Percutaneous Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and End-Stage Renal Disease on Hemodialysis: A Case Series.

Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia in the general population, and its prevalence increases among patients with chronic kidney disease (CKD) undergoing hemodialysis. This population presents high risk of both hemorrhagic and thrombotic events, with little evidence regarding the use of oral anticoagulation treatment (OAT) and multiple complications arising from it; however, stroke prevention with percutaneous left atrial appendage closure (LAAC) is an alternative to be considered. We retrospectively describe the safety and efficacy of percutaneous LAAC in eight patients with NVAF and CKD on hemodialysis during a 12-month follow-up. The mean age was 78.8 years (range 64-86; SD ± 6.7), and seven patients were male. The mean CHA2DS2-VASC and HAS-BLED scores were high, 4.8 (SD ± 1.5) and 3.8 (SD ± 1.3), respectively. Seventy-five percent of the patients were referred for this intervention due to a history of major bleeding, with gastrointestinal bleeding being the most common type, while the remaining twenty-five percent of the patients were referred because of a high risk of bleeding. The percutaneous LAAC procedure was successfully completed in 100% of the patients, with complete exclusion of the appendage without complications or leaks exceeding 5 mm. There was one death not related to the procedure four days after the intervention. Among the other seven patients, no deaths, cardioembolic events or major bleeding were reported during the follow-up period. In our sample, percutaneous LAAC appears to be a safe and effective alternative to anticoagulation in patients with NVAF and CKD on hemodialysis.

Fast unconscious processing of emotional stimuli in early stages of the visual cortex.

Several cortical and subcortical brain areas have been reported to be sensitive to the emotional content of subliminal stimuli. However, the timing of these activations remains unclear. Our scope was to detect the earliest cortical traces of emotional unconscious processing of visual stimuli by recording event-related potentials (ERPs) from 43 participants. Subliminal spiders (emotional) and wheels (neutral), sharing similar low-level visual parameters, were presented at two different locations (fixation and periphery). The differential (peak-to-peak) amplitude from CP1 (77 ms from stimulus onset) to C2 (100 ms), two early visual ERP components originated in V1/V2 according to source localization analyses, was analyzed via Bayesian and traditional frequentist analyses. Spiders elicited greater CP1-C2 amplitudes than wheels when presented at fixation. This fast effect of subliminal stimulation-not reported previously to the best of our knowledge-has implications in several debates: 1) The amygdala cannot be mediating these effects, 2) latency of other evaluative structures recently proposed, such as the visual thalamus, is compatible with these results, 3) the absence of peripheral stimuli effects points to a relevant role of the parvocellular visual system in unconscious processing.

Disparities in pre-health advising across California's public universities.

BACKGROUND: The Supreme Court's decision in Students for Fair Admissions, Inc., v. Harvard College is likely to result in the matriculation of fewer students from historically excluded racial/ethnic groups at more selective colleges and universities and matriculation of more students at less selective colleges and universities. Because of this, it is important to understand how resources for pre-health advising, a modifiable factor that can help increase the diversity of the health workforce, vary across institutions with differing levels of selectivity. Colleges are known to vary in resources, structure, and investment in pre-health advising but data are lacking and there is no estimate of any pre-health advising resource gap. PURPOSE: To quantify availability of advising resources and identify perceived challenges in pre-health advising in California's highly diverse public and select private undergraduate institutions. METHODS: Structured 60-minute Zoom interviews from June 2022 -October 2022 at 18/23 CSU (California State Universities), 9/9 University of California (UC) institutions and 6 select private institutions with varying levels of selectivity. Two investigators independently analyzed interviews using a Grounded Theory Approach. The full study team reviewed transcripts and themes. KEY RESULTS: Pre-health advisor capacity varied greatly across the three types of institutions. CSU: mean = 1 FTE advisor: 24,620 graduates (range: 1: 1,059-1: 150,520); UC mean = 1 FTE advisor: 4,526 graduates (range: 1: 1,912-1: 10,920); private institutions mean = 1 FTE advisor:1,794 graduates (range: 1: 722-1: 5,300). Participants reported common challenges: advising capacity, lack of advisor training, advisor turnover, and student difficulties in accessing clinical opportunities and required coursework. CSU and UC participants noted that these had greatest impact for first generation and racially/ethnically underrepresented students for whom lack of informal professional networks, lack of other mentors, and financial responsibilities complicate college navigation and professional school application. CONCLUSIONS: Students at CSU campuses had 5 times less access to pre-health advising per graduate than UC students, and 13 times less than students at private institutions. Much greater investment is needed in California's public institutions, particularly CSUs, to increase equity in access to advising for pre-health professional students. Research should examine pre-health advising resource capacity in other states, especially those that are now facing race-neutral admissions policies at undergraduate institutions and health professions schools.

