Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine.

Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient's International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16-3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission.

Prognostic Value of the PROFUND Index for 30-Day Mortality in Acute Heart Failure.

Background and Objectives: The prevalence and incidence of heart failure (HF) have been increasing in recent years as the population ages. These patients show a distinct profile of comorbidity, which makes their care more complex. In recent years, the PROFUND index, a specific tool for estimating the mortality rate at one year in pluripathology patients, has been developed. The aim of this study was to evaluate the prognostic value of the PROFUND index and of in-hospital and 30-day mortality after discharge of patients admitted for acute heart failure (AHF). Materials and Methods: A prospective multicenter longitudinal study was performed that included patients admitted with AHF and ≥2 comorbid conditions. Clinical, analytical, and prognostic variables were collected. The PROFUND index was collected in all patients and rates of in-hospital and 30-day mortality after discharge were analyzed. A bivariate analysis was performed with quantitative variables between patients who died and those who survived at the 30-day follow-up. A logistic regression analysis was performed with the variables that obtained statistical significance in the bivariate analysis between deceased and surviving subjects. Results: A total of 128 patients were included. Mean age was 80.5 +/- 9.98 years, and women represented 51.6%. The mean PROFUND index was 5.26 +/- 4.5. The mortality rate was 8.6% in-hospital and 20.3% at 30 days. Preserved left ventricular ejection fraction was found in 60.9%. In the sample studied, there were patients with a PROFUND score < 7 predominated (89 patients (70%) versus 39 patients (31%) with a PROFUND score ≥ 7). Thirteen patients (15%) with a PROFUND score < 7 died versus the 13 (33%) with a PROFUND score ≥ 7, p = 0.03. Twelve patients (15%) with a PROFUND score < 7 required readmission versus 12 patients (35%) with a PROFUND score ≥ 7, p = 0.02. The ROC curve of the PROFUND index for in-hospital mortality and 30-day follow-up in patients with AHF showed AUC 0.63, CI: 95% (0.508-0.764), p <0.033. Conclusions: The PROFUND index is a clinical tool that may be useful for predicting short-term mortality in elderly patients with AHF. Further studies with larger simple sizes are required to validate these results.

Adherence to a priori dietary indexes and baseline prevalence of cardiovascular risk factors in the PREDIMED-Plus randomised trial.

PURPOSE: Cardiovascular disease remains the global leading cause of death. We evaluated at baseline the association between the adherence to eight a priori high-quality dietary scores and the prevalence of individual and clustered cardiovascular risk factors (CVRF) in the PREDIMED-Plus cohort. METHODS: All PREDIMED-Plus participants (6874 men and women aged 55-75 years, with overweight/obesity and metabolic syndrome) were assessed. The prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidaemia), using standard diagnoses criteria, were considered as outcomes. The adherence to eight a priori-defined dietary indexes was calculated. Multivariable models were fitted to estimate differences in mean values of factors and prevalence ratios for individual and clustered CVRF. RESULTS: Highest conformity to any dietary pattern did not show inverse associations with hypertension. The modified Mediterranean Diet Score (PR = 0.95; 95% CI 0.90-0.99), Mediterranean Diet Adherence Score (MEDAS) (PR = 0.94; 95% CI 0.89-0.98), the pro-vegetarian dietary pattern (PR = 0.95; 95% CI 0.90-0.99) and the Alternate Healthy Eating Index 2010 (PR = 0.92; 95% CI 0.87-0.96) were inversely associated with prevalence of obesity. We identified significant inverse trend among participants who better adhered to the MEDAS and the Prime Diet Quality Score (PDQS) in the mean number of CVRF across categories of adherence. Better adherence to several high-quality dietary indexes was associated with better blood lipid profiles and anthropometric measures. CONCLUSIONS: Highest adherence to dietary quality indexes, especially Mediterranean-style and PDQS scores, showed marginal associations with lower prevalence of individual and clustered CVRF among elderly adults with metabolic syndrome at high risk of cardiovascular disease.

Correction to: Morphological MRI-based features provide pretreatment survival prediction in glioblastoma.

The original version of this article, published on 15 October 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The name of Mariano Amo-Salas and the affiliation of Ismael Herruzo were presented incorrectly.

Morphological MRI-based features provide pretreatment survival prediction in glioblastoma.

