Acute esophageal necrosis following cardiac arrest: A rare and lethal syndrome with diagnostic challenges.

INTRODUCTION AND CLINICAL RELEVANCE: Acute esophageal necrosis (AEN) is a condition characterized by the necrosis of the distal portion of the esophageal mucosa. Risk factors predisposing to this condition are associated to compromised vascular perfusion (e.g. diabetes mellitus, chronic kidney disease, advanced age, and hypertension, shock states). Complications of AEN can be severe including UGI stricture, perforation and overall increased mortality. The true incidence of AEN remains uncertain due to potential subclincal presentations and early resolution. CASE PRESENTATION: The case outlined involves a 66-years-old obese male with history of alcoholism and lymph-edema of the left leg who presented to the emergency department with hematemesis, haemodynamic instability and impaired consciousness. Shortly after initial assessment, the patient went into cardiac arrest with pulse-less electrical activity (PEA). Return of spontaneous circulation (ROSC) was achieved following instigation of ALS protocol, fluid resuscitation and the administration of a total of 5 mg of adrenaline. Following stabilization, a CT scan was performed which reported a moderately enlarged esophagus with a thickened wall, liquid hypodense material within the esophagus and stomach, and liver cirrhosis. The emergent esophagogastroduodenoscopy (EGDS) revealed extensive mucosal findings indicative of diffuse necrosis with initial scarring, which was later diagnosed as AEN. The patient unfortunately deceased in ICU after developing progression of the AEN, post-cardiac arrest syndrome and liver failure. CLINICAL DISCUSSION: The presented case highlights several crucial clinical issues and management problems related to AEN. To diagnose AEN, EGDS is still the gold-standard since it allows direct inspection of the esophageal mucosal layer. The management of AEN necessitates a multidisciplinary approach that includes aggressive resuscitation, treatment of underlying comorbidities, and supportive care (e.g. proton pump inhibitors). The mortality rate for AEN remains high despite improvements in diagnosis and treatment highlighting the need to recognize this condition early and intervene promptly in the patients affected. Moreover, long-term sequelae like stricture formation of the esophagus and impaired esophageal motility may contribute to morbidity requiring continuos monitoring. Therefore, to optimize outcomes while reducing complications among affected patients, prompt identification associated with appropriate medical measures are essential. More research needs to be done aiming to better understand the pathophysiology of AEN thereby identifying strategies for its prevention or cure. CONCLUSIONS: AEN is a rare syndrome characterized by upper gastrointestinal bleeding and hypoxic damage of the esophageal mucosa, often associated with ischemia, gastric outlet obstruction, and compromised protective barriers. Treatment involves aggressive resuscitation, proton pump inhibitors, and monitoring for infection or perforation. However, despite intensive efforts, the mortality rate for AEN remains high at 32 %.

Mood regulates the physiological response to whole-body vibration at low intensity.

In the present study we evaluated the relationship between human vibrational comfort and psychophysiological processes. We exposed twenty-one participants to three levels of whole-body vibration at low intensity inside a full-scale mock-up of a ship cabin. Autonomic Nervous System (ANS) activity, mood and well-being state during each level of vibration exposure were measured. We found that a positive affective state determined greater changes in ANS activity in response to vibration variations compared to a negative affective condition. Furthermore, we found that variations of the vibration intensity did not always determine variations of the comfort experience at physiological and psychological level. The relevance of our findings is a challenge for comfort design research showing a gap between guidelines for comfort design and evidence based on psychophysiological responses to environmental stimulation.

Attentional capture in emotion comparison is orientation independent.

Recent findings on emotion comparison show a typical pattern of motor reactivity rising from attentional capture. When pairs of emotional faces are presented simultaneously, the most intense emotional face is recognized faster (Emotional Semantic Congruency-ESC effect). Furthermore, a global response speed advantage for emotional pairs with positive rather than negative average emotion intensity is observed (i.e., emotional size effect), with the choice for the happiest face resulting in a faster response than the choice for the angriest face within the pair (i.e., the happiness advantage). In two experiments, we asked whether these effects are orientation dependent, and thus linked to whether face processing is holistic or part-based. Participants were asked to choose the angriest/happiest face in emotional pairs displayed either in upright or inverted orientation and including (Experiment 1) or not including (Experiment 2) a neutral face. Beyond an overall facilitation for upright relative to inverted pairs, results showed orientation independent ESC and emotional size effects. Furthermore, the happiness advantage was present in emotional pairs of Experiment 2 but not in emotional pairs of Experiment 1, independently from face orientation. Together, results suggest that attentional capture in emotion comparison is immaterial on the type of face processing, being orientation invariant.

Widespread Arterial Thrombosis after ChAdOx1 nCov-19 Vaccination.

Vaccine-induced thrombotic thrombocytopenia is an uncommon complication of COVID-19 vaccines using adenovirus mRNA carriers and has been associated with thrombosis of the cerebral venous sinuses and portal system. We report a case of a 69-year-old woman admitted to the intensive care unit due to stroke caused by thrombosis of the right carotid artery 9 days after receiving the ChAdOx1 nCov-19 vaccine. Further investigations demonstrated multiple thrombi in the arterial tree in the absence of any venous involvement. The clinical course and the treatment are described and discussed.