An extremely fast neural mechanism to detect emotional visual stimuli: A two-experiment study.

Defining the brain mechanisms underlying initial emotional evaluation is a key but unexplored clue to understanding affective processing. Event-related potentials (ERPs), especially suited for investigating this issue, were recorded in two experiments (n = 36 and n = 35). We presented emotionally negative (spiders) and neutral (wheels) silhouettes homogenized regarding their visual parameters. In Experiment 1, stimuli appeared at fixation or in the periphery (200 trials per condition and location), the former eliciting a N40 (39 milliseconds) and a P80 (or C1: 80 milliseconds) component, and the latter only a P80. In Experiment 2, stimuli were presented only at fixation (500 trials per condition). Again, an N40 (45 milliseconds) was observed, followed by a P100 (or P1: 105 milliseconds). Analyses revealed significantly greater N40-C1P1 peak-to-peak amplitudes for spiders in both experiments, and ANCOVAs showed that these effects were not explained by C1P1 alone, but that processes underlying N40 significantly contributed. Source analyses pointed to V1 as an N40 focus (more clearly in Experiment 2). Sources for C1P1 included V1 (P80) and V2/LOC (P80 and P100). These results and their timing point to low-order structures (such as visual thalamic nuclei or superior colliculi) or the visual cortex itself, as candidates for initial evaluation structures.

Early Effects of Mycorrhizal Fungal Inoculum and Fertilizer on Morphological and Physiological Variables of Nursery-Grown Nothofagus alessandrii Plants.

Nothofagus alessandrii (ruil) is an endangered relict species, endemic to the Mediterranean area of Chile, and one of the most threatened trees in the country. Its natural distribution area has been greatly reduced by the effect of human activities; the remaining fragments are mostly intervened and highly deteriorated as a habitat and refuge for the associated biodiversity. In order to produce healthy and resistant nursery plants for recovery and restoration of N. alessandrii forests, this study evaluates the early effects of mycorrhizal fungal inoculum (MFI) combined with fertilization on the cultivation of seedlings. The experiment was established under a completely randomized design with a factorial arrangement of the mycorrhizal factors (M0 = without mycorrhizal, M1 = Thelephora sp. and M2 = Hebeloma sp.) and fertilization (F1 = standard fertilization and F2 = intensive fertilization), with three replicates of each combination, for each type of plant (P1 = plants from one season and P2 = plants from two seasons). Each experimental unit corresponded to a group of 20 plants, with 720 plants in the test. The results indicate that application of fertilizer and MFI significantly affects some growth and photosynthesis parameters of ruil plants in one and two seasons. The morphological parameters obtained in the study show shoot height values ranging between 67 and 91 cm for P1 and between 96 and 111 cm for P2; while, for shoot diameter, values ranged between 7.91 and 8.24 mm for P1 and between 10.91 and 11.49 mm for P2. Although formation of fully developed mycorrhizal roots was not observed during the assay period, we conclude that inoculation of mycorrhizal fungi combined with fertilization could be an efficient strategy to produce a quality plant, in addition to maintaining a high photosynthetic capacity and, therefore, a higher percentage of survival in the field.

