The Power of Suggestion: Posthypnotically Induced Changes in the Temporal Binding of Intentional Action Outcomes.

The sense of agency is the experience of initiating and controlling one's voluntary actions and their outcomes. Intentional binding (i.e., when voluntary actions and their outcomes are perceived to occur closer together in time than involuntary actions and their outcomes) is increased in intentional action but requires no explicit reflection on agency. The reported experience of involuntariness is central to hypnotic responding, during which strategic action is experienced as involuntary. We report reduced intentional binding in a hypnotically induced experience of involuntariness, providing an objective correlate of reports of involuntariness. We argue that this reduced binding results from the diminished influence of motor intentions in the generation of the sense of agency when beliefs about whether an action is intended are altered. Thus, intentional binding depends on awareness of intentions. This finding shows that changes in metacognition of intentions affect perception.

New frontiers in the rubber hand experiment: when a robotic hand becomes one's own.

The rubber hand illusion is an experimental paradigm in which participants consider a fake hand to be part of their body. This paradigm has been used in many domains of psychology (i.e., research on pain, body ownership, agency) and is of clinical importance. The classic rubber hand paradigm nevertheless suffers from limitations, such as the absence of active motion or the reliance on approximate measurements, which makes strict experimental conditions difficult to obtain. Here, we report on the development of a novel technology-a robotic, user- and computer-controllable hand-that addresses many of the limitations associated with the classic rubber hand paradigm. Because participants can actively control the robotic hand, the device affords higher realism and authenticity. Our robotic hand has a comparatively low cost and opens up novel and innovative methods. In order to validate the robotic hand, we have carried out three experiments. The first two studies were based on previous research using the rubber hand, while the third was specific to the robotic hand. We measured both sense of agency and ownership. Overall, results show that participants experienced a "robotic hand illusion" in the baseline conditions. Furthermore, we also replicated previous results about agency and ownership.

Glucose oxidase virus-based nanoreactors for smart breast cancer therapy.

BACKGROUND: Breast cancer is the most common malignant tumor disease and the leading cause of female mortality. The evolution of nanomaterials science opens the opportunity to improve traditional cancer therapies, enhancing therapy efficiency and reducing side effects. METHODS AND MAJOR RESULTS: Herein, protein cages conceived as enzymatic nanoreactors were designed and produced by using virus-like nanoparticles (VLPs) from Brome mosaic virus (BMV) and containing the catalytic activity of glucose oxidase (GOx) enzyme. The GOx enzyme was encapsulated into the BMV capsid (VLP-GOx), and the resulting enzymatic nanoreactors were coated with human serum albumin (VLP-GOx@HSA) for breast tumor cell targeting. The effect of the synthesized GOx nanoreactors on breast tumor cell lines was studied in vitro. Both nanoreactor preparations VLP-GOx and VLP-GOx@HSA showed to be highly cytotoxic for breast tumor cell cultures. Cytotoxicity for human embryonic kidney cells was also found. The monitoring of nanoreactor treatment on triple-negative breast cancer cells showed an evident production of oxygen by the catalase antioxidant enzyme induced by the high production of hydrogen peroxide from GOx activity. CONCLUSIONS AND IMPLICATIONS: The nanoreactors containing GOx activity are entirely suitable for cytotoxicity generation in tumor cells. The HSA functionalization of the VLP-GOx nanoreactors, a strategy designed for selective cancer targeting, showed no improvement in the cytotoxic effect. The GOx containing enzymatic nanoreactors seems to be an interesting alternative to improve the current cancer therapy. In vivo studies are ongoing to reinforce the effectiveness of this treatment strategy.

Virus-like nanoparticles as enzyme carriers for Enzyme Replacement Therapy (ERT).

Enzyme replacement therapy (ERT) has been used to treat a few of the many existing diseases which are originated from the lack of, or low enzymatic activity. Exogenous enzymes are administered to contend with the enzymatic activity deficiency. Enzymatic nanoreactors based on the enzyme encapsulation inside of virus-like particles (VLPs) appear as an interesting alternative for ERT. VLPs are excellent delivery vehicles for therapeutic enzymes as they are biodegradable, uniformly organized, and porous nanostructures that transport and could protect the biocatalyst from the external environment without much affecting the bioactivity. Consequently, significant efforts have been made in the production processes of virus-based enzymatic nanoreactors and their functionalization, which are critically reviewed. The use of virus-based enzymatic nanoreactors for the treatment of lysosomal storage diseases such as Gaucher, Fabry, and Pompe diseases, as well as potential therapies for galactosemia, and Hurler and Hunter syndromes are discussed.