Large as being on top of the world and small as hitting the roof: a common magnitude representation for the comparison of emotions and numbers.

Previous work on the direct speed-intensity association (SIA) on comparative judgement tasks involved spatially distributed responses over spatially distributed stimuli with high motivational significance like facial expressions of emotions. This raises the possibility that the inferred stimulus-driven regulation of lateralized motor reactivity described by SIA, which was against the one expected on the basis of a valence-specific lateral bias, was entirely due to attentional capture from motivational significance (beyond numerical cognition). In order to establish the relevance of numerical cognition on the regulation of attentional capture we ran two complementary experiments. These involved the same direct comparison task on stimulus pairs that were fully comparable in terms of their analog representation of intensity but with different representational domain and motivational significance: symbolic magnitudes with low motivational significance in experiment 1 vs. emotions with rather high motivational significance in experiment 2. The results reveal a general SIA and point to a general mechanism regulating comparative judgements. This is based on the way spatial attention is captured toward locations that contain the stimulus which is closest in term of relative intensity to the extremal values of the series, regardless from its representational domain being it symbolic or emotional.

Acoustic comfort depends on the psychological state of the individual.

Recent studies have shown that comfort can be influenced more by psychological processes than from the characteristics of environmental stimulation. This is relevant for different industrial sectors, where comfort is defined only as a function of the intensity of external stimuli. In the present study, we measured physiological and psychological comfort during the exposure to four levels of acoustic noise [from 45 to 55 dB(A)] corresponding to different comfort classes inside a full-scale mock-up of a cruise ship cabin. We found an increase of psychological and physiological discomfort for higher noise intensities, but not for all the intensities defining the comfort classes. Furthermore, we found that negative psychological states determine a lower physiological sensitivity to acoustic noise variations compared to positive states. Our results show that, at normal/low intensities, psychological processes have a greater role in determining acoustic comfort when compared to the stimulus intensity. Practitioner Summary: This study shows that psychological factors can be more relevant in determining acoustic comfort inside a ship cabin than the intensity of acoustic stimulus itself. This finding suggests that the cruise industry should consider not only the engineering measurements when evaluating comfort on board, but also the passenger' psychological state. Abbreviations: AIC: akaike information criterion; CCT: colour correlated temperature; cd/m2: candela/square meters; df: degrees of freedom; F-test: Fisher's test; HF: high frequency; HR: heart rate; HRV: heart rate variability; HSV: hue saturation value; K: kelvin; LF: low frequency; LF/HF: low frequency to high frequency ratio; lme: linear mixed effects; ms: milliseconds; nu: normalized unit; p: p value; pNN50: percentage of adjacent pairs of normal to normal RR intervals differing by more than 50 milliseconds; r2: coefficient of determination; rc: concordance correlation coefficient; RMSSD: square root of the mean normal to normal RR interval; SD: standard deviation; SDNN: standard deviation of normal to normal RR intervals; SEM: standard error of the mean; t-test: student's tests; χ2: chi-square test.

Emotional Semantic Congruency based on stimulus driven comparative judgements.

A common cognitive process in everyday life consists in the comparative judgements of emotions given a pair of facial expressions and the choice of the most positive/negative among them. Results from three experiments on complete-facial expressions (happy/angry) and mixed-facial expressions (neutral/happy-or-angry) pairs viewed with (Experiment 1 and 3) or without (Experiment 2) foveation and performed in conditions in which valence was either task relevant (Experiment 1 and 2) or task irrelevant (Experiment 3), show that comparative judgements of emotions are stimulus driven. Judgements' speed increased as the target absolute emotion intensity grew larger together with the average emotion of the pair, irrespective of the compatibility between the valence and the side of motor response: a semantic congruency effect in the domain of emotion. This result undermines previous interpretation of results in the context of comparative judgements based on the lateralization of emotions (e.g., SNARC-like instructional flexibility), and is fully consistent with our formalization of emotional semantic congruency: the direct Speed-Intensity Association model.

Don't worry, be active: how to facilitate the detection of errors in immersive virtual environments.

The current research aims to study the link between the type of vision experienced in a collaborative immersive virtual environment (active vs. multiple passive), the type of error one looks for during a cooperative multi-user exploration of a design project (affordance vs. perceptual violations), and the type of setting in which multi-user perform (field in Experiment 1 vs. laboratory in Experiment 2). The relevance of this link is backed by the lack of conclusive evidence on an active vs. passive vision advantage in cooperative search tasks within software based on immersive virtual reality (IVR). Using a yoking paradigm based on the mixed usage of simultaneous active and multiple passive viewings, we found that the likelihood of error detection in a complex 3D environment was characterized by an active vs. multi-passive viewing advantage depending on: (1) the degree of knowledge dependence of the type of error the passive/active observers were looking for (low for perceptual violations, vs. high for affordance violations), as the advantage tended to manifest itself irrespectively from the setting for affordance, but not for perceptual violations; and (2) the degree of social desirability possibly induced by the setting in which the task was performed, as the advantage occurred irrespectively from the type of error in the laboratory (Experiment 2) but not in the field (Experiment 1) setting. Results are relevant to future development of cooperative software based on IVR used for supporting the design review. A multi-user design review experience in which designers, engineers and end-users all cooperate actively within the IVR wearing their own head mounted display, seems more suitable for the detection of relevant errors than standard systems characterized by a mixed usage of active and passive viewing.