Operationalizing Depression Screening in Ambulatory Palliative Care: A Quality Improvement Project.

BACKGROUND: Depression is common in the palliative care setting and impacts outcomes. Operationalized screening is unusual in palliative care. LOCAL PROBLEM: Lack of operationalized depression screening at two ambulatory palliative care sites. METHODS: A fellow-driven quality improvement initiative to implement operationalized depression screening using the patient health questionnaire-2 (PHQ-2). The primary measure was rate of EMR-documented depression screening. Secondary measures were clinician perspectives on the feasibility and acceptability of implementing the PHQ-2. INTERVENTION: The intervention is a clinic-wide implementation of PHQ-2 screening supported by note templates, brief clinician training, referral resources for clinicians, and opportunities for indirect psychiatric consultation. RESULTS: Operationalized depression screening rates increased from 2% to 38%. All clinicians felt incorporation of depression screening was useful and feasible. CONCLUSIONS: Operationalized depression screening is feasible in ambulatory palliative care workflow, though optimization through having screening be completed prior to clinician visit might improve uptake.

The role of the anterior cingulate cortex in emotional response inhibition.

Although the involvement of the anterior cingulate cortex (ACC) in emotional response inhibition is well established, there are several outstanding issues about the nature of this involvement that are not well understood. The present study aimed to examine the precise contribution of the ACC to emotion-modulated response inhibition by capitalizing on fine temporal resolution of the event-related potentials (ERPs) and the recent advances in source localization. To this end, participants (N = 30) performed an indirect affective Go/Nogo task (i.e., unrelated to the emotional content of stimulation) that required the inhibition of a motor response to three types of visual stimuli: arousing negative (A-), neutral (N), and arousing positive (A+). Behavioral data revealed that participants made more commission errors to A+ than to N and A-. Electrophysiological data showed that a specific region of the ACC at the intersection of its dorsal and rostral subdivisions was significantly involved in the interaction between emotional processing and motor inhibition. Specifically, activity reflecting this interaction was observed in the P3 (but not in the N2) time range, and was greater during the inhibition of responses to A+ than to N and A-. Additionally, regression analyses showed that inhibition-related activity within this ACC region was associated with the emotional content of the stimuli (its activity increased as stimulus valence was more positive), and also with behavioral performance (both with reaction times and commission errors). The present results provide additional data for understanding how, when, and where emotion interacts with response inhibition within the ACC.

Effect of Temperature on the Germination of Five Coastal Provenances of Nothofagus glauca (Phil.) Krasser, the Most Representative Species of the Mediterranean Forests of South America.

Temperature is one of the most important abiotic factors affecting seed germination, and it is strongly influenced by local site conditions. Seeds of Nothofagus glauca, an endemic and vulnerable species of the Mediterranean region of Chile and the most representative of the Mediterranean forests of South America, were collected. In this study, we evaluated the effect of temperature on different germinative attributes of five N. glauca provenances representative of their natural distribution. The seeds were treated at a constant temperature (i.e., 18 °C, 22 °C, 26 °C, or 30 °C) in the absence of light for 40 days. The results show that in all the provenances, the germination ratio and energy increase linearly with temperature until reaching an optimum temperature (i.e., 22 °C), above which they decrease severely. At 22 °C, the response of average germination speed and germination vigor was significantly higher than with the other temperatures (performance of germination start day was not clear). The base temperature was around 18 °C and the maximum, above 30 °C, which may be close to thermo-inhibition. Given the threat of climate change, it is necessary to increase research in terms of the possible adaptation of this species to increased temperatures and prolonged periods of drought.

Danger is worse when it moves: neural and behavioral indices of enhanced attentional capture by dynamic threatening stimuli.

