Piaget's 3-mountains task with impossible options: Sighted, blindfolded, early and late blind participants.

In Piaget's 3-mountains task, 3D objects - a cube, cone and sphere - sit on a square tabletop. They are portrayed in 2D pictures as elevations (projections to the sides) such as one with a square on the left, a triangle in the middle and a circle on the right. Three objects offer six elevations, of which four are possible and two impossible. The possibles are elevations from the sides of the table - front, left, right and rear. In the impossibles, an object in the corner of the table is shown in the middle of an elevation. Sighted, sighted-blindfolded, early- and late-blind adults judged the elevations as to side of the table or impossible. The results suggest similar spatial abilities across groups. The impossible options had mid-range accuracy for all groups, with reaction times like possible options. The sighted and blind participants may consider possible and impossible options sequentially, one item at a time.

Clinicopathological characterisation of renal cell carcinoma in young adults: a contemporary update and review of literature.

AIMS: Renal cell carcinomas are relatively rare in children and young adults. While well characterised in adults, the morphological and molecular characterisation of these tumours in young patients is relatively lacking. The objective of this study was to explore the spectrum of renal cell carcinoma (RCC) subtypes in children and young adults and to determine their clinico-pathological, immunohistochemical and molecular characteristics by evaluating a large retrospective cohort of renal cell carcinoma patients age 30 years or younger. METHODS AND RESULTS: Sixty-eight cases with confirmed diagnosis of renal cell carcinoma at age 30 years or younger were identified at our institution. Clear cell carcinoma accounted for the most common subtype seen in this age group. Translocation renal cell carcinoma and rare familial syndrome subtypes such as succinate dehydrogenase deficient renal cell carcinoma and tuberous sclerosis complex-associated renal cell carcinoma were found relatively more frequently in this cohort. Despite applying the 2016 WHO classification criteria, a high proportion of the tumours in our series remained unclassified. CONCLUSIONS: Our results suggest that renal cell carcinoma in children and young adults is a relatively rare disease that shares many histological similarities to renal cell carcinoma occurring in adults and yet demonstrate some unique clinical-pathological differences. Microphthalmia-associated transcription (MiT) family translocation RCC and rare familial syndrome subtypes are relatively more frequent in the paediatric and adolescent age groups than in adults. Clear cell RCC still accounted for the most common subtype seen in this age group. MiT family translocation RCC patients presented with advanced stage disease and had poor clinical outcomes. The large and heterogeneous subgroup of unclassified renal cell carcinoma contains phenotypically distinct tumours with further potential for future subcategories in the renal cell carcinoma classification.

Inverse Sideways Perspective on a Road: A Drawing by a Blind Adult.

An unusual drawing of a road has two lines converging sideways, from right to left. The left side of the picture is explicitly described as the location of the observer. Also, the fronts of the cars on the road face left, with the largest car on the right. This sideways perspective is novel. In linear perspective, roads running parallel with the picture surface should be drawn with parallel lines. Lines for roads running orthogonal to the picture surface should converge with elevation. The rule for roads is if converging, then upward, and if sideways, then not converging. The sketch is by a blind woman with modest experience in drawing, including perspective. It suggests an intermediate stage of drawing development, with inconsistent use of the observer's vantage point, in keeping with theories of perspective drawing by the blind and sighted of Willats, Kennedy and others.

Eyes Outside a Boundary Line: An Example of the Willats Region-Drawing Theory?

A puzzling raised-line drawing of a head by a blind man with no experience in freehand drawing has eyes placed outside the boundary line of the head, not inside. After scribbling, in the John Willats theory of drawing development, 2D "regions" on the page stand for 3D "volumes" in the scene. If Willats is correct, in very early drawing development circles touching the boundary line from outside may show the eyes are "embedded," and very early drawing development may be similar in the blind and sighted.

The forensic significance of pseudomesotheliomatous adenocarcinoma of the lung.

