Auditory aversive generalization learning prompts threat-specific changes in alpha-band activity.

Pairing a neutral stimulus with aversive outcomes prompts neurophysiological and autonomic changes in response to the conditioned stimulus (CS+), compared to cues that signal safety (CS-). One of these changes-selective amplitude reduction of parietal alpha-band oscillations-has been reliably linked to processing of visual CS+. It is, however, unclear to what extent auditory conditioned cues prompt similar changes, how these changes evolve as learning progresses, and how alpha reduction in the auditory domain generalizes to similar stimuli. To address these questions, 55 participants listened to three sine wave tones, with either the highest or lowest pitch (CS+) being associated with a noxious white noise burst. A threat-specific (CS+) reduction in occipital-parietal alpha-band power was observed similar to changes expected for visual stimuli. No evidence for aversive generalization to the tone most similar to the CS+ was observed in terms of alpha-band power changes, aversiveness ratings, or pupil dilation. By-trial analyses found that selective alpha-band changes continued to increase as aversive conditioning continued, beyond when participants reported awareness of the contingencies. The results support a theoretical model in which selective alpha power represents a cross-modal index of continuous aversive learning, accompanied by sustained sensory discrimination of conditioned threat from safety cues.

Moving toward reality: Electrocortical reactivity to naturalistic multimodal emotional videos.

While previous research has investigated the effects of emotional videos on peripheral physiological measures and conscious experience, this study extends the research to include electrocortical measures, specifically the steady-state visual-evoked potential (ssVEP). A carefully curated set of 45 videos, designed to represent a wide range of emotional and neutral content, were presented with a flickering border. The videos featured a continuous single-shot perspective, natural soundtrack, and excluded elements associated with professional films, to enhance realism. The results demonstrate a consistent reduction in ssVEP amplitude during emotional videos which strongly correlates with the rated emotional intensity of the clips. This suggests that narrative audiovisual stimuli have the potential to track dynamic emotional processing in the cortex, providing new avenues for research in affective neuroscience. The findings highlight the potential of using realistic video stimuli to investigate how the human brain processes emotional events in a paradigm that increases ecological validity. Future studies can further develop this paradigm by expanding the video set, targeting specific cortical networks, and manipulating narrative predictability. Overall, this study establishes a foundation for investigating emotional perception using realistic video stimuli and has the potential to expand our understanding of real-world emotional processing in the human brain.

Emotional Perception: Divergence of Early and Late Event-related Potential Modulation.

The early posterior negativity (EPN) is a mid-latency ERP component that is reliably enhanced by emotional cues, with a deflection beginning between 150 and 200 msec after stimulus onset. The brief, bilateral occipital EPN is followed by the centroparietal late positive potential (LPP), a long duration slow-wave that is strongly associated with emotional arousal ratings of scenes. A recent study suggests that the EPN is particularly sensitive to human bodies in scenes, independent of emotional intensity. Here, we directly investigate the influence of human body features on EPN modulation, using emotional and neutral scenes depicting people across a range of body exposures and orientations, in addition to scenes of pleasant, neutral, and unpleasant animals. The results demonstrate that the EPN is quite sensitive to human body features and weakly related to arousal ratings, whereas the LPP is strongly modulated by scenes that receive high arousal ratings. Based on these results and relevant work on body-specific visual perception, we speculate that modulation of the EPN may strongly reflect the early detection of human bodies, which serves as a predictor of emotional significance, whereas LPP modulation is more closely associated with the extended elaborative processing of scenes that are explicitly judged to be emotionally arousing.

What is the role of the multidisciplinary team meeting in primary prolapse surgery and are alternative formats acceptable?