Both dynamic non-emotional stimuli (moving dots or digits) and danger-related static stimuli have previously shown to capture attention. This study explored whether the combination of the two factors (i.e., threatening moving stimuli), frequent in natural situations, enhances attentional capture. To this end, static and moving distractors containing emotionally negative and non-negative information were presented to 30 volunteers while they were engaged in a digit categorization task. Behavioral responses and event-related potentials (ERPs) were analyzed. Behavioral and electrophysiological data were convergent: moving negative distractors produced the longest reaction times in the digit categorization task, and elicited the highest amplitudes in the P1 component of the ERPs (peaking at 112ms), an electrophysiological signal of attentional capture. These results suggest that motion provides additional salience to threatening stimuli that facilitates attentional capture.

Negative brain: an integrative review on the neural processes activated by unpleasant stimuli.

Evolutionary pressure has led the nervous system to guarantee rapid and intense responses to negative events (dangerous, harmful or repugnant). Thus, the 'negative brain' (the set of neural mechanisms triggered by unpleasant or negative stimuli) is equipped with several specific characteristics. This review organizes the current data on the human negative brain in three blocks. Firstly, the "Input mechanisms" block describes those structures responsible for the rapid distribution of all sensory information. Secondly, the "Evaluation systems" block refers to the key pieces: those responsible for evaluating negative consequences of stimulation and deciding which response is the most appropriate for coping with them. Thirdly, the "Associated and output processes" block describes how evaluative elements may interact with other brain structures to modulate attention, store and recover situational information, activate defense/withdrawal motor programs (or plan new actions) and develop autonomic/motor actions to cope with the unpleasant event. Finally, an integrative summary that serves as a tentative model of the negative brain is provided.

Incidental encoding of emotional pictures: affective bias studied through event related brain potentials.

Emotional stimuli are better remembered than neutral stimuli. Most of the studies taking into account this emotional bias refer to explicit memory, use behavioral measures of the recall and predict better recall of negative stimuli. The few studies taking into account implicit memory and the valence emotional dimension are inconclusive on the effect of the stimulus' emotional valence. In the present study, 120 pictures (30 positive, 30 negative, 30 relaxing and 30 neutral) were shown to, and assessed by, 28 participants (study phase). Subsequently, event related brain potentials (ERPs) were recorded during the presentation of 120 new (shown for the first time) and 120 old (already shown in the study phase) pictures (test phase). No explicit instructions or clues related to recovery were given to participants, and a distractor task was employed, in order to maintain implicit the memory assessment. As expected from other studies' data, our results showed that old stimuli elicited an enhanced late positive component 450 ms after stimulus onset (repetition effect). Moreover, this effect was modulated by the stimuli's emotional valence, since the most positively valenced stimuli were associated with a decreased repetition effect with respect to the most negatively valenced stimuli. This effect was located at ventromedial prefrontal cortex. These results suggest the existence of a valence-mediated bias in implicit memory.

An electrophysiological study on the interaction between emotional content and spatial frequency of visual stimuli.

Previous studies suggest that the magnocellular pathway, a visual processing system that rapidly provides low spatial frequency information to fast-responding structures such as the amygdala, is more involved in the processing of emotional facial expressions than the parvocellular pathway (which conveys all spatial frequencies). The present experiment explored the spatio-temporal characteristics of the spatial frequency modulation of affect-related neural processing, as well as its generalizability to non-facial stimuli. To that aim, the event-related potentials (ERPs) elicited by low-pass filtered (i.e., high spatial frequencies are eliminated) and intact non-facial emotional images were recorded from 31 participants using a 60-electrode array. The earliest significant effect of spatial frequency was observed at 135 ms from stimulus onset: N135 component of the ERPs. In line with previous studies, the origin of N135 was localized at secondary visual areas for low-pass filtered stimuli and at primary areas for intact stimuli. Importantly, this component showed an interaction between spatial frequency and emotional content: within low-pass filtered pictures, negative stimuli elicited the highest N135 amplitudes. By contrast, within intact stimuli, neutral pictures were those eliciting the highest amplitudes. These results suggest that high spatial frequencies are not essential for the initial affect-related processing of visual stimuli, which would mainly rely on low spatial frequency visual information. According to present data, high spatial frequencies would come into play later on.