Faster but Less Careful Prehension in Presence of High, Rather than Low, Social Status Attendees.

Ample evidence attests that social intention, elicited through gestures explicitly signaling a request of communicative intention, affects the patterning of hand movement kinematics. The current study goes beyond the effect of social intention and addresses whether the same action of reaching to grasp an object for placing it in an end target position within or without a monitoring attendee's peripersonal space, can be moulded by pure social factors in general, and by social facilitation in particular. A motion tracking system (Optotrak Certus) was used to record motor acts. We carefully avoided the usage of communicative intention by keeping constant both the visual information and the positional uncertainty of the end target position, while we systematically varied the social status of the attendee (a high, or a low social status) in separated blocks. Only thirty acts performed in the presence of a different social status attendee, revealed a significant change of kinematic parameterization of hand movement, independently of the attendee's distance. The amplitude of peak velocity reached by the hand during the reach-to-grasp and the lift-to-place phase of the movement was larger in the high rather than in the low social status condition. By contrast, the deceleration time of the reach-to-grasp phase and the maximum grasp aperture was smaller in the high rather than in the low social status condition. These results indicated that the hand movement was faster but less carefully shaped in presence of a high, but not of a low social status attendee. This kinematic patterning suggests that being monitored by a high rather than a low social status attendee might lead participants to experience evaluation apprehension that informs the control of motor execution. Motor execution would rely more on feedforward motor control in the presence of a high social status human attendee, vs. feedback motor control, in the presence of a low social status attendee.

Bodily action penetrates affective perception.

Fantoni & Gerbino (2014) showed that subtle postural shifts associated with reaching can have a strong hedonic impact and affect how actors experience facial expressions of emotion. Using a novel Motor Action Mood Induction Procedure (MAMIP), they found consistent congruency effects in participants who performed a facial emotion identification task after a sequence of visually-guided reaches: a face perceived as neutral in a baseline condition appeared slightly happy after comfortable actions and slightly angry after uncomfortable actions. However, skeptics about the penetrability of perception (Zeimbekis & Raftopoulos, 2015) would consider such evidence insufficient to demonstrate that observer's internal states induced by action comfort/discomfort affect perception in a top-down fashion. The action-modulated mood might have produced a back-end memory effect capable of affecting post-perceptual and decision processing, but not front-end perception. Here, we present evidence that performing a facial emotion detection (not identification) task after MAMIP exhibits systematic mood-congruent sensitivity changes, rather than response bias changes attributable to cognitive set shifts; i.e., we show that observer's internal states induced by bodily action can modulate affective perception. The detection threshold for happiness was lower after fifty comfortable than uncomfortable reaches; while the detection threshold for anger was lower after fifty uncomfortable than comfortable reaches. Action valence induced an overall sensitivity improvement in detecting subtle variations of congruent facial expressions (happiness after positive comfortable actions, anger after negative uncomfortable actions), in the absence of significant response bias shifts. Notably, both comfortable and uncomfortable reaches impact sensitivity in an approximately symmetric way relative to a baseline inaction condition. All of these constitute compelling evidence of a genuine top-down effect on perception: specifically, facial expressions of emotion are penetrable by action-induced mood. Affective priming by action valence is a candidate mechanism for the influence of observer's internal states on properties experienced as phenomenally objective and yet loaded with meaning.

Web party effect: a cocktail party effect in the web environment.

In goal-directed web navigation, labels compete for selection: this process often involves knowledge integration and requires selective attention to manage the dizziness of web layouts. Here we ask whether the competition for selection depends on all web navigation options or only on those options that are more likely to be useful for information seeking, and provide evidence in favor of the latter alternative. Participants in our experiment navigated a representative set of real websites of variable complexity, in order to reach an information goal located two clicks away from the starting home page. The time needed to reach the goal was accounted for by a novel measure of home page complexity based on a part of (not all) web options: the number of links embedded within web navigation elements weighted by the number and type of embedding elements. Our measure fully mediated the effect of several standard complexity metrics (the overall number of links, words, images, graphical regions, the JPEG file size of home page screenshots) on information seeking time and usability ratings. Furthermore, it predicted the cognitive demand of web navigation, as revealed by the duration judgment ratio (i.e., the ratio of subjective to objective duration of information search). Results demonstrate that focusing on relevant links while ignoring other web objects optimizes the deployment of attentional resources necessary to navigation. This is in line with a web party effect (i.e., a cocktail party effect in the web environment): users tune into web elements that are relevant for the achievement of their navigation goals and tune out all others.