OBJECTIVES: We wished to determine whether tumor morphology descriptors obtained from pretreatment magnetic resonance images and clinical variables could predict survival for glioblastoma patients. METHODS: A cohort of 404 glioblastoma patients (311 discoveries and 93 validations) was used in the study. Pretreatment volumetric postcontrast T1-weighted magnetic resonance images were segmented to obtain the relevant morphological measures. Kaplan-Meier, Cox proportional hazards, correlations, and Harrell's concordance indexes (c-indexes) were used for the statistical analysis. RESULTS: A linear prognostic model based on the outstanding variables (age, contrast-enhanced (CE) rim width, and surface regularity) identified a group of patients with significantly better survival (p < 0.001, HR = 2.57) with high accuracy (discovery c-index = 0.74; validation c-index = 0.77). A similar model applied to totally resected patients was also able to predict survival (p < 0.001, HR = 3.43) with high predictive value (discovery c-index = 0.81; validation c-index = 0.92). Biopsied patients with better survival were well identified (p < 0.001, HR = 7.25) by a model including age and CE volume (c-index = 0.87). CONCLUSIONS: Simple linear models based on small sets of meaningful MRI-based pretreatment morphological features and age predicted survival of glioblastoma patients to a high degree of accuracy. The partition of the population using the extent of resection improved the prognostic value of those measures. KEY POINTS: • A combination of two MRI-based morphological features (CE rim width and surface regularity) and patients' age outperformed previous prognosis scores for glioblastoma. • Prognosis models for homogeneous surgical procedure groups led to even more accurate survival prediction based on Kaplan-Meier analysis and concordance indexes.

Prevention of type 2 diabetes in prediabetic patients by using functional olive oil enriched in oleanolic acid: The PREDIABOLE study, a randomized controlled trial.

AIM: To assess whether the regular intake of an oleanolic acid (OA)-enriched olive oil is effective in the prevention of diabetes. METHODS: In the PREDIABOLE study, prediabetic individuals (impaired fasting glucose and impaired glucose tolerance) of both sexes (176 patients, aged 30-80 years) were randomized to receive 55 mL/day of OA-enriched olive oil (equivalent dose 30 mg OA/day) [intervention group (IG)] or the same oil not enriched [control group (CG)]. The main outcome was the incidence of new-onset type 2 diabetes in both groups. RESULTS: Forty-eight new diabetes cases occurred, 31 in the CG and 17 in the IG. The multivariate-adjusted hazard ratio was 0.45 (95% CI, 0.24-0.83) for the IG compared with the CG. Intervention-related adverse effects were not reported. CONCLUSIONS: The intake of OA-enriched olive oil reduces the risk of developing diabetes in prediabetic patients. The results of the PREDIABOLE study promote the use of OA in new functional foods and drugs for the prevention of diabetes in individuals at risk of developing it.

Time course of selective attention to face regions in social anxiety: eye-tracking and computational modelling.

We investigated the time course of selective attention to face regions during judgment of dis/approval by low (LSA) and high (HSA) social anxiety undergraduates (with clinical levels on questionnaire measures). The viewers' gaze direction was assessed and the stimulus visual saliency of face regions was computed, for video-clips displaying dynamic facial expressions. Social anxiety was related to perception of disapproval from faces with an ambiguous smile (i.e. with non-happy eyes), but not those with congruent happy eyes and a smile. HSA observers selectively looked earlier at the eye region, whereas LSA ones preferentially looked at the smiling mouth. Consistently, gaze allocation was less related to visual saliency of the smile for HSA than for LSA viewers. The attentional bias towards the less salient eye region - thus opposing the automatic capture by the smile - suggests that it is strategically driven in HSA individuals, possibly aimed at detecting negative evaluators.

Facial attractiveness impressions precede trustworthiness inferences: lower detection thresholds and faster decision latencies.

Prior research has found a relationship between perceived facial attractiveness and perceived personal trustworthiness. We examined the time course of attractiveness relative to trustworthiness evaluation of emotional and neutral faces. This served to explore whether attractiveness might be used as an easily accessible cue and a quick shortcut for judging trustworthiness. Detection thresholds and judgment latencies as a function of expressive intensity were measured. Significant correlations between attractiveness and trustworthiness consistently held for six emotional expressions at four intensities, and neutral faces. Importantly, perceived attractiveness preceded perceived trustworthiness, with lower detection thresholds and shorter decision latencies. This reveals a time course advantage for attractiveness, and suggests that earlier attractiveness impressions could bias trustworthiness inferences. A heuristic cognitive mechanism is hypothesised to ease processing demands by relying on simple and observable clues (attractiveness) as a substitute for more complex and not easily accessible information (trustworthiness).