A Novel Mouse Model of Traumatic Optic Neuropathy Using External Ultrasound Energy to Achieve Focal, Indirect Optic Nerve Injury.

Traumatic optic neuropathy (TON) is a devastating cause of permanent visual loss following blunt injury to the head. Animal models for TON exist, but most fail to recapitulate the clinical scenario of closed head indirect trauma to the nerve and subsequent neurodegeneration. Thus, we developed a clinically-relevant animal model for TON using a novel ultrasonic pulse injury modality (sonication-induced TON; SI-TON). To trigger TON, a microtip probe sonifier was placed on the supraorbital ridge directly above the entrance of the optic nerve into the bony canal. An ultrasonic pulse was then delivered to the optic nerve. After injury, the number of RGCs in the retina as well as visual function measured by PERG steadily decreased over a two-week period. In the optic nerve, pro-inflammatory markers were upregulated within 6 hours following injury. Immunohistochemistry showed activation of microglia and infiltration of CD45-positive leukocytes in the optic nerve and initiation of a gliotic response. The SI-TON model is capable of delivering a non-contact concussive injury to the optic nerve and induce TON in mice. Thus, our data indicate that the SI-TON model reliably recapitulates the pathophysiology and progressive neurodegeneration seen in the human manifestation.

The influence of emotional context on attention in anxious subjects: neurophysiological correlates.

Several studies have shown the influence of threatening context on level of attention to target environmental stimuli. The present experiment explored the possibility that this influence of aversive context is particularly strong in anxious subjects, due to their known attentional bias towards negative information. Event-related potentials, that provide a direct index of attention-related cerebral processing, were recorded in 27 participants selected from a larger sample of 250, as a function of their trait anxiety scores (14 high, 13 low). State anxiety was also measured in selected subjects. Several contexts were presented: positive, negative, relaxing and neutral, and participants were instructed to attend, within these contexts, to a series of auditory stimuli. Threatening context triggered an increase in attention to these auditory stimuli only in conditions of high state anxiety, this increase being reflected in the greater amplitude of the P2 component, which is related to attentional processes. There were no significant differences in relation to trait anxiety. Data show that threatening context and high level of state anxiety in combination increase the quantity of attentional resources directed to the environment.

Working memory of emotional stimuli: Electrophysiological characterization.

Memorizing emotional stimuli in a preferential way seems to be one of the adaptive strategies brought on by evolution for supporting survival. However, there is a lack of electrophysiological evidence on this bias in working memory. The present study analyzed the influence of emotion on the updating component of working memory. Behavioral and electrophysiological indices were measured from a 3-back task using negative, neutral, and positive faces. Electrophysiological data evidenced an emotional influence on the working memory sensitive P3 component, which presented larger amplitudes for negative matching faces compared to neutral ones. This effect originated in the superior parietal cortex, previously reported to be involved in N-back tasks. Additionally, P3 results showed a correlation with reaction times, where higher amplitudes were associated with faster responses for negative matching faces. These findings indicate that electrophysiological measures seem to be very suitable indices of the emotional influence on working memory.

Neural activity associated with metaphor comprehension: spatial analysis.