Pseudomesotheliomatous carcinomas (PMC) are rare tumors that clinically, macroscopically, and sometimes histologically resemble malignant pleural mesotheliomas. We report a case of a 91 year woman who was found to have diffuse nodular pleural thickening and a lung mass during a workup for persistent cough. She declined rapidly and died before a histologic diagnosis could be made. Postmortem examination revealed a tumor that diffusely involved the pleural surface with local extension into the chest wall, pericardium, and diaphragm along with a concurrent lung mass. Histologic examination showed poorly-differentiated cells predominantly arranged in sheets, cords, and nests with focal glandular differentiation. An immunohistochemical panel of calretinin, WT1, BEREP4, MOC31, and TTF1 confirmed the diagnosis of primary lung adenocarcinoma. The macroscopic, histologic, and immunohistochemical features used to distinguish metastatic and primary lung adenocarcinoma from epithelioid malignant mesothelioma are discussed. The distinction of malignant mesothelioma from pseudomesotheliomatous carcinoma is important for medicolegal reasons regarding asbestos related compensation claims.

Gibson and Pictures in Perspective: Reverse the Directions.

In his extensive writing about pictures, James J. Gibson offered perspective formulae for square tiles projecting trapezoids onto a picture plane, foreshortening to zero height with distance. I reverse the claim: as distance decreases, the trapezoids increase to infinite height, in marginal distortion, or forelengthening. I also reverse the direction of projection. Usually considered to be incoming, from the distant tile to the picture plane, in reverse-outgoing-the tiles have directions from the center of projection, with implications for haptics and people who are blind. A drawing of a cube illustrates the argument. It is by an adult who is blind. It includes foreshortening, and shows directions of surfaces from a vantage point.

Extension of Dancer's Legs: Increasing Angles Show Motion.

Usain Bolt's Lightning Bolt pose, one arm highly extended to one side, suggests action. Likewise, static pictures of animals, legs extended, show animation. We tested a new cue for motion perception-extension-and in particular extension of dancer's legs. An experiment with pictures of a dancer finds larger angles between the legs suggest greater movement, especially with in-air poses and in lateral views. Leg positions graded from simply standing to very difficult front and side splits. Liking ratings (a small range) were more related to Difficulty ratings (a large range) than Movement ratings (a moderate range).

Foreshortening increases apparent angles.

The hypothesis that perspective foreshortening leads to errors in the visual perception of angles, was tested in four experiments. An oblique to a z-dimension line was presented (a) on the ground in Experiments 1 and 2, and (b) on a wall in Experiments 3 and 4. Observers judged the acute angle between the oblique and the z-line. Foreshortening increased with the oblique's distance along the z-line and, in Experiments 2 and 4, shorter distances from the eye to the ground or wall. As distance and eye-height vary, so does the target's slant to the line of sight. We argue the apparent angles between the lines increased with foreshortening because vision underestimates the fast rate of foreshortening with elevation compared with the slower rates in azimuth.

Clinical and morphologic review of 60 hereditary renal tumors from 30 hereditary renal cell carcinoma syndrome patients: lessons from a contemporary single institution series.

Hereditary renal cell carcinoma syndromes (HRCCS) are characterized by the presence of pathogenic germline variants that predispose patients to renal cell carcinomas as well as additional extra-renal manifestations. The importance of identifying HRCCS patients cannot be overemphasized, as patients and their families can begin surveillance for syndrome-associated manifestations once identified. The present study is a retrospective clinical and morphologic review of 60 hereditary renal tumors from 30 HRCCS patients treated at our institution with either Von Hippel-Lindau disease (VHL), Birt-Hogg-Dubé syndrome (BHD), tuberous sclerosis complex (TSC), hereditary leiomyomatosis and renal cell cancer syndrome, or succinate dehydrogenase (SDH) deficiency syndrome. Hereditary renal cell carcinoma syndromes kidney tumors often demonstrate specific morphologic features, characteristic background changes in renal parenchyma, and extra-renal manifestations, which, when recognized by the pathologist, can trigger genetic testing referral for specific familial cancer syndromes. Our study demonstrates the majority of tumors were consistent with the anticipated clinicopathologic profile of renal tumors found within HRCCS patients, although we found some unique characteristics within this cohort including a case of clear cell papillary renal cell carcinoma within a VHL patient, and a unique renal tumor with tubulopapillary features present in a patient with a germline SDHD mutation. Additionally, although the literature reports the presence of epithelioid angiomyolipoma (AML) as a common occurrence in TSC patients, our cohort of 3 patients with AMLs demonstrated only classic features. The findings we describe facilitate pathologist-based recognition of HRCCS and can prompt genetic evaluation for relevant patients.