[Thymoma in a patient with klinefelter syndrome. Case report]. / Síndrome de Klinefelter diagnosticado en un adulto a raíz del estudio de infección respiratoria recurrente y masa mediastínica. Caso clínico.

Klinefelter syndrome (47, XXY in most cases) is a frequently underdiagnosed chromosomal anomaly associated with multiple comorbidities in adult life. Patients with Klinefelter syndrome have a higher risk of cancer. Specifically, these patients have a higher risk for mediastinal germ cell tumors. It is estimated that 8% of male patients with mediastinal tumors have Klinefelter. We report a 42-years-old male who suffered recurrent respiratory infections. During the study, a mediastinal mass was found, whose pathological study disclosed a type B thymoma. The patient had a history of infertility, high stature, gynecomastia, obesity with gynecoid distribution of body fat and testicular atrophy. A karyotype was requested (47, XXY), confirming the diagnosis of Klinefelter syndrome.

Mediterranean Diet Improves High-Density Lipoprotein Function in High-Cardiovascular-Risk Individuals: A Randomized Controlled Trial.

BACKGROUND: The biological functions of high-density lipoproteins (HDLs) contribute to explaining the cardioprotective role of the lipoprotein beyond quantitative HDL cholesterol levels. A few small-scale interventions with a single antioxidant have improved some HDL functions. However, to date, no long-term, large-scale, randomized controlled trial has been conducted to assess the effects of an antioxidant-rich dietary pattern (such as a traditional Mediterranean diet [TMD]) on HDL function in humans. METHODS: This study was performed in a random subsample of volunteers from the PREDIMED Study (Prevención con Dieta Mediterránea; n=296) after a 1-year intervention. We compared the effects of 2 TMDs, one enriched with virgin olive oil (TMD-VOO; n=100) and the other enriched with nuts (TMD-Nuts; n=100), with respect to a low-fat control diet (n=96). We assessed the effects of both TMDs on the role of HDL particles on reverse cholesterol transport (cholesterol efflux capacity, HDL ability to esterify cholesterol, and cholesteryl ester transfer protein activity), HDL antioxidant properties (paraoxonase-1 arylesterase activity and total HDL antioxidant capacity on low-density lipoproteins), and HDL vasodilatory capacity (HDL ability to induce the release of nitric oxide in endothelial cells). We also studied the effects of a TMD on several HDL quality-related characteristics (HDL particle oxidation, resistance against oxidative modification, main lipid and protein composition, and size distribution). RESULTS: Both TMDs increased cholesterol efflux capacity relative to baseline (P=0.018 and P=0.013 for TMD-VOO and TMD-Nuts, respectively). The TMD-VOO intervention decreased cholesteryl ester transfer protein activity (relative to baseline, P=0.028) and increased HDL ability to esterify cholesterol, paraoxonase-1 arylesterase activity, and HDL vasodilatory capacity (relative to control, P=0.039, P=0.012, and P=0.026, respectively). Adherence to a TMD induced these beneficial changes by improving HDL oxidative status and composition. The 3 diets increased the percentage of large HDL particles (relative to baseline, P<0.001). CONCLUSIONS: The TMD, especially when enriched with virgin olive oil, improved HDL atheroprotective functions in humans. CLINICAL TRIAL REGISTRATION: URL: http://www.controlled-trials.com. Unique identifier: ISRCTN35739639.

Tumor Surface Regularity at MR Imaging Predicts Survival and Response to Surgery in Patients with Glioblastoma.

