The impact of torture on interpersonal threat and reward neurocircuitry.

OBJECTIVE: Torture adversely influences emotional functioning, but the neurophysiological mechanisms underpinning its impact are unknown. This study examined how torture exposure affects the neural substrates of interpersonal threat and reward processing. METHODS: Male refugees with (N = 31) and without (N = 27) torture exposure completed a clinical interview and functional magnetic resonance imaging scan where they viewed fear, happy and neutral faces. Between-group activations and neural coupling were examined as moderated by posttraumatic stress disorder symptom severity and cumulative trauma load. RESULTS: Posttraumatic stress disorder symptom severity and trauma load significantly moderated group differences in brain activation and connectivity patterns. Torture survivors deactivated the ventral striatum during happy processing compared to non-torture survivor controls as a function of increased posttraumatic stress disorder symptom severity - particularly avoidance symptoms. The ventral striatum was more strongly coupled with the inferior frontal gyrus in torture survivors. Torture survivors also showed left hippocampal deactivation to both fear and happy faces, moderated by trauma load, compared to controls. Stronger coupling between the hippocampus and frontal, temporoparietal and subcortical regions during fear processing was observed, with pathways being predicted by avoidance and hyperarousal symptoms. CONCLUSION: Torture exposure was associated with distinct brain activity and connectivity patterns during threat and reward processing, dependent on trauma exposure and posttraumatic stress disorder symptom severity. Torture appears to affect emotional brain functioning, and findings have the potential to guide more targeted interventions for torture survivors.

Complex Posttraumatic Stress Disorder Symptom Profiles in Traumatized Refugees.

Although it is well documented that exposure to severe, cumulative trauma and postdisplacement stress increases the risk for posttraumatic stress symptom disorder (PTSD), less is known about the representation and predictors of complex PTSD (CPTSD) symptoms in refugee populations. We examined PTSD and CPTSD symptom profiles (co-occurring PTSD and disturbances in self-organization [DSO] symptoms) and their premigration, postmigration, and demographic predictors, using latent class analysis (LCA), in a cohort of 112 refugees resettled in Australia. The LCA identified a four-factor model as the best fit to the data, comprising classes categorized as: (a) CPTSD, exhibiting high levels of PTSD and DSO symptoms (29.5%); (b) PTSD only (23.5%); (c) high affective dysregulation (AD) symptoms (31.9%); and (d) low PTSD and DSO symptoms (15.1%). Membership in the CPTSD and PTSD classes was specifically associated with cumulative traumatization, CPTSD OR = 1.56, 95% CI [1.15, 2.12], and PTSD OR = 1.64, 95% CI [1.15, 2.34]; and female gender, CPTSD OR = 14.18, 95% CI [1.66, 121.29], and PTSD OR = 16.84, 95% CI [1.78, 159.2], relative to the low-symptom class. Moreover, CPTSD and AD class membership was significantly predicted by insecure visa status, CPTSD OR = 7.53, 95% CI [1.26, 45.08], and AD OR = 7.19, 95% CI [1.23, 42.05]. These findings are consistent with the ICD-11 model of CPTSD and highlight the contributions of cumulative trauma to CPTSD and PTSD profiles as well as of contextual stress from visa uncertainty to DSO symptom profiles in refugee cohorts, particularly those characterized by AD.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Perfiles de Síntomas de Trastorno de Estrés Postraumático Complejo en Refugiados Traumatizados PERFILES DE SÍNTOMAS DE TEPT COMPLEJO EN REFUGIADOS TRAUTATIZADOS Aunque está bien documentado que la exposición a trauma severo y acumulativo y el estrés posterior al desplazamiento en poblaciones de refugiados aumenta el riesgo de trastorno por síntomas de estrés postraumático (TEPT), se conoce menos acerca de la representación y los predictores de síntomas del TEPT complejo (TEPT-C). Examinamos los perfiles de síntomas de TEPT y TEPT-C (TEPT concurrente y síntomas de alteraciones en la auto-organización [DSO en su sigla en inglés]) y su pre-migración, post-migración y predictores demográficos, utilizando el análisis de clases latentes (ACL), en una cohorte de 112 refugiados reasentados en Australia. El ACL identificó un modelo de cuatro factores como el que mejor se ajusta a los datos, que comprende clases clasificadas tales como: (a) TEPT-C, que exhiben altos niveles de síntomas de TEPT y DSO (29.5%); (b)TEPT (23.5%); (c) síntomas de alta desregulación afectiva (DA) (31,9%); y (d) síntomas bajos de TEPT y DSO (15,1%). La adscripción en las clases de TEPT-C y TEPT se asociaron específicamente con traumatización acumulativa, TEPT-C OR = 1.56, IC 95% [1.15, 2.12] y TEPT OR = 1.64, IC 95% [1.15, 2.34]; y género femenino, TEPT-C OR = 14.18, IC 95% [1.66, 121.29], y TEPT OR = 16.84, IC 95% [1.78, 159.2], en relación con la clase de síntomas bajos. Además, la adscripción a la clase TEPT-C y AD se predijo significativamente por la inseguridad en el estado de su visa, TEPT-C OR = 7.53, IC 95% [1.26, 45.08], y AD OR = 7.19, IC 95% [1.23, 42.05]. Estos hallazgos son consistentes con el modelo CIE-11 de TEPT-C y destacan las contribuciones del trauma acumulativo a los perfiles de TEPT-C y TEPT, así como del estrés contextual desde la incertidumbre del estado de las visas hasta los perfiles de síntomas de DSO en cohortes de refugiados, particularmente en aquellos caracterizados por DA.