[Pregnancy and acute pulmonary embolism: a case report]. / Tromboembolismo pulmonar agudo na gravidez. A propósito de um caso clínico.

We describe the case of a 37-year-old pregnant woman who presented at 29 weeks of gestation with syncope and shortness of breath caused by pulmonary embolism. Due to persistent hypotension thrombolytic therapy with tenecteplase was administered and the clinical and hemodynamic response was excellent, with no maternal or fetal hemorrhagic complications. The clinical presentation of pulmonary embolism is sometimes camouflaged by the physiological changes that occur in pregnancy and diagnosis is often delayed by reluctance to expose the fetus to ionizing radiation. Systemic thrombolysis is considered a high-risk treatment in pregnancy and very few women have received it. However the complication rates of thrombolytic therapy are acceptable in the light of the underlying disease.

On the cognitive mechanisms supporting prosocial disobedience in a post-genocidal context.

The aim of the present study was to offer a first investigation of the neuro-cognitive processes and the temporal dynamics at the neural level, together with cultural, social and psychological dimensions, that may support resistance to orders to harm another person. Using a novel experimental approach to study experimentally disobedience, we recruited individuals from the first generation born after the 1994 genocide in Rwanda. Seventy-two were recruited and tested in Rwanda and 72 were recruited and tested in Belgium. Results indicated that a higher neural response to the pain of others and a higher feeling of responsibility when people obeyed orders were associated with more resistance to immoral orders. We also observed that participants who had a higher processing, as measured through mid-frontal theta activity, when listening to the orders of the experimenter disobeyed less frequently to immoral orders. Further, participants experiencing a higher conflict before administering a shock to the 'victim' also disobeyed more frequently to immoral orders. Finally, a low cultural relationship to authority and a high estimated family suffering during the genocide were also associated with more disobedience to immoral orders. The present study opens new paths for interdisciplinary field research dedicated to the study of obedience.

Longitudinal left ventricular strain in hypertrophic cardiomyopathy: correlation with nonsustained ventricular tachycardia.

AIMS: Stratifying risk of sudden death is a major issue in the management of hypertrophic cardiomyopathy (HCM). Existing risk factors have low positive predictive value and new parameters are needed. Determination of myocardial deformation (strain) by 2D Speckle tracking is a new methodology for determining LV regional function and could correlate with myocite disarray and fibrosis. The aim of this study was to assess the relationship between strain analysis and nonsustained ventricular tachycardia (NSVT) in patients with HCM. METHODS: Thirty-two consecutive patients with HCM (mean age 55, 17-78) were studied. All underwent standard echocardiographic and two-dimensional strain examination. Twenty-four-hour Holter monitoring was performed and echocardiographic parameters were correlated with NSVT. RESULTS: Nine patients (28%) had one or more episodes of NSVT. Patients with NSVT had a higher value of maximal LV thickness (23.6 mm vs. 19.4 mm, P = 0.027). There were no significant associations between NSVT on Holter monitoring and LV outflow gradient left atrial diameter, E/Em or left ventricle ejection fraction. Patients with HCM and NSVT had significant reductions in mid septal, apical-septal, apical-lateral strain, and in mean longitudinal strain. Midseptal strain >-10.5% had a sensitivity of 89% and a specificity of 74% (area under the curve, 0.787; P < 0.0013) for predicting NSVT independently of age or maximum wall thickness. CONCLUSION: Lower end-systolic peak longitudinal strain obtained by 2D speckle tracking was a predictor of NSVT in HCM patients. This parameter could become a useful tool in stratifying SCD risk in this population.

Noncompaction of the ventricular myocardium: characterization and follow-up of an affected population.

Noncompaction of the ventricular myocardium (NVM) is a rare congenital disease caused by an arrest in normal myocardial embryogenesis, leading to persistence of numerous prominent trabeculations which communicate with the left ventricle. It was first described as a congenital condition affecting children, but several cases have been reported of late presentation, and recent studies suggest it may be underdiagnosed. The main clinical manifestations are congestive heart failure, arrhythmias (supraventricular or ventricular) and systemic embolism. We describe a series of twenty patients, focusing on clinical history, echocardiography and follow-up.