INTRODUCTION AND HYPOTHESIS: In 2019, the UK National Institute for Health and Care Excellence (NICE) recommended discussion of all primary prolapse cases at a multidisciplinary team (MDT) meeting prior to surgery. However, following the COVID-19 pandemic, face-to-face meetings were suspended. The aim of this study was to evaluate the role of MDT meetings in an observational retrospective review of primary prolapse cases and determine whether alternatives to face-to-face MDT meetings such as virtual and remote paper result in different outcomes. METHODS: A total of 100 consecutive patients with primary prolapse, who had already been through face-to-face MDT meetings in 2019, were subjected to remote paper (independent review by team members, who then submit a paper outcome to the MDT meeting chair) and a virtual MDT meeting by the same team (blinded). Outcomes included agree, minor amendment (changing the order of priority of the compartment, changing procedure from + to +/-), major amendment (adding/removing a compartment) and insufficient information. MDT outcomes were compared for remote paper, virtual, and face-to-face MDT options. RESULTS: In 88% of cases, face-to-face MDT meetings agreed to proceed unchanged (4% minor amendment, 7% major amendment, 1% insufficient information). This compared with 80% at virtual MDT (5% minor amendment, 11% major amendment, 4% insufficient information) and 74% when conducted by remote paper (5% minor amendment, 15% major amendment, 6% insufficient information). There was no significant difference in outcomes among the MDT meeting formats (Chi-squared 7.73, p=0.26). CONCLUSIONS: Multidisciplinary team discussion changes management in a minority of primary prolapse cases. Similar MDT decisions are produced by virtual and remote paper formats, although the latter had the lowest concordance of opinions.

Outcomes of law enforcement officer administered naloxone.

OBJECTIVE: Law enforcement officer (LEO) administered naloxone is an effective intervention for treating prehospital opioid overdoses. Our objective is to determine the rate and factors associated with adverse behavioral effects and efficacy following LEO naloxone administration. METHODS: This is a retrospective cohort study of patients treated with naloxone law enforcement over 5 years in one county EMS system. Law enforcement officers utilized intranasal 4 mg/0.1 mL for suspected opioid overdose. Data were acquired from forms completed by LEO following administration of naloxone. We performed descriptive statistics. Univariate regression analysis with a primary outcome of improved neurological status and a secondary outcome of patient irritability/combativeness post-naloxone. RESULTS: A total of 597 cases of LEO administered naloxone were reported. Naloxone was felt to be effective by the LEO in 370 (62%) of these cases with 6 (1%) exhibiting combativeness and 57 (10%) having the composite outcome of irritability or combativeness. The perceived rate of efficacy was higher when an opioid, rather than a non-opioid agent was suspected (239/346 [67%] vs. 83/165 [50%], OR 2.21, 95% CI 1.51-3.23), and for heroin and fentanyl specifically. Suspected fentanyl exposure was the only variable associated with our secondary outcome of irritability or combativeness (7/22 [32%] vs. 45/489 [9%], OR 4.60, 95% CI 1.78-11.8). CONCLUSIONS: LEO administered naloxone remains an effective intervention for overdose victims, with higher perceived efficacy when opioids are specifically implicated. Combativeness is rare following LEO naloxone administration. Further research is needed to understand a relationship between suspected fentanyl intoxication and post-naloxone behavioral disturbances.

Routine Laboratory Screening for Acetaminophen and Salicylate Ingestion in Preadmission Psychiatric Patients Is Unnecessary.

STUDY OBJECTIVE: Screening preadmission psychiatric patients for acetaminophen or salicylate overdose is unnecessary in the absence of specific clinical concern for medication ingestion. METHODS: This was a multicenter retrospective cohort study of 3 Veteran's Administration emergency departments that medically evaluate patients prior to psychiatric admission. During the 10-year study period, these departments followed screening protocols that required the measurement of acetaminophen and salicylate levels on every patient prior to psychiatric admission. We examined all the acetaminophen and salicylate assays performed to see if any that were sent for screening led to a diagnosis of overdose and/or the administration of antidotal therapy. RESULTS: A total of 33,439 combined acetaminophen and salicylate assays were sent on 10,482 unique patients over approximately 17,000 patient encounters. An estimated 29,000 assays were sent for screening purposes only-87% (95% confidence interval [CI] 85% to 89%) of salicylate assays and 85% (95% CI 83% to 87%) of acetaminophen assays. We identified 43 patients with elevated acetaminophen levels and 11 with elevated salicylate levels. Among these patients, only 6 in total had their levels drawn for screening purposes only, with no history of suspected ingestion; in all but 1 patient, the levels were only slightly above the reference range. None of the patients with elevated levels identified by screening had clinical toxicity or received antidotal therapy. CONCLUSION: Over a 10-year period, 3 Veteran's Administration emergency departments performed psychiatric preadmission screening protocols with acetaminophen and salicylate assays approximately 17,000 times without diagnosing a single case of toxicity. Our results suggest that this practice is unnecessary and wasteful.

Outcomes following Naloxone Administration by Bystanders and First Responders.