The Application of Contrast Media for In Vivo Feature Enhancement in X-Ray Computed Tomography of Soil-Grown Plant Roots.

The use of in vivo X-ray microcomputed tomography (µCT) to study plant root systems has become routine, but is often hampered by poor contrast between roots, soil, soil water, and soil organic matter. In clinical radiology, imaging of poorly contrasting regions is frequently aided by the use of radio-opaque contrast media. In this study, we present evidence for the utility of iodinated contrast media (ICM) in the study of plant root systems using µCT. Different dilutions of an ionic and nonionic ICM (Gastrografin 370 and Niopam 300) were perfused into the aerial vasculature of juvenile pea plants via a leaf flap (Pisum sativum). The root systems were imaged via µCT, and a variety of image-processing approaches used to quantify and compare the magnitude of the contrast enhancement between different regions. Though the treatment did not appear to significantly aid extraction of full root system architectures from the surrounding soil, it did allow the xylem and phloem units of seminal roots and the vascular morphology within rhizobial nodules to be clearly visualized. The nonionic, low-osmolality contrast agent Niopam appeared to be well tolerated by the plant, whereas Gastrografin showed evidence of toxicity. In summary, the use of iodine-based contrast media allows usually poorly contrasting root structures to be visualized nondestructively using X-ray µCT. In particular, the vascular structures of roots and rhizobial nodules can be clearly visualized in situ.

FKBP5 risk alleles and the development of intrusive memories.

Intrusive memories are unwanted recollections that maintain distress and are central to numerous psychological disorders, including posttraumatic stress disorder (PTSD). Convergent evidence suggests that glucocorticoid increases enhance the strength of emotional memories. The FKBP5 polymorphism modulates glucocorticoid receptor sensitivity, and has been shown to increase risk for PTSD. Healthy high and low risk FKBP5 allele carriers (N=46) underwent a cold pressor task, and then viewed negative and neutral images. Two days later participants were given a surprise recall test and measure of intrusive memories of the images. Following the cold pressor task, high-risk allele participants had a higher cortisol response than low-risk participants. High-risk carriers also reported more intrusive memories of the negative and neutral images than low-risk carriers. These findings point to the minor alleles of the FKBP5 polymorphism being a risk factor for development of intrusive memories, possibly as a result of impaired glucocorticoid receptor sensitivity. This may explain one mechanism for FKBP5 being a risk factor for PTSD following traumatic events.

The role of stress during memory reactivation on intrusive memories.

