evidence from a systematic review and pooled lesion analysis

Despite claims that lesional mania is associated with right-hemisphere lesions, supporting evidence is scarce, and association with specific brain areas has not been demonstrated. Here, we aimed to test whether focal brain lesions in lesional mania are more often right- than left-sided, and if lesions converge on areas relevant to mood regulation. We thus performed a systematic literature search (PROSPERO registration CRD42016053675) on PubMed and Web-Of-Science, using terms that reflect diagnoses and structures of interest, as well as lesional mechanisms. Two researchers reviewed the articles separately according to PRISMA Guidelines, selecting reports of adult-onset hypomania, mania or mixed state following a focal brain lesion, for pooled-analyses of individual patient data. Eligible lesion images were manually traced onto the corresponding MNI space slices, and lesion topography analyzed using standard brain atlases. Using this approach, data from 211 lesional mania patients was extracted from 114 reports. Among 201 cases with focal lesions, more patients had lesions involving exclusively the right (60.7%) than exclusively the left (11.4%) hemisphere. In further analyses of 56 eligible lesion images, while findings should be considered cautiously given the potential for selection bias of published lesion images, right-sided predominance of lesions was confirmed across multiple brain regions, including the temporal lobe, fusiform gyrus and thalamus. These, and several frontal lobe areas, were also identified as preferential lesion sites in comparisons with control lesions. Such pooled-analyses, based on the most comprehensive dataset of lesional mania available to date, confirm a preferential association with right-hemisphere lesions, while suggesting that several brain areas/circuits, relevant to mood regulation, are most frequently affected.publishersversionpublishe

Immortality of the soul as an intuitive idea: towards a psychological explanation of the origins of afterlife beliefs

This study tried to investigate if intuitive ideas about the continuation of the Self after death determine the way people represent the state of being dead, and, in this way, investigate possible psychological origins of afterlife beliefs, which constitute a recurrent cultural phenomenon. A semi-structured interview and a self-report questionnaire were used to obtain information on the experience of imagining oneself as dead and the representation of the dead-I of young adults. he results suggest that (1) there is a tendency to imagine the state of being dead as a continuation of the I, even in the absence of explicit afterlife beliefs; (2) perceptual, emotional, epistemic and desire experiences are associated to the dead-I; (3) the representation of the dead-I seems to be determined by an interaction between cognitive processes related to self-awareness and theory of mind, and the cultural afterlife beliefs explicitly learned. A previous alternative hypothesis, suggesting that simulation constraints were responsible for the emergence of non-reflective afterlife concepts (Bering, 2002, 2006) is not completely supported by our results. he data presented here suggest that immortality of the soul might be an intuitive religious concept, connected to the experience of the Self and to the implicit theorization that the experienced Self is independent from the body. Future studies should focus on the collection of cross-cultural and developmental data

North American monsoon and convectively coupled equatorial waves simulated by IPCC AR4 coupled GCMs

This study evaluates the fidelity of North American monsoon and associated intraseasonal variability in the Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report (AR4) coupled general circulation models (CGCMs). Twenty years of monthly precipitation data from each of the 22 models' twentieth-century climate simulations, together with the available daily precipitation data from 12 of them, are analyzed and compared with Global Precipitation Climatology Project (GPCP) monthly and daily precipitation. The authors focus on the seasonal cycle and horizontal pattern of monsoon precipitation in conjunction with the two dominant convectively coupled equatorial wave modes: the eastward-propagating Madden-Julian oscillation (MJO) and the westward-propagating easterly waves. The results show that the IPCC AR4 CGCMs have significant problems and display a wide range of skill in simulating the North American monsoon and associated intraseasonal variability. Most of the models reproduce the monsoon rainbelt, extending from southeast to northwest, and its gradual northward shift in early summer, but overestimate the precipitation over the core monsoon region throughout the seasonal cycle and fail to reproduce the monsoon retreat in the fall. Additionally, most models simulate good westward propagation of the easterly waves, but relatively poor eastward propagation of the MJO and overly weak variances for both the easterly waves and the MJO. There is a tendency for models without undiluted updrafts in their deep convection scheme to produce better MJO propagation.open221

Significant benefits of AIP testing and clinical screening in familial isolated and young-onset pituitary tumors

Context Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs). Objective To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients. Design 12-year prospective, observational study. Participants & Setting We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases. Interventions & Outcome AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310). Results Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650). Conclusions Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700