Background: Naloxone is widely available to bystanders and first responders to treat patients with suspected opioid overdose. In these patients, the prognostic factors and potential benefits associated with additional naloxone administered by emergency medical services (EMS) are uncertain. Objectives: We sought to identify prognostic factors for admission to the hospital following prehospital administration of naloxone for suspected opioid overdose by bystanders and first responders. We secondarily examined whether administration of additional naloxone by paramedics after initial treatment by non-EMS personnel was associated with improvement in level of consciousness prior to hospital arrival. Methods: This is a retrospective cross-sectional study of patients treated within a single urban EMS system from 2013 to 2016. Inclusion criteria were administration of naloxone by bystanders or first responders and transport to one of three academic medical centers. For the secondary analysis, only patients with a Glasgow Coma Scale (GCS) score ≤12 on paramedic arrival were included. We performed univariate and multivariable analyses examining a primary outcome of hospital admission and secondary outcome of improvement in consciousness as defined by GCS >12 in patients with initial GCS ≤12. Results: Of 359 patients identified for the primary analysis, 60 were admitted to the hospital. Factors associated with increased rate of admission included higher total naloxone dosage (OR 1.36, 95% CI 1.09-1.70) and presence of alternate/additional non-opioid central nervous system (CNS) depressants (OR 2.51, 95% CI 1.13-5.56). Among 178 patients who had poor neurologic status (GCS ≤12) on paramedic arrival following naloxone administered by bystander or first responder, administration of additional naloxone was not associated with a better rate of neurologic improvement prior to hospital arrival (77% improved with additional naloxone, 81% improved without additional naloxone; OR 0.82, 95% CI 0.39-1.76). Conclusions: Among patients with suspected opioid overdose treated with naloxone by bystanders and first responders, a higher total dose of naloxone and polysubstance intoxication with additional CNS depressants were predictors of admission. Administration of additional naloxone by paramedics was not associated with a higher rate of neurologic improvement prior to hospital arrival, suggesting a ceiling effect on naloxone efficacy in opioid overdose.

Pulmonary Complications of Opioid Overdose Treated With Naloxone.

STUDY OBJECTIVE: We aim to determine whether administration of higher doses of naloxone for the treatment of opioid overdose is associated with increased pulmonary complications. METHODS: This was a retrospective, observational, cross-sectional study of 1,831 patients treated with naloxone by the City of Pittsburgh Bureau of Emergency Medical Services. Emergency medical services and hospital records were abstracted for data in regard to naloxone dosing, route of administration, and clinical outcomes, including the development of complications such as pulmonary edema, aspiration pneumonia, and aspiration pneumonitis. For the purposes of this investigation, we defined high-dose naloxone as total administration exceeding 4.4 mg. Multivariable analysis was used to attempt to account for confounders such as route of administration and pretreatment morbidity. RESULTS: Patients receiving out-of-hospital naloxone in doses exceeding 4.4 mg were 62% more likely to have a pulmonary complication after opioid overdose (42% versus 26% absolute risk; odds ratio 2.14; 95% confidence interval 1.44 to 3.18). This association remained statistically significant after multivariable analysis with logistic regression (odds ratio 1.85; 95% confidence interval 1.12 to 3.04). A secondary analysis showed an increased risk of 27% versus 13% (odds ratio 2.57; 95% confidence interval 1.45 to 4.54) when initial naloxone dosing exceeded 0.4 mg. Pulmonary edema occurred in 1.1% of patients. CONCLUSION: Higher doses of naloxone in the out-of-hospital treatment of opioid overdose are associated with a higher rate of pulmonary complications. Furthermore, prospective study is needed to determine the causality of this relationship.

The personal impact of pelvic floor symptoms and their relationship to age.

INTRODUCTION AND HYPOTHESIS: The aim was to evaluate the relationship between age and the impact of pelvic floor disorders (PFD) using a multi-dimensional pelvic floor questionnaire METHODS: Questionnaire data on 4,311 women attending urogynaecology clinics with PFD were stratified by age into four groups: ≤35, 36-50, 51-65 and >65 years. The symptom frequency (ranging from 0 to 100) was divided in to mild (0-33), moderate (34-67), and severe (68-100) symptoms. Impact scores for equivalent levels of symptom frequency (mild, moderate and severe symptoms) were compared in women of different ages. RESULTS: Overall, bowel continence was associated with the greatest bother and constipation the least. Older women were significantly less bothered by mild to moderate urinary, bowel and vaginal symptoms (except IBS and vaginal capacity) than younger women. There was no difference in the impact of severe symptoms in different ages. In contrast, for sexual symptoms, there was a significant difference in the impact in older women for all grades of severity. CONCLUSIONS: Women's views and attitudes towards symptoms are variable and age is a significant factor. In women attending urogynaecology clinics with pelvic floor symptoms the impact of most symptoms (particularly sexual dysfunction) become less bothersome with age.