Intrusive memories are unwanted recollections that maintain distress in psychological disorders. Increasing evidence suggests that memories that are reactivated through retrieval become temporarily vulnerable to environmental or pharmacological manipulation, including changes in levels of circulating stress hormones. This study investigated the influence of stress during memory reactivation of an emotionally arousing trauma film on subsequent intrusive memories. Three groups of participants (N=63) viewed a trauma film depicting a serious car accident at baseline. Two days later (Time 2), one group received a reactivation induction following a socially evaluated cold pressor test (SECPT; Stress/Reactivation condition), whilst the second group reactivated the memory after a control procedure (Reactivation condition). A third group underwent the SECPT but was not asked to reactivate memory of the trauma film (Stress condition). Two days later (Time 3), all participants received a surprise cued memory recall test and intrusions questionnaire which they completed online. Results showed that those in the Stress/Reactivation group had higher intrusions scores than the other two groups, suggesting that acute stress promotes intrusive memories only when the memory trace is reactivated shortly afterwards. Increased cortisol predicted enhanced intrusive experiences in the Stress/Reactivation condition but not in the other conditions. This pattern of results suggests that acute stress during the reactivation of emotional material impacts on involuntary emotional memories. These findings suggest a possible explanation for the mechanism underlying the maintenance of intrusive memories in clinical disorders.

Role of contextualizing a crisis scenario on the performance of a cricothyrotomy procedural task.

PURPOSE: Simulation is an important alternative to evaluate cricothyrotomy, a rare life-saving procedure. This crossover study aimed to determine whether contextualization of a crisis scenario would impact the performance of a cricothyrotomy procedural task. METHODS: Sixty-five anesthesia assistants and emergency medicine and anesthesia residents underwent a teaching session in surgical cricothyrotomy using one of two sets of cricothyrotomy kits: the Portex 6.0 and Melker 3.5 (n = 32) or the Portex 6.0 and Melker 5.0 (n = 33). Within six weeks following the session, the participants performed cricothyrotomies on a full-body patient mannequin simulator coupled with a porcine larynx (tissue-mannequin simulator) using the assigned two kits in a "cannot intubate, cannot ventilate" (CICV) contextualized scenario (CS) and in a CICV verbalized non-contextualized scenario (NCS). Each participant performed a total of four cricothyrotomies using the two kits in the two scenarios. The primary outcome measure was insertion time, and secondary outcome measures were severity of injuries and failure rate. Outcome measures were compared between scenarios for each kit. RESULTS: Mean (SD) insertion time for a successful cricothyrotomy was not significantly different between NCS and CS for the Melker 3.5 [83.0 (45.0) sec vs 63.3 (36.1) sec, respectively; P = 0.96; mean difference (MD), 19.7 sec; 95% confidence interval (CI), -1.9 to 41.3], the Melker 5.0 [86.5 (36.8) sec vs 107.1 (55.6) sec, respectively; P = 0.11; MD, -20.6 sec; 95% CI, -44.9 to 3.7], and the Portex 6.0 [59.5 (35.5) sec vs 59.0 (35.0) sec, respectively; P = 0.95; MD, 0.5 sec; 95% CI, -13.2 to 14.2]. Failure rate and severity of injuries, measured as mean average injury score for each kit, were also similar between scenarios. CONCLUSIONS: Contextualization of a crisis scenario did not affect the performance of a cricothyrotomy procedural task on a tissue-mannequin simulator. These findings may have implications when considering the feasibility and cost-effectiveness for assessing the performance of cricothyrotomy procedural tasks.

Cognitive deficits and delayed neuronal loss in a mouse model of multiple microinfarcts.

Microinfarcts are a common clinical feature of the aging brain, particularly in patients with cognitive decline or vascular or Alzheimer's dementia. However, the natural history of these lesions remains largely unexplored. Here we describe a mouse (C57BL/6J) model of multiple diffuse microinfarcts induced by unilateral internal carotid artery injection of cholesterol crystals (40-70 µm). Microinfarcts were spread throughout the deep cortex, subcortical tissue, and hippocampus and were comprised of a core positive for CD68 (a marker for reactive microglia and macrophages), surrounded by large regions of glial fibrillary acidic protein-positive reactive astrogliosis. Widespread reactive gliosis, including mislocalization of the astrocytic water channel aquaporin 4 persisted long after injury, recovering only after 1 month after stroke. Within the cortex, neuronal cell death progressed gradually over the first month, from ∼35% at 3 d to 60% at 28 d after stroke. Delayed demyelination was also observed in lesions, beginning 28 d after stroke. These findings demonstrate that microinfarct development follows a distinct course compared to larger regional infarcts such as those induced by middle cerebral artery occlusion. The long-lasting gliosis, delayed neuronal loss, and demyelination suggest that the therapeutic window for microinfarcts may be much wider (perhaps days to weeks) than for larger strokes.

