The differential processing of verbal jokes by neural substrates in indigenous and Han Chinese populations: An fMRI study

Limited research has been conducted on humor among the Taiwanese indigenous (IND) population. This study attempted to identify the differential neural correlates of humor comprehension and appreciation between IND and Han Chinese (HAN) populations. Each participant was presented with jokes and non-jokes. IND participants when encountered with jokes displayed a greater activation of the mesolimbic dopaminergic reward system, including the amygdala, midbrain, and nucleus accumbens than HAN participants. This suggests a more pleasurable response and appreciation of humor. The IND group also displayed greater activation in the right temporoparietal junction (rTPJ) than HAN, suggesting that the IND group may experience a greater sense of novelty and be more involved in social understanding, thus exhibiting greater humor appreciation. In terms of humor comprehension, both IND and HAN showed greater activation in the superior temporal gyrus (STG) and dorsal anterior cingulate cortex (dACC). IND exhibited greater activation in the anterior STG (aSTG), while HAN showed greater activation in the posterior STG (pSTG). This suggests that the IND tends to integrate emotional messages, whereas the HAN focuses on comprehending semantic cognitive information. Interestingly, HAN did not show any greater activation than IND in terms of appreciation of humor. These group disparities have substantial implications for advancing our knowledge of the neural mechanisms underlying humor comprehension and appreciation.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Amygdala-frontoparietal effective connectivity in creativity and humor processing

Although both creativity and humor elicit experiences of surprise followed by appreciation, it remains unknown whether shared or distinct patterns of effective connectivity are involved in their processing. The present fMRI study used dynamic causal modeling and parametrical empirical Bayes analysis to examine the effective connectivity between the amygdala and frontoparietal network during two-stage creativity and humor processing. We examined processing during the setup and punch line stages for creativity and humor, including typical forms (alternate uses for creativity and incongruity-resolution humor), atypical forms (aesthetic uses for creativity and nonsense humor), and baseline forms. Our focus was on the mesolimbic pathway during the punch line stage. We found that the amygdala plays a key role in expectation violation and appreciation. Broadly, amygdala-to-IFG connectivity was important for evaluating typical and atypical forms of both creativity and humor, while amygdala-to-precuneus connectivity was involved in evaluating typical forms. Amygdala-to-IFG connectivity was involved in the expectation violation to resolution stage of processing for typical and atypical forms of creativity and humor. Amygdala-to-precuneus connectivity was involved in processing the novelty and usefulness of typical forms of creativity (alternate uses) and understanding others' intentions in typical forms of humor (incongruity-resolution). Interestingly, VTA-to-amygdala connectivity was involved in processing the appreciation of both typical (incongruity-resolution humor) and atypical (nonsense humor) forms of humor while amygdala-to-VTA connectivity was involved in processing the appreciation of atypical (aesthetic uses) forms of creativity. Altogether, these findings suggest that the amygdala and frontoparietal circuitry are critical for creativity and humor processing.

Verification of the Four-Stage Model of Humor Processing: Evidence from an fMRI Study by Three-Element Verbal Jokes

The four-stage model comprises the expectation, incongruity, resolution, and elaboration stages of humor processing. In previous studies, most researchers used two-element jokes (setup and punch line) as stimuli, based on experimental methods, to explore the humor process. By contrast, the present study used a humor corpus with the novelty of three-element verbal jokes to perform direct separation from the material and clarify the humor processes. In this study, we used three-element verbal jokes and nonjokes, and we conducted a repeated-measures analysis of variance with a 3 × 2 two-way within-subject design. In humor processing, the posterior insula and middle frontal gyrus were mainly activated in the expectation; the middle temporal gyrus and the medial frontal gyrus in the incongruity; the inferior frontal gyri, superior frontal gyrus, and inferior parietal lobule in the resolution; and the ventromedial prefrontal cortex, amygdala, anterior insula, nucleus accumbens, and midbrain in the elaboration. The contributions of this study lie in its use of a humor corpus with the novelty of self-compiled three-element jokes, which not only successfully verified the models established in previous studies but added the expectation to the model; thus, this study separated the expectation and incongruity processes, making humor processing more complete.