[Severe left ventricular outflow tract obstruction as a complication of mitral valve repair: case report]. / Obstrução grave do tracto de saída do ventrículo esquerdo como complicação de valvuloplastia mitral: a propósito de um caso clínico.

Systolic anterior motion (SAM) is a postoperative complication of mitral valve repair, with an incidence of 5 to 10%. Early recognition of the signs and symptoms of SAM is essential for the management of these patients. This article focuses on the pathophysiology and dynamics of SAM and the treatment strategies described in the literature. The authors present a case study and echocardiographic images illustrating the clinical relevance of the mechanism involved, in order to clarify whether surgical reintervention is necessary.

The threshold of human endurance: 60 years of a congenital heart defect.

Long term survival in patients with partial atrioventricular septal defect (PAVSD) without adequate surgical management is very rare. The authors present the case of a 60 year-old woman who was referred to our hospital with dyspnea and worsening of general condition. A heart defect was diagnosed at the age of 25 years, but at the time the patient declined surgery. The patient underwent echocardiographic and haemodynamic evaluation prior to corrective surgery. The present report highlights the complications of chronic volume overload due to a congenital cardiac defect characterized by left--to-right shunts and atrio-ventricular valvular regurgitation with its haemodynamic implications. Despite the haemodynamic burden, the patient underwent successful corrective surgery, demonstrating the resilience of human endurance facing various comorbidities.

Virus-Based Nanoreactors with GALT Activity for Classic Galactosemia Therapy.

Enzymatic nanoreactors were obtained by galactose-1-phosphate uridylyl-transferase (GALT) encapsulation into plant virus capsids by a molecular self-assembly strategy. The aim of this work was to produce virus-like nanoparticles containing GALT for an enzyme-replacement therapy for classic galactosemia. The encapsulation efficiency and the catalytic constants of bio-nanoreactors were determined by using different GALT and virus coat protein ratios. The substrate affinity of nanoreactors was slightly lower than that of the free enzyme; the activity rate was 16 % of the GALT free enzyme. The enzymatic nanoreactors without functionalization were internalized into different cell lines including fibroblast and kidney cells, but especially into hepatocytes. The enzymatic nanoreactors are an innovative enzyme preparation with potential use for the treatment of classic galactosemia.

The effect of military training on the sense of agency and outcome processing.

Armed forces often rely on strict hierarchical organization, where people are required to follow orders. In two cross-sectional studies, we investigate whether or not working in a military context influences the sense of agency and outcome processing, and how different durations (junior cadets vs senior cadets) and types (cadets vs privates) of military experience may modulate these effects. Participants could administer painful electrical shocks to a 'victim' in exchange for money, either by their own free choice, or following orders of the experimenter. Results indicate that working in a strictly hierarchical structure may have a generalized negative impact on one's own sense of agency and outcome processing by reducing it, even when participants could freely decide their action. However, trained officers showed an enhanced sense of agency and outcome processing. This study offers insights on the potential for training the sense of agency and outcome processing.

Ascending thoracic aorta aneurysm surgery and aortic valve repair during pregnancy.

Open-heart surgery during pregnancy is challenging because it requires attention to both mother and fetus. A 31-year-old pregnant woman underwent surgery for a large ascending aorta aneurysm threatening rupture in the 12th week and then went on to a cesarean section at 38 weeks, which produced a healthy baby.

A portuguese family with Brugada syndrome.

The authors present a family with Brugada syndrome, the largest ever described in Portugal. From a fortuitous electrocardiographic finding in a previously symptomatic young man with a family history of sudden death, 126 possibly affected family members were studied. This article describes the diagnostic approach, risk stratification for sudden death and therapeutic interventions offered to this family, and presents a brief review of Brugada syndrome.

Left ventricular noncompaction: diagnosis by three-dimensional echocardiography.

Left ventricular noncompaction (LVNC) is a rare congenital disease caused by an arrest in normal myocardial embryogenesis, leading to persistence of numerous prominent trabeculations that communicate with the left ventricle. It was first described as a congenital condition affecting children, but several cases have been reported of late presentation. The main clinical manifestations are congestive heart failure, arrhythmias (supraventricular or ventricular) and systemic embolism. We present the case of a 51-year-old patient brought to our emergency department after an episode of symptomatic ventricular flutter requiring electrical cardioversion. Two-dimensional echocardiography with color Doppler suggested the diagnosis and the three-dimensional echocardiogram revealed the deep trabeculations typical of LVNC.