The role of estrogen in intrusive memories.

Intrusive memories are highly vivid, emotional and involuntary recollections which cause significant distress across psychological disorders including posttraumatic disorder (PTSD). Recent evidence has potentially extended our understanding of the development of intrusive memories by identifying biological factors which significantly impact on memories for emotionally arousing stimuli. This study investigated the role of stress on the development of intrusions for negative and neutral images, and indexed the potential contributions of sex (estrogen and progesterone) and stress (noradrenaline and cortisol) hormones. Whilst viewing the images, half the participants underwent a cold pressor stress (CPS) procedure to induce stress while the control participants immersed their hands in warm water. Saliva samples were collected to index estrogen, progesterone and noradrenergic and cortisol response. Participants (55 university students, 26 men, 29 women) viewed a series of negatively arousing and neutral images. Participants completed recall and intrusions measures 2 days later. Negative images resulted in greater recall and more intrusions than neutral images. In the cold water condition females recalled fewer neutral memories than males. Cortisol increase predicted decreased recall of negative memories in males, and estrogen predicted increased intrusions of negative images in women. These findings are consistent with evidence that circulating levels of ovarian hormones influence memory for emotionally arousing events, and provides the first evidence of the influence of sex hormones on intrusive memories. These results provide one possible explanation for the higher incidence of anxiety disorders in women.

Opponent intrinsic brain network connectivity profiles associated with posttraumatic fear and dysphoria symptoms in trauma-exposed refugees.

OBJECTIVE: Resting-state functional magnetic resonance imaging (rsfMRI) studies report functional alterations in the connectivity between intrinsic brain networks in posttraumatic stress disorder (PTSD), but PTSD heterogeneity is rarely considered. Evidence points to fear (e.g., reexperiencing) and dysphoria (e.g., withdrawal) symptom factors as important in PTSD presentations, including relating to variable emotion dysregulation patterns. This study, therefore, tested how fear and dysphoria posttraumatic symptoms were differentially associated with core network connectivity and emotion dysregulation behaviors in a large group of trauma-exposed refugees. METHOD: A final sample of 77 trauma-exposed participants completed a rsfMRI scan. Independent component analysis identified active networks and functional network connectivity (FNC) between networks was assessed. Fear and dysphoria posttraumatic symptoms were partially correlated with FNCs, and linear regression models examined relationships with self-reported difficulties in emotion regulation. RESULTS: Twenty-three active networks were identified, eight being in the networks of interest (p < .05 false discovery rate-corrected). Fear and dysphoria symptoms were specifically related to connectivity patterns between two subnetworks of the default mode network (DMN). Fear symptoms were negatively associated with anterior dorsomedial DMN (admDMN) and temporoparietal DMN (tpDMN) connectivity; whereas dysphoria symptoms were positively associated with admDMN-tpDMN connectivity. Additionally, admDMN-tpDMN connectivity was positively predicted by goal-directed emotion dysregulation but negatively predicted by poor emotional clarity. CONCLUSIONS: Fear and dysphoria posttraumatic symptoms showed opponent associations with admDMN and tpDMN connectivity, potentially reflecting patterns of under- and overemotion dysregulation associated with these symptom profiles respectively. Findings highlight the importance of considering posttraumatic heterogeneity when constructing neural models of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Refugee visa insecurity disrupts the brain's default mode network.

BACKGROUND: Research has largely focused on the psychological consequences of refugee trauma exposure, but refugees living with visa insecurity face an uncertain future that also adversely affects psychological functioning and self-determination. OBJECTIVE: This study aimed to examine how refugee visa insecurity affects the functional brain. METHOD: We measured resting state brain activity via fMRI in 47 refugees with insecure visas (i.e. temporary visa status) and 52 refugees with secure visas (i.e. permanent visa status) residing in Australia, matched on key demographic, trauma exposure and psychopathology. Data analysis comprised independent components analysis to identify active networks and dynamic functional causal modelling tested visa security group differences in network connectivity. RESULTS: We found that visa insecurity specifically affected sub-systems within the default mode network (DMN) - an intrinsic network subserving self-referential processes and mental simulations about the future. The insecure visa group showed less spectral power in the low frequency band in the anterior ventromedial DMN, and reduced activity in the posterior frontal DMN, compared to the secure visa group. Using functional dynamic causal modelling, we observed positive coupling between the anterior and posterior midline DMN hubs in the secure visa group, while the insecure visa group displayed negative coupling that correlated with self-reported fear of future deportation. CONCLUSIONS: Living with visa-related uncertainty appears to undermine synchrony between anterior-posterior midline components of the DMN responsible for governing the construction of the self and making mental representations of the future. This could represent a neural signature of refugee visa insecurity, which is marked by a perception of living in limbo and a truncated sense of the future.