Looking at perspective pictures from too far, too close, and just right.

A central problem for psychology is vision's reaction to perspective. In the present studies, observers looked at perspective pictures projected by square tiles on a ground plane. They judged the tile dimensions while positioned at the correct distance, farther or nearer. In some pictures, many tiles appeared too short to be squares, many too long, and many just right. The judgments were strongly affected by viewing from the wrong distance, eye height, and object orientation. The authors propose a 2-factor angles and ratios together (ART) theory, with the following factors: the ratio of the visual angles of the tile's sides and the angle between (a) the direction to the tile from the observer and (b) the perpendicular, from the picture plane to the observer, that passes through the central vanishing point.

Blind man draws using diminution in three dimensions.

Can the principle of convergence in three spatial dimensions be reflected in drawings by the congenitally blind? A man who had been totally blind since birth was asked to draw scenes such as a tabletop with three cubes receding to the observer's left side. He used converging lines to show the tops of the cubes receding in depth. He drew the cubes to the left smaller than the cube in front of the observer. He drew faces of cubes to the left with tilted lines, pointing to below the front face of the cube in front. The result approximates three-point perspective. We note that the directions of objects from a vantage point in touch converge much as they do in vision.

Similes on the Internet have explanations.

We searched the Internet for expressions linking topics, such as crime, and vehicles, such as disease, as similes (crime is like a disease) and as metaphors (crime is a disease). We counted the number of times the expressions were accompanied by explanations (crime is like a disease because it spreads by direct personal influence). Similes were more likely than metaphors to be accompanied by explanations. Similes may be preferred if a writer wants to express an out-of-the-ordinary relation between the topic and the vehicle.

Thyroid Frozen Sections in Patients With Preoperative FNAs: Review of Surgeons' Preoperative Rationale, Intraoperative Decisions, and Final Outcome.

OBJECTIVES: We wished to discover (1) in what circumstances surgeons wished to request frozen sections (FSs) on thyroid nodules having a prior fine needle aspiration (FNA) and the preoperative plan in these cases; (2) what the surgeons did with the information provided by FS and (3) in what types of cases was value added with the FS. METHODS: A retrospective chart review was performed of 121 consecutive patients receiving an intraoperative FS diagnosis on a thyroid nodule, all of which had been evaluated with a preoperative FNA. RESULTS: The medical record documented rationale for the request in 83% of cases. The most common reason for a FS request of a nodule was whether a planned hemithyroidectomy should proceed to a total thyroidectomy (TT). This scenario led to a TT in 9% of patients with a FNA diagnosed as benign thyroid nodule, 16% diagnosed as follicular neoplasm/suspicious for follicular neoplasm and 69% diagnosed as suspicious for malignancy. CONCLUSIONS: The stated rationale for FSs in patients with preoperative FNA was not supported by patient outcome in most cases. There may be some utility for FSs in lesions with a suspicious for malignancy preoperative FNA diagnosis.

Pot/Lid Illusion.

A new everyday visual size illusion is presented-the Pot/Lid illusion. Observers choose an unduly large lid for a pot. We ask whether the optic slant of the pot brim would increase its apparent size or if vision underestimates the size of tilted lids.

Foreshortening produces errors in the perception of angles pictured as on the ground.

Observers viewed pictures of a simulated ground plane and judged the orientation of lines pictured as lying on the ground. We presented three lines at a time and manipulated three factors: (1) the declination of the lines below the horizon (depicting distance to the target angles), (2) their length, and (3) whether or not they converged to a point on the horizon. Only the first factor had a substantial effect on these errors. We conclude that perspective foreshortening in pictures produces errors in perceived 3-D orientation. Our explanation is based on the different rates of change of elevation and azimuth with distance.

