend the finding of a performance advantage for such stimuli to vision.

Keeping the world a constant size: object constancy in human touch.

The perceived size of objects touching different regions of skin varies across the body surface by much less than is predicted from variations in tactile receptor density. Here we show that altering the visual experience of the body alters perceived tactile distances. We propose that the brain attempts to preserve tactile size constancy by rescaling the primary, distorted body-surface representation into object-centered space according to visual experience of the body.

Persistence of visual-tactile enhancement in humans.

We report two experiments in which non-informative vision of the finger enhanced tactile acuity on the fingertip. The right index finger was passively lifted to contact a grating. Twelve participants judged orientations of tactile gratings while viewing either the fingertip, or a neutral object presented via a mirror at the fingertip's location. In Expt. 1, tactile orientation discrimination for near-threshold gratings was improved when viewing the fingertip, compared to viewing the neutral object. Experiment 2 examined the temporal persistence of this effect, and found significant visual-tactile enhancement when a dark interval of up to 10 s intervened between viewing the finger and tactile stimulation. These results suggest that viewing the body modulates the neural circuitry of primary somatosensory cortex, outlasting visual inputs.

Visual enhancement of touch in spatial body representation.

Perception of our own bodies is based on integration of visual and tactile inputs, notably by neurons in the brain's parietal lobes. Here we report a behavioural consequence of this integration process. Simply viewing the arm can speed up reactions to an invisible tactile stimulus on the arm. We observed this visual enhancement effect only when a tactile task required spatial computation within a topographic map of the body surface and the judgements made were close to the limits of performance. This effect of viewing the body surface was absent or reversed in tasks that either did not require a spatial computation or in which judgements were well above performance limits. We consider possible mechanisms by which vision may influence tactile processing.

Awareness of action in schizophrenia.

An abnormal sense of agency is among the most characteristic yet perplexing positive symptoms of schizophrenia. Schizophrenics may either attribute the consequences of their own actions to the intentions of others (delusions of influence), or may perceive themselves as causing events which they do not in fact control (megalomania). Previous reports have often described inaccurate agency judgements in schizophrenia, but have not identified the disordered neural mechanisms or psychological processes underlying these judgements. We report the perceived time of a voluntary action and its consequence in eight schizophrenic patients and matched controls. The patients showed an unusually strong binding effect between actions and consequences. Specifically, the temporal interval between action and consequence appeared shorter for patients than for controls. Patients may overassociate their actions with subsequent events, experiencing their actions as having unusual causal efficacy. Disorders of agency may reflect an underlying abnormality in the experience of voluntary action.

Vision modulates somatosensory cortical processing.

Over 150 years ago, E.H. Weber declared that experience showed that tactile acuity was not affected by viewing the stimulated body part. However, more recent investigations suggest that cross-modal links do exist between the senses. Viewing the stimulated body site improves performance on tactile discrimination and detection tasks and enhances tactile acuity. Here, we show that vision modulates somatosensory cortex activity, as measured by somatosensory event-related potentials (ERPs). This modulation is greatest when tactile stimulation is task relevant. Visual modulation is not present in the P50 component reflecting the primary afferent input to the cortex but appears in the subsequent N80 component, which has also been localized to SI, the primary somatosensory cortex. Furthermore, we replicate previous findings that noninformative vision improves spatial acuity. These results are consistent with a hypothesis that vision modulates cortical processing of tactile stimuli via back projections from multimodal cortical areas. Several neurophysiological studies suggest that primary and secondary somatosensory cortex (SI and SII, respectively) activity can be modulated by spatial and tactile attention and by visual cues. To our knowledge, this is the first demonstration of direct modulation of somatosensory cortex activity by a noninformative view of the stimulated body site with concomitant enhancement of tactile acuity in normal subjects.