The predictive value of heart rate in determining clinical course after a bupropion overdose.

INTRODUCTION: Bupropion is a popular antidepressant due to its favorable side effect profile and indications for smoking cessation and weight loss. Due to the possibility of delayed onset seizure and other adverse outcomes after bupropion overdose, patients are often observed for periods of 12-24 hours following suspected ingestion. Tachycardia is a clinical predictor that holds promise in differentiating cases at risk for seizures from low-risk cases that do not require prolonged observation. This study assessed whether heart rate within the first eight hours of presentation can identify cases that do not require extended observation. METHODS: This is a retrospective cohort study of all supra-therapeutic bupropion cases from two hospital systems between 2010 and 2022. RESULTS: Data from 216 charts were included. Seizures, hypotension, and dysrhythmias occurred in 19 percent (n = 41), 1.4 percent (n = 3), 0.9 percent (n = 2) respectively. One patient died. Delayed adverse effects were rare (n = 4); they occurred from 14 hours to 28 hours post-ingestion. Maximum heart rate in eight hours was associated with a risk of adverse outcomes. (odds ratio, 1.07; 95 percent confidence interval: 1.05 to 1.09; P < 0.001). An eight hour maximum heart rate threshold of 104 beats/minute had a negative predictive value of 100 percent (95 percent confidence interval: 96.7 percent to 100 percent) for the occurrence of delayed adverse effects. All patients with delayed effects had tachycardia within five hours of emergency department arrival. DISCUSSION: Delayed adverse outcomes of seizures, hypotension, dysrhythmia, and death were uncommon in this cohort. Heart rate during the first eight hours of observation performs reliably as a screening test to identify patients at low risk for delayed adverse outcomes. This study is limited by its retrospective nature, the inability to ascertain time of ingestion for most cases and the lack of confirmatory laboratory testing. CONCLUSION: This study supports the use of an eight hour observation period when there are no other clinical signs of toxicity to warrant admission and if no co-ingestion or administration of substances that mask tachycardia are present.

Emergency Department Visits at Veteran's Health Administration Hospitals Related to Alcohol Intoxication: A Ten-Year Retrospective.

We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010-2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse. Descriptive statistics and univariate analysis were performed. We identified 95,123 patients with a total of 251,310 emergency department visits. The annual number of visits increased over the study period, reaching 32,333 in 2019. Men aged 40-60 were the most common demographic group in the cohort (48% of all patients), and men made up a high proportion of patients in the database (94%) than the VHA population overall (90%). A disproportionate number of visits (32%) came from the top 4.4% of most frequent visitors. Most of the emergency department visits in the database (68%) were associated with medical or psychiatric admission, or interfacility transfer for admission elsewhere. Patients in the cohort accounted for 1.3% of all VHA emergency department visits during the study period, a proportion which is somewhat smaller than what has been reported at non-VHA facilities, and despite the high prevalence of addiction disorders in the VHA patient population. We submit that this lower-than-expected proportion of alcohol-related emergency department visits may be due to the access to primary and mental care which is afforded by VHA patient benefits.

A 5-min paradigm to evoke robust emotional reactivity in neuroimaging studies.

The advent of the Research Domain Criteria (RDoC) approach to funding translational neuroscience has highlighted a need for research that includes measures across multiple task types. However, the duration of any given experiment is quite limited, particularly in neuroimaging contexts, and therefore robust estimates of multiple behavioral domains are often difficult to achieve. Here we offer a "turn-key" emotion-evoking paradigm suitable for neuroimaging experiments that demonstrates strong effect sizes across widespread cortical and subcortical structures. This short series could be easily added to existing fMRI protocols, and yield a reliable estimate of emotional reactivity to complement research in other behavioral domains. This experimental adjunct could be used to enable an initial comparison of emotional modulation with the primary behavioral focus of an investigator's work, and potentially identify new relationships between domains of behavior that have not previously been recognized.