Purpose To evaluate the prognostic and predictive value of surface-derived imaging biomarkers obtained from contrast material-enhanced volumetric T1-weighted pretreatment magnetic resonance (MR) imaging sequences in patients with glioblastoma multiforme. Materials and Methods A discovery cohort from five local institutions (165 patients; mean age, 62 years ± 12 [standard deviation]; 43% women and 57% men) and an independent validation cohort (51 patients; mean age, 60 years ± 12; 39% women and 61% men) from The Cancer Imaging Archive with volumetric T1-weighted pretreatment contrast-enhanced MR imaging sequences were included in the study. Clinical variables such as age, treatment, and survival were collected. After tumor segmentation and image processing, tumor surface regularity, measuring how much the tumor surface deviates from a sphere of the same volume, was obtained. Kaplan-Meier, Cox proportional hazards, correlations, and concordance indexes were used to compare variables and patient subgroups. Results Surface regularity was a powerful predictor of survival in the discovery (P = .005, hazard ratio [HR] = 1.61) and validation groups (P = .05, HR = 1.84). Multivariate analysis selected age and surface regularity as significant variables in a combined prognostic model (P < .001, HR = 3.05). The model achieved concordance indexes of 0.76 and 0.74 for the discovery and validation cohorts, respectively. Tumor surface regularity was a predictor of survival for patients who underwent complete resection (P = .01, HR = 1.90). Tumors with irregular surfaces did not benefit from total over subtotal resections (P = .57, HR = 1.17), but those with regular surfaces did (P = .004, HR = 2.07). Conclusion The surface regularity obtained from high-resolution contrast-enhanced pretreatment volumetric T1-weighted MR images is a predictor of survival in patients with glioblastoma. It may help in classifying patients for surgery.

Neural time course and brain sources of facial attractiveness vs. trustworthiness judgment.

Prior research has shown that the more (or less) attractive a face is judged, the more (or less) trustworthy the person is deemed and that some common neural networks are recruited during facial attractiveness and trustworthiness evaluation. To interpret the relationship between attractiveness and trustworthiness (e.g., whether perception of personal trustworthiness may depend on perception of facial attractiveness), we investigated their relative neural processing time course. An event-related potential (ERP) paradigm was used, with localization of brain sources of the scalp neural activity. Face stimuli with a neutral, angry, happy, or surprised expression were presented in an attractiveness judgment, a trustworthiness judgment, or a control (no explicit social judgment) task. Emotional facial expression processing occurred earlier (N170 and EPN, 150-290 ms post-stimulus onset) than attractiveness and trustworthiness processing (P3b, 400-700 ms). Importantly, right-central ERP (C2, C4, C6) differences reflecting discrimination between "yes" (attractive or trustworthy) and "no" (unattractive or untrustworthy) decisions occurred at least 400 ms earlier for attractiveness than for trustworthiness, in the absence of LRP motor preparation differences. Neural source analysis indicated that facial processing brain networks (e.g., LG, FG, and IPL-extending to pSTS), also right-lateralized, were involved in the discrimination time course differences. This suggests that attractiveness impressions precede and might prime trustworthiness inferences and that the neural time course differences reflect truly facial encoding processes.

What makes a smiling face look happy? Visual saliency, distinctiveness, and affect.

We investigated the relative contribution of (a) perceptual (eyes and mouth visual saliency), (b) conceptual or categorical (eye expression distinctiveness), and (c) affective (rated valence and arousal) factors, and (d) specific morphological facial features (Action Units; AUs), to the recognition of facial happiness. The face stimuli conveyed truly happy expressions with a smiling mouth and happy eyes, or blended expressions with a smile but non-happy eyes (neutral, sad, fearful, disgusted, surprised, or angry). Saliency, distinctiveness, affect, and AUs served as predictors; the probability of judging a face as happy was the criterion. Both for truly happy and for blended expressions, the probability of perceiving happiness increased mainly as a function of positive valence of the facial configuration. In addition, for blended expressions, the probability of being (wrongly) perceived as happy increased as a function of (a) delayed saliency and (b) reduced distinctiveness of the non-happy eyes, and (c) enhanced AU 6 (cheek raiser) or (d) reduced AUs 4, 5, and 9 (brow lowerer, upper lid raiser, and nose wrinkler, respectively). Importantly, the later the eyes become visually salient relative to the smiling mouth, the more likely it is that faces will look happy.

Glioblastoma: does the pre-treatment geometry matter? A postcontrast T1 MRI-based study.