Allocentric Spatial Performance Higher in Early-Blind and Sighted Adults Than in Retinopathy-of-Prematurity Adults.

The question as to whether people totally blind since infancy process allocentric or external spatial information like the sighted has caused considerable debate within the literature. Due to the extreme rarity of the population, researchers have often included individuals with retinopathy of prematurity (RoP--over oxygenation at birth) within the sample. However, RoP is inextricably confounded with prematurity per se. Prematurity, without visual disability, has been associated with spatial processing difficulties. In this experiment, blindfolded sighted participants and two groups of functionally totally blind participants heard text descriptions from a survey (allocentric) or route (egocentric) perspective. One blind group lost their sight due to RoP and a second group before 24 months of age. The accuracy of participants' mental representations derived from the text descriptions was assessed via questions and maps. The RoP participants had lower scores than the sighted and early blind, who performed similarly. In other words, it was not visual impairment alone that resulted in impaired allocentric spatial performance in this task but visual impairment together with RoP. This finding may help explain the contradictions within the existing literature on the role of vision in allocentric spatial processing.

Metaphoric Car Drawings By a 12-Year-Old Congenitally Blind Girl.

A 12-year-old congenitally-blind girl drew a car moving, stationary, and braking. For stationary, she put the wheels inside the car and, for braking, drew the wheels as rough rectangles. At the age verbal metaphor is understood (Winner, 1988), the girl invented metaphoric drawings. In these, what is shown is not what is meant. In late childhood, metaphor may be understood similarly in pictures and words and by the sighted and blind.

Progressive failure analysis of laminated composite femoral prostheses for total hip arthroplasty.

In this research program, a numerical method was developed to predict the progressive failure of a thick laminated composite femoral component for total hip arthroplasty. A 3-D global/local technique was used to capture the overall structural response of this system while also enabling the 3-D ply level stress state to be determined efficiently and accurately. Different failure criteria and different material degradation models were incorporated as individual subroutines in the numerical method, giving it the flexibility to model a wide range of materials and structures. Numerical modeling was also conducted to design experimental test methods for component fatigue testing that closely simulate in vivo loading conditions. Parametric studies were then conducted with the numerical model of the experimental system and the results were compared to the actual experimentally determined damage behavior of fabricated laminated composite femoral component to assess which parameter set most accurately predicted the actual damage development behavior. The best fitting parameter set was then applied to the failure problem of the composite hip prosthesis implanted in an anatomically modeled femur to predict in vivo performance. This work provides a ply level understanding of the damage behavior of laminated composite femoral components and a numerical tool which can serve as a guide for the design of fatigue resistant implants made from composite material for this and other implant applications.

Failure analysis of composite femoral components for hip arthroplasty.

In this research, a numerical method was developed for predicting the progressive failure of thick laminated composite femoral components. A three-dimensional (3-D) global/ 3-D local technique was developed to capture the overall structural response of this system, while also enabling the 3-D ply-level stress state to be determined efficiently and accurately. Different failure criteria and material degradation models were incorporated in the method, giving it the flexibility to model a wide range of materials and structures. Numerical modeling was also conducted to design experimental test methods to simulate in vivo loading conditions for component fatigue tests. Parametric studies were then conducted with the numerical model of the experimental system. Next, we compared the results to the damage behavior of the experimentally determined laminated composite femoral component to assess which parameter set most accurately predicted the actual damage development behavior. We then applied the best-fitting parameter set to analyze simulated in situ composite femoral components. Results showed that this methodology efficiently and accurately predicted damage initiation and propagation. This research demonstrates how analytical and numerical models may be used before conducting extensive experimental tests as initial tools to evaluate components for the design of composite hip implants that possess a high level of damage resistance and damage tolerance.

Clinical case of the month. Severe progressive weakness in a 58-year-old man. Myasthenia gravis.

Myasthenia gravis historically has been associated with significant morbidity and mortality rates, and most of those afflicted either died of the disease or became greatly disabled. However, modern understanding of the pathogenesis of this disorder has led to several effective treatments which have transformed the prognosis of this disease greatly.