Though neuropsychological data indicate that the right hemisphere (RH) plays a major role in metaphor processing, other studies suggest that, at least during some phases of this processing, a RH advantage may not exist. The present study explores, through a temporally agile neural signal--the event-related potentials (ERPs)--, and through source-localization algorithms applied to ERP recordings, whether the crucial phase of metaphor comprehension presents or not a RH advantage. Participants (n=24) were submitted to a S1-S2 experimental paradigm. S1 consisted of visually presented metaphoric sentences (e.g., "Green lung of the city"), followed by S2, which consisted of words that could (i.e., "Park") or could not (i.e., "Semaphore") be defined by S1. ERPs elicited by S2 were analyzed using temporal principal component analysis (tPCA) and source-localization algorithms. These analyses revealed that metaphorically related S2 words showed significantly higher N400 amplitudes than non-related S2 words. Source-localization algorithms showed differential activity between the two S2 conditions in the right middle/superior temporal areas. These results support the existence of an important RH contribution to (at least) one phase of metaphor processing and, furthermore, implicate the temporal cortex with respect to that contribution.

Lymphocyte adhesion and autoimmunity.

Aberrant lymphocytes signaling is one of the numerous mechanisms thought to be responsible for the pathogenesis of autoimmune diseases. One of the most successful approaches to the treatment of autoimmunity is through targeting of lymphocytes, whose multiple targetable functions include proliferation, cytokine secretion, and migration. The adhesion process is a critical step, not only for migration but also for their communication with antigen-presenting cells, and is therefore a clear target for therapy. This manuscript will discuss the migration of T cells, which are at the heart of many autoimmune responses. We will review the importance of increasing our comprehension of these events, focusing on migration since they enclose a multitude of potential therapeutic targets for autoimmunity. The interface between lymphocytes and antigen presenting cells and the formation of the immunological synapse will be reported in detail. We will address the following questions: What enables T cells to migrate to sites of injury, and what are the options to intervene? What is the contribution of co-receptors to T cell adhesion? How can we manipulate this knowledge for therapeutic purposes? Finally, we will review the latest data regarding current and future therapeutics that target the adhesion process, describing their strength and weaknesses.

El VIH y la proximidad corporal. Sexo, amor y silencio entre varones gay / HIV e proximidade corporal. Sexo, amor e silêncio entre homens gay / HIV and corporal proximity. Sex, love and silence between gay men

Resumen Este artículo presenta los resultados de un estudio etnográfico que tuvo como objetivo central analizar los modos en que el vivir con VIH se entrecruza con normativas de valoración social que delinean posibilidades de la proximidad corporal. A partir de una serie de visitas que se hicieron en un lugar de encuentro sexual para varones gay denominado "las cabinas", y recurriendo a distintas narrativas sobre lo que significa ser gay y vivir con el virus, se analiza cómo la identidad se posiciona según conocimientos relativos al amor y el sexo. Se concluye que algunas de las formas en que los acercamientos y los distanciamientos afectivos, así como otros elementos que regulan la interacción sexual -como el silencio- coadyuvan a configurar la experiencia de vivir con VIH.

Resumo Apresentamos os resultados de um estudo etnográfico cujo objetivo principal foi analisar as formas pelas quais a convivência com o HIV interage com normas de valoração social que delineiam possibilidades de proximidade corporal. A partir de uma série de visitas que foram feitas em um local de encontro sexual de gays chamado de "las cabinas", e recorrendo a diferentes narrativas sobre o que significa ser gay e viver com o vírus, analisa-se como a identidade é posicionada de acordo com conhecimentos relacionados ao amor e ao sexo. Conclui-se que algumas das maneiras pelas quais abordagens e distanciamentos afetivos, bem como outros elementos que regulam a interação sexual -como o silêncio- ajudam a moldar a experiência de viver com HIV.

Abstract We present the results of an ethnographic study, which the main objective was to analyze the ways in which living with HIV is intertwined with norms of social valuation that delineate possibilities of corporal proximity. From a series of visits made to a place of sexual encounters for gay men called "las cabinas", and resorting to other narratives about what it means to be gay and live with the virus, it is analyzed how the identity is positioned according to knowledge related to love and sex. In conclusion, some of the ways in which affective approaches and distances, as well as other elements that regulate sexual interaction - such as silence - help to shape the experience of living with HIV.