The effect of prolapse repair on sexual function in women.

INTRODUCTION: Sexual dysfunction is common in women with pelvic organ prolapse (POP). Treatment of symptomatic prolapse often requires surgery. The outcome of prolapse symptoms following surgery is well studied and reported, but evidence on outcomes of sexual function following pelvic reconstructive surgeries is limited. AIM: The objective of this study was to assess the impact of different forms of surgery for POP on sexual function using prospectively collected data. METHODS: In this ethically approved project, data were collected prospectively for women undergoing prolapse repair between 2008 and 2010 and were stratified into four groups: "posterior repair,""anterior repair,""anterior repair with vaginal hysterectomy," and "combined anterior and posterior repair." The electronic personal assessment questionnaire-pelvic floor (ePAQ-PF) was used to assess symptoms. The sexual dimension of ePAQ-PF computes domain scores for sexual dysfunction secondary to vaginal symptoms and dyspareunia on a scale of 0-100 (0 = best possible and 100 = worst possible health status). ePAQ-PF was completed in 123 sexually active women both pre- and 3-6 month postoperatively. Results were analyzed using SPSS (SPSS Inc., Chicago, IL, USA). Pre- and postoperative scores for each domain were compared in all groups (Student's t-test). Individual symptoms in these domains were compared using Wilcoxon signed-rank test. MAIN OUTCOME MEASURES: Change in sexual symptoms and dyspareunia following prolapse surgery in each group. RESULTS: Women undergoing anterior repair or anterior repair and vaginal hysterectomy reported significant improvement in sexual symptoms and dyspareunia. Women undergoing a posterior repair in isolation had improved sexual function following surgery though improvement in dyspareunia was not significant. Women undergoing combined anterior and posterior repair had the least improvement in sexual function. CONCLUSIONS: Sexual function improves in women following pelvic reconstructive surgery, but the improvement is more substantial following anterior repair either alone or in combination with a vaginal hysterectomy when compared with posterior repair.

Poison center consultation reduces hospital length of stay.

CONTEXT: Prior studies have observed shorter lengths of stay when practitioners consult a US poison control center (PCC) regarding hospitalized toxicology patients, but the most recent study used data from 2010. Since then, the implementation of the Affordable Care Act, a trend toward shorter hospitalizations and substantial adjustments in hospital charges have occurred. METHODS: This is a retrospective study of administrative hospital data and poison center data obtained from the Wisconsin Hospital Association and Wisconsin Poison Center for patients treated from 2010 to 2017. Stratified analysis was used to investigate the potential effects of PCC consultation on hospitalization. Univariate and multivariable regression analysis was used to characterize which factors were associated with an increased rate of PCC consultation. DISCUSSION: 127,224 hospitalized cases were found, of which 44,628 were entered into a stratified hospital charge and length of stay analysis. PCC consultation was associated with an 11.6 h (95% CI 10.4-13.0 h) shorter mean length of stay overall, with children aged 0-6 having a larger reduction of 1.18 days. While total charges were higher by $600 in PCC consultation cases in the overall analysis (95% CI $390-$777), mean charges in patients aged 0-6 were $6695 lower when the PCC was consulted. PCC consultation was more likely to occur in cases involving children and adolescents, intentional overdoses (versus accidental or unknown intent), and women. CONCLUSIONS: Our findings suggest that PCC consultation should be encouraged to potentially shorten hospitalizations of poisoned patients, and for pediatric patients in particular. Intentionality and demographic factors affect the rate of PCC consultation for overdose, but the nature of these relationships is unclear.

QTc Prolongation in Poison Center Exposures to CredibleMeds List of Substances with "Known Risk of Torsades de Pointes".