Refugee visa insecurity disrupts default mode network (DMN) connectivity ­ a core network that supports the internal construction of the self.Refugees living with insecure visa status showed decreased connectivity in the DMN and more negative coupling between midline anterior­posterior hubs of the DMN, compared to refugees living with secure visas.Diminished DMN connectivity may represent a neural basis for the psychological effects of refugee visa insecurity, which is associated with prolonged uncertainty regarding the future self and increased risk for psychological distress.

The chances of obtaining a euploid embryo and subsequent live birth remain consistent with national age-based rates after an in vitro fertilization cycle that produced only aneuploid embryos.

OBJECTIVE: To determine the prognosis of patients who were only able to obtain aneuploid embryos in their first in vitro fertilization (IVF) cycle if they attempted a second cycle. DESIGN: Case series and retrospective cohort study. SETTING: A single, large fertility center. PATIENT(S): All patients who obtained only aneuploid embryos after IVF with preimplantation genetic testing for aneuploidy during the initial cycle and returned for a second cycle. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The percentage of patients who obtained a euploid embryo and live birth rates in the second cycle, stratified by Society for Assisted Reproductive Technology-defined age groups, was compared with that of controls from the same period. RESULT(S): A total of 538 patients with only aneuploid embryos in their first cycle were included. Three hundred (56%) patients obtained euploid blastocysts in the second cycle, with younger women having a higher chance of obtaining at least 1 euploid embryo (81% in women aged <35 years vs. 25% in women aged >42 years). The cumulative live birth rates were 71%, 62%, 46%, 27%, and 13% for the age groups <35, 35-37, 38-40, 41-42, and >42 years, respectively. The live birth rates per first embryo transfer were >57% across all the age groups and similar to those of the controls in the same age groups. CONCLUSION(S): Patients who obtained only aneuploid embryos during their initial IVF cycle retained favorable prognosis in their second cycle, with outcomes comparable with the national age-based standards. Younger women and those who had more embryos available for biopsy had the highest chance of success. These women should receive age-appropriate counseling and should not be discouraged from a second IVF attempt based on the results of their first cycle.

Torture exposure and the functional brain: investigating disruptions to intrinsic network connectivity using resting state fMRI.

Torture has profound psychological and physiological consequences for survivors. While some brain structures and functions appear altered in torture survivors, it is unclear how torture exposure influences functional connectivity within and between core intrinsic brain networks. In this study, 37 torture survivors (TS) and 62 non-torture survivors (NTS) participated in a resting-state fMRI scan. Data-driven independent components analysis identified active intrinsic networks. Group differences in functional connectivity in the default mode network (DMN), salience network (SN) and central executive network (CEN) of the triple network model, as well any prefrontal network, were examined while controlling for PTSD symptoms and exposure to other potentially traumatic events. The analysis identified 25 networks; eight comprised our networks of interest. Within-network group differences were observed in the left CEN (lCEN), where the TS group showed less spectral power in the low-frequency band. Differential internetwork dynamic connectivity patterns were observed, where the TS group showed stronger positive coupling between the lCEN and anterior dorsomedial and ventromedial DMN, and stronger negative coupling between a lateral frontal network and the lCEN and anterior dorsomedial DMN (when contrasted with the NTS group). Group differences were not attributed to torture severity or dissociative symptoms. Torture survivors showed disrupted dynamic functional connectivity between a laterally-aligned lCEN that serves top-down control functions over external processes and the midline DMN that underpins internal self-referential processes, which may be an adaptive response to mitigate the worst effects of the torture experience. This study provides a critical step in mapping the neural signature of torture exposure to guide treatment development and selection.

Low optical power reference detector implemented in the validation of two independent techniques for calibrating photon-counting detectors.

