The wandering mind of men: ERP evidence for gender differences in attention bias towards attractive opposite sex faces

To examine the time course and automaticity of our attention bias towards attractive opposite sex faces, event-related potentials (ERPs) were recorded from 20 males and 20 females while they carried out a covert orienting task. Faces that were high, low or average in attractiveness, were presented in focus of attention, but were unrelated to task goals. Across the entire sample larger P2 amplitudes were found in response to both attractive and unattractive opposite sex faces, presumably reflecting early implicit selective attention to distinctive faces. In male but not female participants this was followed by an increased late slow wave for the attractive faces, signifying heightened processing linked to motivated attention. This latter finding is consistent with sexual strategy theory, which suggests that men and women have evolved to pursue different mating strategies with men being more attentive to cues such as facial beauty. In general, our ERP results suggest that, in addition to threat-related stimuli, other evolutionary-relevant information is also prioritized by our attention systems.     

n-3 fatty acids, ventricular arrhythmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes

OBJECTIVE

We carried out a secondary analysis in high-risk patients with a previous myocardial infarction (MI) and diabetes in the Alpha Omega Trial. We tested the hypothesis that in these patients an increased intake of the n-3 fatty acids eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and α-linolenic acid (ALA) will reduce the incidence of ventricular arrhythmias and fatal MI.

RESEARCH DESIGN AND METHODS

A subgroup of 1,014 post-MI patients with diabetes aged 60–80 years was randomly allocated to receive one of four trial margarines, three with an additional amount of n-3 fatty acids and one placebo for 40 months. The end points were ventricular arrhythmia–related events and fatal MI. The data were analyzed according to the intention-to-treat principle, using multivariable Cox proportional hazards models.

RESULTS

The patients consumed on average 18.6 g of margarine per day, which resulted in an additional intake of 223 mg EPA plus 149 mg DHA and/or 1.9 g ALA in the active treatment groups. During follow-up, 29 patients developed a ventricular arrhythmia–related events and 27 had a fatal MI. Compared with placebo patients, the EPA-DHA plus ALA group experienced less ventricular arrhythmia–related events (hazard ratio 0.16; 95% CI 0.04–0.69). These n-3 fatty acids also reduced the combined end-point ventricular arrhythmia–related events and fatal MI (0.28; 0.11–0.71).

CONCLUSIONS

Our results suggest that low-dose supplementation of n-3 fatty acids exerts a protective effect against ventricular arrhythmia–related events in post-MI patients with diabetes.There is strong evidence from prospective cohort studies and randomized trials that >250 mg/day of the fish fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) will reduce fatal coronary heart disease (CHD) by as much as 36% (1). There is also evidence, although less conclusive, that EPA-DHA reduces sudden death (2,3). Prospective cohort studies have provided evidence that the plant food–derived n-3 fatty acid α-linolenic acid (ALA) may reduce fatal CHD (4). Animal experiments showed that n-3 fatty acids reduce the vulnerability to cardiac arrhythmias (5). The Alpha Omega Trial tested the hypothesis that an additional intake of 0.4 g/day of EPA-DHA or 1.9 g/day of ALA will reduce fatal CHD and ventricular arrhythmia–related events in stable postmyocardial infarction (post-MI) patients (6). However, this hypothesis was not confirmed in the main analysis of the trial (7).A post hoc analysis of the Alpha Omega Trial showed that in post-MI patients with diabetes, EPA-DHA reduced both fatal CHD and ventricular arrhythmia–related events by 49% (7). The reduction in these end points was in accord with that obtained in the Gruppo Italiano per lo Studio della Sopravvivenza nell''Infarto miocardico (GISSI)-Prevenzione trial for fatal coronary and sudden death (8). In the Alpha Omega Trial, an even stronger reduction of 61% of ventricular arrhythmia–related events was observed for ALA. This evokes the question of whether post-MI patients with diabetes are particularly susceptible to protective effects of n-3 fatty acids on fatal CHD and ventricular arrhythmia–related events.In a cohort study of diabetic women, a dose-response relation was observed between fish consumption and CHD mortality (9). Women who consumed fish five or more times per week had a 64% lower risk of CHD mortality compared with those who consumed fish less than once per month. In a trial of heart failure patients with diabetes, a supplement of 0.9 g EPA-DHA per day reduced the composite end point of all-cause mortality or admission to the hospital for cardiovascular reasons significantly with 11% (10). Although evidence of the effect of fish consumption and EPA-DHA supplementation on fatal CHD in patients with diabetes is small, the available data are compatible with the hypothesis that EPA-DHA may protect against fatal CHD.The life expectancy of a 50-year-old patient with diabetes is 6 years shorter than that of a person without diabetes (11). This difference is largely due to an increased risk of macrovascular diseases among diabetic patients. In addition, they have an increased risk of fatal CHD (12) and an increased risk of sudden death (13,14). A previous MI in combination with diabetes especially makes patients prone to fatal CHD and ventricular arrhythmia–related sudden death (12,15). Therefore, post-MI patients with diabetes are a suitable group to test the hypothesis that n-3 fatty acids protect against fatal CHD and ventricular arrhythmia–related events.Overlap in the definitions of ventricular arrhythmia–related events and in fatal CHD was present in the main publication of the results of the Alpha Omega Trial (7). Both end points included fatal cardiac arrest and sudden death. In the present analysis, mutually exclusive definitions will be used; therefore, fatal CHD is limited to fatal MI. In the main publication, the two groups that received EPA-DHA were compared with the two groups that did not receive EPA-DHA. The same strategy was used for ALA. This was done because in the analysis of the primary end-point major cardiovascular events, the cumulative incidence of the four treatment groups did not differ. Here we present the results of an in-depth analysis of the effects of different n-3 fatty acids compared with placebo on ventricular arrhythmia–related events and fatal MI in stable post-MI patients with diabetes.     