BACKGROUND: The potential of a tumour's volumetric measures obtained from pretreatment MRI sequences of glioblastoma (GBM) patients as predictors of clinical outcome has been controversial. Mathematical models of GBM growth have suggested a relation between a tumour's geometry and its aggressiveness. METHODS: A multicenter retrospective clinical study was designed to study volumetric and geometrical measures on pretreatment postcontrast T1 MRIs of 117 GBM patients. Clinical variables were collected, tumours segmented, and measures computed including: contrast enhancing (CE), necrotic, and total volumes; maximal tumour diameter; equivalent spherical CE width and several geometric measures of the CE "rim". The significance of the measures was studied using proportional hazards analysis and Kaplan-Meier curves. RESULTS: Kaplan-Meier and univariate Cox survival analysis showed that total volume [p = 0.034, Hazard ratio (HR) = 1.574], CE volume (p = 0.017, HR = 1.659), spherical rim width (p = 0.007, HR = 1.749), and geometric heterogeneity (p = 0.015, HR = 1.646) were significant parameters in terms of overall survival (OS). Multivariable Cox analysis for OS provided the later two parameters as age-adjusted predictors of OS (p = 0.043, HR = 1.536 and p = 0.032, HR = 1.570, respectively). CONCLUSION: Patients with tumours having small geometric heterogeneity and/or spherical rim widths had significantly better prognosis. These novel imaging biomarkers have a strong individual and combined prognostic value for GBM patients. KEY POINTS: • Three-dimensional segmentation on magnetic resonance images allows the study of geometric measures. • Patients with small width of contrast enhancing areas have better prognosis. • The irregularity of contrast enhancing areas predicts survival in glioblastoma patients.

Adaptive attunement of selective covert attention to evolutionary-relevant emotional visual scenes.

We investigated selective attention to emotional scenes in peripheral vision, as a function of adaptive relevance of scene affective content for male and female observers. Pairs of emotional-neutral images appeared peripherally-with perceptual stimulus differences controlled-while viewers were fixating on a different stimulus in central vision. Early selective orienting was assessed by the probability of directing the first fixation towards either scene, and the time until first fixation. Emotional scenes selectively captured covert attention even when they were task-irrelevant, thus revealing involuntary, automatic processing. Sex of observers and specific emotional scene content (e.g., male-to-female-aggression, families and babies, etc.) interactively modulated covert attention, depending on adaptive priorities and goals for each sex, both for pleasant and unpleasant content. The attentional system exhibits domain-specific and sex-specific biases and attunements, probably rooted in evolutionary pressures to enhance reproductive and protective success. Emotional cues selectively capture covert attention based on their bio-social significance.

Association between dietary fibre intake and fruit, vegetable or whole-grain consumption and the risk of CVD: results from the PREvención con DIeta MEDiterránea (PREDIMED) trial.

Prospective studies assessing the association between fibre intake or fibre-rich food consumption and the risk of CVD have often been limited by baseline assessment of diet. Thus far, no study has used yearly repeated measurements of dietary changes during follow-up. Moreover, previous studies included healthy and selected participants who did not represent subjects at high cardiovascular risk. We used yearly repeated measurements of diet to investigate the association between fibre intake and CVD in a Mediterranean cohort of elderly adults at high cardiovascular risk. We followed-up 7216 men (55-80 years) and women (60-80 years) initially free of CVD for up to 7 years in the PREvención con DIeta MEDiterránea study (registered as ISRCTN35739639). A 137-item validated FFQ was repeated yearly to assess diet. The primary end point, confirmed by a blinded ad hoc Event Adjudication Committee, was a composite of cardiovascular death, myocardial infarction and stroke. Time-dependent Cox's regression models were used to estimate the risk of CVD according to baseline dietary exposures and to their yearly updated changes. We found a significant inverse association for fibre (P for trend=0·020) and fruits (P for trend=0·024) in age-sex adjusted models, but the statistical significance was lost in fully adjusted models. However, we found a significant inverse association with CVD incidence for the sum of fruit and vegetable consumption. Participants who consumed in total nine or more servings/d of fruits plus vegetables had a hazard ratio 0·60 (95 % CI 0·40, 0·96) of CVD in comparison with those consuming <5 servings/d.

Perceptual and affective mechanisms in facial expression recognition: An integrative review.