We introduce a technique for measuring detection efficiency that is traceable to the primary standard, the cryogenic radiometer, through a reference silicon photodiode trap detector. The trap detector, used in conjunction with a switched integrator amplifier, can measure signals down to the 0.1 pW (3 x 105 photons second-1) level with 0.1% uncertainty in a total integration time of 300 seconds. This provides a convenient calibration standard for measurements at these levels across the optical spectrum (UV - near IR). A second technique is also described, based on correlated photons produced via parametric down-conversion. This can be used to directly measure detection efficiency in the photon counting regime, and provides a route for expanding the formulation of the candela in terms of photon flux to enable it to address the needs of emerging quantum optical technologies and applications. The two independent techniques were cross-validated by a comparison carried out at 702.2 nm, which showed agreement to within 0.2%.

Measurement of photon indistinguishability to a quantifiable uncertainty using a Hong-Ou-Mandel interferometer.

We present a method for using the Hong-Ou-Mandel (HOM) interference technique to quantify photon indistinguishability within an associated uncertainty. The method allows the relative importance of various experimental factors affecting the HOM visibility to be identified, and enables the actual indistinguishability, with an associated uncertainty, to be estimated from experimentally measured quantities. A measurement equation has been derived that accounts for the non-ideal performance of the interferometer. The origin of each term of the equation is explained, along with procedures for their experimental evaluation and uncertainty estimation. These uncertainties are combined to give an overall uncertainty for the derived photon indistinguishability. The analysis was applied to measurements from an interferometer sourced with photon pairs from a parametric downconversion process. The measured photon indistinguishably was found to be 0.954+/-0.036 by using the prescribed method.

Endodermal Maternal Transcription Factors Establish Super-Enhancers during Zygotic Genome Activation.

Elucidation of the sequence of events underlying the dynamic interaction between transcription factors and chromatin states is essential. Maternal transcription factors function at the top of the regulatory hierarchy to specify the primary germ layers at the onset of zygotic genome activation (ZGA). We focus on the formation of endoderm progenitor cells and examine the interactions between maternal transcription factors and chromatin state changes underlying the cell specification process. Endoderm-specific factors Otx1 and Vegt together with Foxh1 orchestrate endoderm formation by coordinated binding to select regulatory regions. These interactions occur before the deposition of enhancer histone marks around the regulatory regions, and these TFs recruit RNA polymerase II, regulate enhancer activity, and establish super-enhancers associated with important endodermal genes. Therefore, maternal transcription factors Otx1, Vegt, and Foxh1 combinatorially regulate the activity of super-enhancers, which in turn activate key lineage-specifying genes during ZGA.

The impact of appraisals on intrusive memories.

BACKGROUND AND OBJECTIVES: Intrusive memories are a core feature of posttraumatic stress disorder (PTSD). Cognitive models posit that PTSD symptoms are stimulated by maladaptive appraisals about symptoms. This study aimed to test the causal pathway of maladaptive appraisals about the meaning of intrusions on subsequent intrusive memories. METHODS: Forty-five healthy participants were presented with a traumatic film, and were subsequently told either (a) intrusions are indicative of poor psychological functioning, (b) intrusions are not indicative of psychological functioning, or (c) no instructions. Participants subsequently completed a measure of cognitive performance to index potential interference by intrusions, as well as a scale of intrusive memories. RESULTS: Participants who were told that intrusions are indicative of negative psychological state subsequently reported more intrusive memories than those who were told that intrusions have no particular significance. LIMITATIONS: Inferences are reduced by lack of group differences in appraisals reported by participants. A stronger index of intrusions would have been achieved through diary keeping in the period after the experimental session. CONCLUSIONS: This finding provides initial causal evidence that appraising intrusions as maladaptive may directly enhance the occurrence of intrusions following encoding of an aversive event, and in this sense is supportive of cognitive models of PTSD.

Management of anticoagulation with rivaroxaban in trauma and acute care surgery: Complications and reversal strategies as compared to warfarin therapy.