Many drugs carry some risk of QT interval prolongation, which can lead to life-threatening dysrhythmias including Torsades de Pointes (TdP). CredibleMeds.org identifies medications categorized as "Known Risk of TdP" but does not stratify risk in acute supratherapeutic ingestions. We sought to determine the proportion of cases exhibiting QTc prolongation and life-threatening dysrhythmias including ventricular tachycardia (VT)/ventricular fibrillation (VF), TdP, and asystole in patients exposed to these substances. Retrospective chart review of cases reported to our Regional Poison Center from 2014 to 2019 of exposures to one or more of the "Known Risk" substances was performed. Demographics, therapies, clinical effects, and medical outcome for each case were analyzed. There were 1125 exposures, of which 760 had a documented QTc interval. QTc ≥ 500 ms was reported in 138 (18.2%) of the 760 cases. The most common "Known Risk" substances were citalopram, escitalopram and cocaine. Although not in the "Known Risk" category, mirtazapine, amitriptyline, diphenhydramine, and trazodone had a statistically significant association with QTc > 500 ms. Life-threatening dysrhythmias occurred in 13 cases, with VT/VF in 6 of the 760 (0.8%) cases, and one case of TdP. Flecainide (OR 11.1, 95% CI 2.2-55.8) and methadone (OR 7.1, 95% CI 2.1-23.4) were associated with increased risk of all life-threatening dysrhythmias. Exposures to medications on the Credible Meds list of "Known Risk of TdP" QTc prolongation is common, but life-threatening dysrhythmias are rare. Mirtazapine, amitriptyline, diphenhydramine, and trazodone were associated with prolonged QTc. Flecainide and methadone had the highest associated risk of life-threatening dysrhythmias.

Do rare emotional scenes enhance LPP modulation?

The slow wave late positive potential (LPP) is one of the most dependable measures of emotional processing in human neuroscience. While LPP positivity shows modest malleability by emotional regulation and competing tasks, its fundamental enhancement by emotional scene perception is extremely reliable. Here we assess the impact of emotional scene frequency (67%, 50% and 17%) on the strength of LPP modulation, across 3 groups of participants, using consistent presentation and analysis methods. The results demonstrate strong consistency in the strength of emotional modulation across frequent, equiprobable, and rare emotion conditions. However, a small enhancement of LPP positivity was found during unpleasant scenes in the rare emotion condition. The LPP thus appears to be largely insensitive to contextual features such as scene frequency and predictability, suggesting that strong emotional cues persistently engage orienting and evaluation processes because this tendency was selected in phylogeny.

Humor and emotion: Quantitative meta analyses of functional neuroimaging studies.

Humor is a ubiquitous aspect of human behavior that is infrequently the focus of neuroscience research. To localize human brain structures associated with the experience of humor, we conducted quantitative activation likelihood estimate (ALE) meta analyses of 57 fMRI studies (n = 1248) reporting enhanced regional brain activity evoked by humorous cues versus matched control cues. We performed separate ALE analyses of studies that employed picture-driven, text-based, and auditory laughter cues to evoke humor. A primary finding was that complex humor activates supramodal areas of the brain strongly associated with emotional processes, including bilateral amygdala and inferior frontal gyrus. Moreover, activation in brain regions associated with language, semantic knowledge, and theory of mind were differentially modulated by text and picture-driven humor cues, while hearing laughter enhances activation in auditory association cortex. The identification of humor-driven brain networks has the potential to expand brain-derived models of human emotion and could provide useful targets in translational research and therapy.

Emotional and feature-based modulation of the early posterior negativity.

The early posterior negativity (EPN) has been shown to be enhanced by emotional relative to neutral scene perception. A subset of studies has also reported a bias in the EPN toward pleasant relative to unpleasant scenes. Functional MRI research has also identified a region in lateral occipital cortex that shows a sensitivity to the visual perception of body parts, which may contribute to the EPN. Here, we assess the roles of rated scene pleasantness and the depiction of body parts on modulation of the EPN in two studies, using scenes that are chosen to be of equivalent perceptual complexity. In Study 1, we presented two distinct highly pleasant and arousing scene contents (erotic couples and moments of jubilant victory) as well as neutral people, threat, and mutilation scenes. As in prior research, the EPN was enhanced by emotionally arousing scenes, with the greatest modulation evoked by erotic scenes, although victory scenes elicited stronger ratings of pleasantness and equivalent ratings of arousal. This result suggests that the EPN may be sensitive to distinct features found in erotic scenes. To determine the extent to which body part perception modulates the EPN, Study 2 compared EPN modulation evoked by erotic scenes with nonerotic nudist scenes. Ratings of pleasantness and arousal were reduced, yet nudist scenes led to stronger modulation of the EPN compared to erotic scenes. These data indicate that, in addition to the emotional intensity of scenes, modulation of the EPN may in part reflect the discrimination of unclothed body parts.