Facial expressions of emotion involve a physical component of morphological changes in a face and an affective component conveying information about the expresser's internal feelings. It remains unresolved how much recognition and discrimination of expressions rely on the perception of morphological patterns or the processing of affective content. This review of research on the role of visual and emotional factors in expression recognition reached three major conclusions. First, behavioral, neurophysiological, and computational measures indicate that basic expressions are reliably recognized and discriminated from one another, albeit the effect may be inflated by the use of prototypical expression stimuli and forced-choice responses. Second, affective content along the dimensions of valence and arousal is extracted early from facial expressions, although this coarse affective representation contributes minimally to categorical recognition of specific expressions. Third, the physical configuration and visual saliency of facial features contribute significantly to expression recognition, with "emotionless" computational models being able to reproduce some of the basic phenomena demonstrated in human observers. We conclude that facial expression recognition, as it has been investigated in conventional laboratory tasks, depends to a greater extent on perceptual than affective information and mechanisms.

Brain signatures of perceiving a smile: Time course and source localization.

Facial happiness is consistently recognized faster than other expressions of emotion. In this study, to determine when and where in the brain such a recognition advantage develops, EEG activity during an expression categorization task was subjected to temporospatial PCA analysis and LAURA source localizations. Happy, angry, and neutral faces were presented either in whole or bottom-half format (with the mouth region visible). The comparison of part- versus whole-face conditions served to examine the role of the smile. Two neural signatures underlying the happy face advantage emerged. One peaked around 140 ms (left N140) and was source-located at the left IT cortex (MTG), with greater activity for happy versus non-happy faces in both whole and bottom-half face format. This suggests an enhanced perceptual encoding mechanism for salient smiles. The other peaked around 370 ms (P3b and N3) and was located at the right IT (FG) and dorsal cingulate (CC) cortices, with greater activity specifically for bottom-half happy versus non-happy faces. This suggests an enhanced recruitment of face-specific information to categorize (or reconstruct) facial happiness from diagnostic smiling mouths. Additional differential brain responses revealed a specific "anger effect," with greater activity for angry versus non-angry expressions (right N170 and P230; right pSTS and IPL); and a coarse "emotion effect," with greater activity for happy and angry versus neutral expressions (anterior P2 and posterior N170; vmPFC and right IFG).

Lateralized discrimination of emotional scenes in peripheral vision.

This study investigates whether there is lateralized processing of emotional scenes in the visual periphery, in the absence of eye fixations; and whether this varies with emotional valence (pleasant vs. unpleasant), specific emotional scene content (babies, erotica, human attack, mutilation, etc.), and sex of the viewer. Pairs of emotional (positive or negative) and neutral photographs were presented for 150 ms peripherally (≥6.5° away from fixation). Observers judged on which side the emotional picture was located. Low-level image properties, scene visual saliency, and eye movements were controlled. Results showed that (a) correct identification of the emotional scene exceeded the chance level; (b) performance was more accurate and faster when the emotional scene appeared in the left than in the right visual field; (c) lateralization was equivalent for females and males for pleasant scenes, but was greater for females and unpleasant scenes; and (d) lateralization occurred similarly for different emotional scene categories. These findings reveal discrimination between emotional and neutral scenes, and right brain hemisphere dominance for emotional processing, which is modulated by sex of the viewer and scene valence, and suggest that coarse affective significance can be extracted in peripheral vision.

Brain lateralization of holistic versus analytic processing of emotional facial expressions.

This study investigated the neurocognitive mechanisms underlying the role of the eye and the mouth regions in the recognition of facial happiness, anger, and surprise. To this end, face stimuli were shown in three formats (whole face, upper half visible, and lower half visible) and behavioral categorization, computational modeling, and ERP (event-related potentials) measures were combined. N170 (150-180 ms post-stimulus; right hemisphere) and EPN (early posterior negativity; 200-300 ms; mainly, right hemisphere) were modulated by expression of whole faces, but not by separate halves. This suggests that expression encoding (N170) and emotional assessment (EPN) require holistic processing, mainly in the right hemisphere. In contrast, the mouth region of happy faces enhanced left temporo-occipital activity (150-180 ms), and also the LPC (late positive complex; centro-parietal) activity (350-450 ms) earlier than the angry eyes (450-600 ms) or other face regions. Relatedly, computational modeling revealed that the mouth region of happy faces was also visually salient by 150 ms following stimulus onset. This suggests that analytical or part-based processing of the salient smile occurs early (150-180 ms) and lateralized (left), and is subsequently used as a shortcut to identify the expression of happiness (350-450 ms). This would account for the happy face advantage in behavioral recognition tasks when the smile is visible.