Cardiac sarcoidosis: a case report.

Cardiac involvement is found in approximately 5% of patients with sarcoidosis. The course of the disease is variable, ranging from benign arrhythmias to high-degree heart block or sudden death, and diagnosis is difficult. Endomyocardial biopsy can confirm the diagnosis but the diagnostic yield of the procedure is low because of the uneven distribution of the granulomatous process. Cardiac sarcoidosis should be presumed in patients with known sarcoidosis who develop arrhythmias, conduction disease, heart failure or ECG abnormalities. The authors present a case report and brief review of cardiac sarcoidosis.

Acute myocardial infarction with angiographically normal coronary arteries.

The authors present the case of a 51-year-old woman, with no known cardiovascular risk factors, admitted with anterior acute myocardial infarction complicated by primary ventricular fibrillation, who underwent reperfusion therapy with tenecteplase. Left heart catheterization on the sixth day showed left ventricular anteroapical akinesia and normal coronary arteries. The causes of acute myocardial infarction with normal coronary arteries and its differential diagnosis are discussed.

Brucella endocarditis--case report and literature review.

Endocarditis is a rare and serious complication of brucellosis and is the main cause of death in this pathology. Diagnosis requires a high level of suspicion and is based on the association of epidemiological, clinical and serological elements. Echocardiography plays a crucial role in early diagnosis, as well as in identifying predisposing heart disease and local complications typical of this pathology. Treatment is not consensual; most authors recommend an early surgical approach, due to the degree of tissue destruction caused by Brucella and the high rate of recurrence. Nevertheless, other authors stress the need for prognostic stratification of each case and support conservative treatment in low-risk cases. This article describes the case of a patient with brucella endocarditis that was treated medically and reviews the relevant literature.

The Influence of (Dis)belief in Free Will on Immoral Behavior.

One of the hallmarks of human existence is that we all hold beliefs that determine how we act. Amongst such beliefs, the idea that we are endowed with free will appears to be linked to prosocial behaviors, probably by enhancing the feeling of responsibility of individuals over their own actions. However, such effects appear to be more complex that one might have initially thought. Here, we aimed at exploring how induced disbeliefs in free will impact the sense of agency over the consequences of one's own actions in a paradigm that engages morality. To do so, we asked participants to choose to inflict or to refrain from inflicting an electric choc to another participant in exchange of a small financial benefit. Our results show that participants who were primed with a text defending neural determinism - the idea that humans are a mere bunch of neurons guided by their biology - administered fewer shocks and were less vindictive toward the other participant. Importantly, this finding only held for female participants. These results show the complex interaction between gender, (dis)beliefs in free will and moral behavior.

Streptococcus agalactiae Native Valve Endocarditis: Uncommon Presentation of Multiple Myeloma.

Adults with chronic immunosuppressive conditions are at an increased risk for Streptococcus agalactiae endocarditis, which is typically characterized by acute onset, presence of large vegetations, rapid valvular destruction and frequent complications. We report a rare case of a 74 years old man presenting with fever, renal infarction, ischemic stroke and uveitis. Infective endocarditis was diagnosed and Streptococcus agalactiae was isolated in blood cultures. A multiple myeloma Ig G-K was also diagnosed. The infective endocarditis was successfully treated with a course of benzylpenicillin and gentamicin. The authors highlight the severity of vascular embolic disease present in this case and the diagnostic challenge. They also intend to remind about the association between Streptococcus agalactiae endocarditis and chronic diseases, despite its low reported prevalence.

Adultos com doenças imunossupressoras crónicas apresentam risco aumentado de endocardite a Streptococcus agalactiae, caracterizada por clínica de início súbito, vegetações de grandes dimensões, destruição valvular rápida e complicações frequentes. Relatamos o caso de um doente de 74 anos de idade, admitido por quadro febril associado a enfarte renal, acidente vascular cerebral e uveíte, com o diagnóstico subsequente de endocardite infeciosa, tendo-se objetivado bacteriemia a Streptococcus agalactiae. Simultaneamente foi diagnosticado mieloma múltiplo Ig G-K. A endocardite infeciosa foi tratada com sucesso recorrendo a antibioterapia com benzilpenicilina e gentamicina. Os autores destacam a gravidade da doença embólica vascular presente neste caso e o desafio diagnóstico. Pretendem ainda relembrar a associação entre endocardite a Streptococcus agalactiae e as doenças crónicas, apesar da sua baixa prevalência.