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.

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.

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.

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.

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.

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.

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.

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.

Papel de la fotoaféresis en el tratamiento del rechazo celular agudo refractario en trasplante renal / Role of photopheresis in the treatment of refractory cellular rejection in kidney transplantation

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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.

Differential neural mechanisms underlying exogenous attention to peripheral and central distracters.

Mechanisms underlying exogenous attention to central and peripheral distracters were temporally and spatially explored while 30 participants performed a digit categorization task. Neural (event-related potentials-ERPs-, analyzed both at the scalp and at the voxel level) and behavioral indices of exogenous attention were analyzed. Distracters were either biologically salient or neutral, in order to test whether the exogenous attention bias to the former observed in previous studies is independent of, or interacts with, distracter eccentricity. Two subcomponents of the N2 component of the ERPs, N2olp and N2ft, reflected processes related to peripheral distracters processing. N2olp effects, located in the dorsal attention network (supplementary motor area), were probably related to covert reorientation to peripheral distracters. N2ft effects, located in the default mode network (posterior cingulate cortex), appeared to reflect less effort in the ongoing task when peripheral distracters were presented. N2ft also showed a biological saliency effect which was independent of eccentricity and was located in the polar/ventral prefrontal cortex. P3 showed greater amplitudes to centrally presented distracters. These latter effects were located in TEO (visual cortex), and would be functionally associated with spatial interference between the target and central distracters. Behavior showed the relevance of both central and peripheral distracters in exogenous attention. These results indicate that exogenous attention to peripheral distracters differed in temporal and spatial terms from exogenous attention to central distracters and that it is biased towards biologically salient events irrespective of their eccentricity.

Exogenous attention to facial vs non-facial emotional visual stimuli.

The capacity of the two types of non-symbolic emotional stimuli most widely used in research on affective processes, faces and (non-facial) emotional scenes, to capture exogenous attention, was compared. Negative, positive and neutral faces and affective scenes were presented as distracters to 34 participants while they carried out a demanding digit categorization task. Behavioral (reaction times and number of errors) and electrophysiological (event-related potentials-ERPs) indices of exogenous attention were analyzed. Globally, facial expressions and emotional scenes showed similar capabilities to attract exogenous attention. Electrophysiologically, attentional capture was reflected in the P2a component of ERPs at the scalp level, and in left precentral areas at the source level. Negatively charged faces and scenes elicited maximal P2a/precentral gyrus activity. In the case of scenes, this negativity bias was also evident at the behavioral level. Additionally, a specific effect of facial distracters was observed in N170 at the scalp level, and in the fusiform gyrus and inferior parietal lobule at the source level. This effect revealed maximal attention to positive expressions. This facial positivity offset was also observed at the behavioral level. Taken together, the present results indicate that faces and non-facial scenes elicit partially different and, to some extent, complementary exogenous attention mechanisms.

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.

Actitudes de las enfermeras hacia el cuidado del paciente en la dimensión psicológica y espiritual en los Servicios de Medicina, Cirugía, Traumatología y Gineco - Obstetricia del Hospital Nacional Cayetano Heredia diciembre - 2009 / Attitudes of the nurses toward the care of the patient in the psychological dimensions and spiritual in the Medicine Services, Surgery, Traumatology and Gynecology-Obstetrics at the National Hospital Cayetano Heredia, December - 2009

La Enfermería en sus orígenes fue concebida como una ocupación basada en la experiencia práctica y el conocimiento común, sin embargo en la actualidad "la Enfermería es considerada como una profesión de servicio, con un gran impacto social cuya misión medular es la atención a los seres humanos en sus experiencias de Salud y Enfermedad", basada en principios y conocimientos que le permiten brindar una atención de calidad y desarrollarse mejor como profesión, es por ello que el profesional de enfermería requiere una serie de competencias cognitivas y técnicas, de un gran compromiso social y ética en el desempeño de sus actividades". Sin embargo, en la parte práctica propiamente dicha se observa que la enfermera más se dedica a la administración de medicamentos y a la realización de procedimientos técnicos, que al cuidado directo de las respuestas humanas. Ante lo anteriormente expuesto se formula el siguiente problema de investigación ¿Cuál es la Actitud de las enfermeras hacia el cuidado del paciente en la dimensión psicológica y espiritual en los servicios de Medicina, Cirugía, Traumatología y Gineco-Obstetricia del Hospital Nacional Cayetano Heredia?, con el objetivo de identificar la ¿Cuál es la actitud de las enfermeras hacia el cuidado del paciente en la dimensión psicológica y espiritual en los servicios de Medicina, Cirugía, Traumatología y Gineco-Obstetricia del Hospital Nacional Cayetano Heredia? con el propósito de proporcionar información valida, actualizada y confiable a las autoridades de enfermería de la institución sobre aspectos importantes del ejercicio profesional a fin de sensibilizarlos y motivar la elaboración de programas de actualización permanente sobre aspectos conceptuales de la profesión y su esencia, con énfasis en el tema de estudio, con el fin último de mejorar la atención que se brinda al usuario y la imagen de la enfermera en la sociedad, reflejados en el cambio de actitud del profesional de enfermaría hacia el cuidado que...