BACKGROUND: Rivaroxaban has gained popularity as an anticoagulant (AC) for stroke prevention in nonvalvular atrial fibrillation (afib) and venous thromboembolism (VTE). Although adverse bleeding events are associated with all AC, lack of point-of-care testing to measure the effect of rivaroxaban in emergent situations has contributed to perceived increased risk among physicians. METHODS: This study aims to describe a single-center experience with trauma and emergency general surgery (EGS) patients taking rivaroxaban and evaluate outcomes compared with patients taking warfarin using a propensity score analysis. Trauma and EGS patients taking rivaroxaban or warfarin for afib/VTE over a 2-year period were eligible for inclusion and matched for injury/illness severity in a 1:2 ratio using propensity score matching. In a single quaternary referral center, 192 warfarin patients were matched to 96 rivaroxaban patients. Groups were well matched with no significant difference in age/sex, admission systolic blood pressure/heart rate, admission hemoglobin, injury severity score (trauma patients), or need for ICU admission. Conditional logistic regression determined association of AC type with bleeding complications, adjusting for age/sex, AC indication, coagulation laboratory values, antiplatelet medications or other AC, comorbidities, renal impairment, and operative intervention. Primary outcome was bleeding complications, defined as hemorrhage during admission or as a presenting problem. Secondary outcomes included invasive interventions, AC reversal, VTE complications, and mortality. RESULTS: There was no difference between rivaroxaban and warfarin for bleeding complications (37% vs. 39%, p = 0.49), VTE complications (4.2% vs. 5.7%, p = 0.44), or mortality (4.2% vs. 5.8%, p = 0.63). Fewer rivaroxaban patients underwent surgical or interventional radiology procedures during admission (32% vs. 43%, p = 0.01), but there was no difference in procedures specifically for bleeding (10% vs. 12% p = 0.68). Rivaroxaban patients less frequently underwent AC reversal (34% vs. 46%, p = 0.01) or received multiple reversal agents (20% vs. 29%, p = 0.02). Regression analysis confirmed AC type was not associated with bleeding complications (rivaroxaban vs. warfarin relative risk 1.02; 95% CI 0.85-1.22, p = 0.85). CONCLUSION: Reversal of rivaroxaban was less common and required fewer agents, whereas bleeding complications and hemostatic interventions do not seem to be different between these AC types. LEVEL OF EVIDENCE: Therapeutic study, level II.

Foxh1 Occupies cis-Regulatory Modules Prior to Dynamic Transcription Factor Interactions Controlling the Mesendoderm Gene Program.

The interplay between transcription factors and chromatin dictates gene regulatory network activity. Germ layer specification is tightly coupled with zygotic gene activation and, in most metazoans, is dependent upon maternal factors. We explore the dynamic genome-wide interactions of Foxh1, a maternal transcription factor that mediates Nodal/TGF-ß signaling, with cis-regulatory modules (CRMs) during mesendodermal specification. Foxh1 marks CRMs during cleavage stages and recruits the co-repressor Tle/Groucho in the early blastula. We highlight a population of CRMs that are continuously occupied by Foxh1 and show that they are marked by H3K4me1, Ep300, and Fox/Sox/Smad motifs, suggesting interplay between these factors in gene regulation. We also propose a molecular "hand-off" between maternal Foxh1 and zygotic Foxa at these CRMs to maintain enhancer activation. Our findings suggest that Foxh1 functions at the top of a hierarchy of interactions by marking developmental genes for activation, beginning with the onset of zygotic gene expression.

Emotional suppression in torture survivors: Relationship to posttraumatic stress symptoms and trauma-related negative affect.

While clinical reports suggest that torture survivors may try to suppress their emotions during torture, little is known about the use of emotional suppression following torture. In this study, 82 refugees and asylum-seekers (including 33 torture survivors) completed self-report measures of trait suppression, PTSD symptoms and baseline negative affect before being exposed to images depicting scenes of interpersonal trauma. The use of suppression while viewing the images was indexed and negative affect was measured both immediately after viewing the images and following a five minute rest period. Findings indicated that torture survivors did not show higher rates of trait suppression or state emotional suppression during the experimental session compared to non-torture survivors. However, torture survivors who endorsed state suppression higher levels of distress, and this relationship was especially strong for those with more severe PTSD symptoms. In contrast, there was a negative relationship between state suppression and distress for non-torture survivors with high levels of PTSD symptoms. These findings suggest that, while torture exposure does not lead to greater use of suppression, it does influence the impact of suppression on emotional responses to stimuli.