Intraoperative glycemic control without insulin infusion during pediatric cardiac surgery for congenital heart disease

Background: Many studies are reporting that the occurrence of hyperglycemia in the postoperative period is associated with increased morbidity and mortality rates in children after cardiac surgery for congenital heart disease. This study sought to determine blood glucose levels in standard pediatric cardiac anesthesiological management without insulin infusions. Methods: The study population consisted of 204 consecutive pediatric patients aged from 3 days to 15.4 years undergoing open cardiac surgery for congenital heart disease between June 2007 and January 2009. Glucose‐containing fluids were not administrated intraoperatively, and all patients received high dose of opioids (sufentanil 10 mcg·kg^?1) and steroids (30 mg·kg^?1 methylprednisolone) iv. Glucose levels were measured before CPB, 10 min after initiation of CPB, every hour on CPB, post–CPB, and on arrival at intensive care unit (ICU). Results: Intraoperatively, only one patient had a glucose level <50 mg·dl^?1 (=34.2 mg·dl^?1), 57/204 patients (27.9%) had at least one intraoperative glucose >180 mg·dl^?1, but only 12 patients (5.8%) had a glucose level >180 mg·dl^?1 at ICU arrival. Thirty‐day mortality was 1.5% (3/204). Younger age, lower body weight, and lower CPB temperature were associated with hyperglycemia at ICU arrival, as were higher RACHS and Aristotle severity scores. Conclusion: A conventional (no insulin, no glucose) anesthetic management seems sufficient in the vast majority of patients (96.5%). Special attention should be paid to small neonates with complex congenital heart surgery, in whom insulin treatment may be contemplated.     

Superior mesenteric artery stent fracture leading to recurrent mesenteric ischemia

We report 2 cases of patients with recurrent symptoms of mesenteric ischemic disease after percutaneous transluminal angioplasty (PTA) and stenting due to superior mesenteric artery stent fracture. Both patients were treated by redo PTA and stenting successfully. Stent fractures, their complications, and management are discussed.     

Implementing electronic medication management at an Australian teaching hospital

We describe the implementation of an electronic medication management system (eMMS) in an Australian teaching hospital, to inform future similar exercises. The success of eMMS implementation depends on: a positive workplace culture (leadership, teamwork and clinician ownership); acceptance of the major impact on work practices by all staff; timely system response to user feedback; training and support for clinicians; a usable system; adequate decision support.     

A Comparison of Participants and Non-Participants in the Chennai Glaucoma Study—Rural Population

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss and blindness in elderly Americans. The etiology of this condition remains unknown and treatment options are limited. Some epidemiological findings point to a cardiovascular risk profile among persons with AMD. Documented risk factors for cardiovascular disease (such as age, smoking, hypertension, hypercholesterolemia, post-menopausal estrogen use, diabetes, and dietary intake of fats, alcohol and antioxidants) have also been associated with AMD in some studies. This raises the possibility that the causal pathways for cardiovascular disease and AMD may share similar risk factors. Future research on this hypothesis could lead to important insights into etiologic factors for AMD. Research could also identify modifiable risk factors and suggest new treatment options which could prevent AMD, slow its progression, or reduce visual loss. Susceptible individuals could then be targeted for improved health promotion and disease prevention measures for this disabling and highly prevalent disorder.