Nursing was originally conceived as an occupation based on practical experience and common knowledge, however at present ôNursing is regarded as a profession of service, with a great social impact whose core mission is to care for loved human experiences in health and disease" based on principles and knowledge that allow it to provide quality care and better developed as a profession, which is why the nurse requires a range of cognitive skills and techniques, a strong commitment social and ethical performance of their activities. However, the actual practice shows that the nurse is engaged in more medication administration and implementation of technical procedures that the direct care of the human responses. Given the above it is drawn up the following research problem what is the attitude of nurses towards the care of the patient's psychological and spiritual dimension in the services of medicine, surgery, traumatology and Gynecology-Obstetrics at the National Hospital Cayetano Heredia? With the aim of identifying of what is the attitude of nurses towards the care of the patient's psychological and spiritual dimension in the services of Medicine, Surgery, Traumatology and Gynecology-Obstetrics at the National Hospital Cayetano Heredia? in order to provide accurate, current and reliable nursing authorities of the institution on important aspects of professional practice in order to sensitize and motivate the development of programs for updating the conceptual aspects of the profession and its essence, with emphasis on the subject of study, with the ultimate aim of improving the care provided to the user and the image of the nurse in society, reflected in the change of attitude toward the infirmary professional care provided. The method used was descriptive cross-sectional, population consisted of all the hospital care nurses, the sample consisted of 49 nurses who met the inclusion criteria and were obtained by non-probability sampling. The instrument for...

Enteroparasitosis en alumnos de educación básica de la ciudad de Antofagasta (2006 - 2007) / Enteroparasitism in students of basic education in two municipal schools of the city of Antofagasta (2006-2007)

In the northern part of Chile, due to its geoclimatic characteristics, enteroparasitosis in school children is mainly due to protozoos is such as Giardiosis and Blastocystosis, and Enterobiosis among helminthic infections. During the years 2006 and 2007, we made an enteroparasitosis survey of 92 school children in grades 1 to 8 in two municipal schools of Antofagasta. The global prevalence rate of parasites and commensals was 83.69%. We found frequencies of 68.48% for Blastocystis hominis, 8.70% for Giardia duodenalis, and 23.91% for Enterobius vermicularis. The frequencies for commensals were 18.48% for Entamoeba coli, 16.30% for Endolimax nana, 5.43% for Chilomastix mesnili and 3.26% for Lodamoeba bütschlii. We conclude that the frequency of infection by parasites and commensals among school children is related to the deficient sanitary conditions present in some sectors of the city of Antofagasta, associated with socioeconomic and cultural factors of the population.

En el norte de Chile por las características geoclimáticas, las enteroparasitosis en escolares se centra principalmente en protozoosis como la Giardiosis y Blastocistosis y la Enterobiosis entre las helmintiasis. Durante los años 2006 y 2007 se encuestó enteroparasitológicamente a 92 escolares que cursaban entre 1° y 8° básico en dos escuelas municipales de Antofagasta. La tasa de prevalencia global por parásitos y comensales fue de 83,69%. Con indicadores de 68,48% para Blastocystis hominis y 8,70% para Giardia duodenalis, y de 23,91% para Enterobius vermicularis. Entre los comensales se encontró Entamoeba coli (18,48%), Endolimax nana (16,30%), Chilomastix mesnili (5,43%) y Iodamoeba bütschlii (3,26%). Se concluye que la frecuencia de infecciones por parásitos y comensales entre los escolares estaría relacionada con las condiciones sanitarias deficitarias presentes en algunos sectores de la ciudad de Antofagasta, asociadas a factores socioeconómicos y culturales de la población.

Immunocytochemical evidence for the coexistence of aromatase P450 and estrogen receptor α in the pituitary gland of the adult male rat

In previous studies we demonstrated the immunocytochemical expression of aromatase in rat pituitary cells. The aim of the present study is to demonstrate the synthesis of the enzyme through the expression of the mRNA of the enzyme in pituitary cells by in situ hybridization and the relationship between the immunocytochemical expression of aromatase and estrogen receptor α in adult male rats. In situ hybridization revealed that aromatase-mRNA is located in the cytoplasm of 41% of pituitary cells. By immunocytochemistry, different patterns of reaction for aromatase were found. Moreover, using immunocytochemistry and RT-PCR, all aromatase-positive tumors proved be estrogen receptor α-positive tumors. The immunocytochemical coexistence of aromatase and estrogen receptor α was found. These observations demonstrate the synthesis of aromatase in the pituitary gland and its functional ability to develop its estrogenic effects mediated by estrogen receptor α (AU)

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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.