Cultural Differences in How People Deal with Ridicule and Laughter: Differential Item Functioning between the Taiwanese Chinese and Canadian English Versions of the PhoPhiKat-45

The PhoPhiKat-45 measures three dispositions toward ridicule and laughter, including gelotophobia (i.e., the fear of being laughed at), gelotophilia (i.e., the joy of being laughed at), and katagelasticism (i.e., the joy of laughing at others). Despite numerous cultural adaptations, there is a paucity of cross-cultural studies investigating measurement invariance of this measure. Undergraduate students from a Canadian university (N = 1467; 71.4% females) and 14 universities in Taiwan (N = 1274; 64.6% females) completed the English and Chinese PhoPhiKat-45 measures, respectively. Item response theory and differential item functioning analyses demonstrated that most items were well-distributed across the latent continuum. Five of 45 items were flagged for DIF, but all values had negligible effect sizes (McFadden's pseudo R² < 0.13). The Canadian sample was further subdivided into subsamples who identified as European White born in Canada (n = 567) and Chinese born in China, Hong Kong, or Taiwan (n = 180). In the subgroup analyses, no evidence of DIF was found. Findings support the utility of this measure across these languages and samples.

Money or funny: Effective connectivity during service recovery with a DCM-PEB approach

While monetary compensation is considered the most effective service recovery strategy, relief theory claims that humor may also be useful in service recovery situations. This study investigated the effects of humor in service recovery using dynamic causal modeling and parametric empirical Bayes analysis to identify effective connectivity (EC) patterns in the dopaminergic reward system across four conditions representing different service recovery strategies: monetary compensation and humor (MH), monetary compensation and an apology (MA), non-monetary compensation using humor (H), and non-monetary compensation using an apology (CON, the control condition). The findings support the importance of the nucleus accumbens (NAc) in the monetary compensation (MH and MA) conditions and the amygdala in the non-monetary compensation (H and CON) conditions. Monetary compensation (MH and MA) resulted in right substantia nigra (rSN) to NAc EC, suggesting the processing of recovery satisfaction associated with perceived outcome fairness. Conversely, non-monetary compensation strategies (H and CON) resulted in left substantia nigra (lSN) to amygdala EC, suggesting the processing of satisfaction related to perceived interactional fairness. The use of humor for service recovery resulted in VTA-to-lSN-to-amygdala EC during humor appreciation, while the use of apologies (CON and MA) resulted in lSN-to-amygdala and lSN-to-VTA connectivity. Surprisingly, processing satisfaction in the MH condition did not activate the amygdala during humor appreciation. Coping humor could be norm-violating for service recovery, and its effectiveness depends on multiple factors. The results suggest that monetary compensation, humorous responses, and apologies play key roles in neurological responses to service recovery strategies.

Effective connectivity of the amygdala during the consumption of erotic, sexual humor, and monetary rewards with a DCM-PEB approach

While a large body of research exists on the processing of monetary rewards, less is known about sexual reward processing. This study aimed to identify effective connectivity for the consumption of sexual (erotic and sexual humor) and non-sexual (monetary) rewards, using dynamic causal modeling and parametric empirical Bayes with subjective hedonic ratings included. Our results support the importance of the amygdala for sexual humor amusement, the nucleus accumbens (NAc) for monetary rewards, and the lateral orbitofrontal cortex (lOFC) for erotic pleasure. The amygdala, NAc, and lOFC are major dopaminergic targets with known roles in the reward circuitry. Appreciating sexual humor was associated with ventral tegmental area (VTA) to amygdala connectivity. Enjoying monetary gains was associated with VTA-to-NAc and amygdala-to-NAc connectivity. The mesolimbic dopamine system originates in the VTA and sends major projections to the amygdala and NAc. Specifically, sexual humor appreciation was associated with effective connectivity from the ventromedial prefrontal cortex (vmPFC) to the amygdala, suggesting that subjective pleasure triggers activation of the vmPFC which exerts an excitatory influence on the amygdala. Unexpectedly, processing pleasure from monetary gains was linked to VTA-to-vmPFC connectivity, rather than the expected vmPFC-to-NAc connectivity. Importantly, we identified core roles for the amygdala. Sexual humor appreciation was associated with VTA-to-amygdala and vmPFC-to-amygdala effective connectivity, while we found amygdala-to-lOFC connectivity for erotic pleasure and amygdala-to-NAc connectivity for pleasure from monetary gains. Our findings represent an important step in understanding how effective connectivity in the mesocorticolimbic-amygdala circuitry differs for processing the consumption of sexual and monetary rewards.

Differential Neural Substrates for Responding to Monetary, Sexual Humor, and Erotic Rewards

Sexual humor involves neural mechanisms related to both humor and sexual arousal. However, evidence on the role of the amygdala in processing sexual humor is lacking. Unlike erotic stimuli that directly involve a biological drive, sexual humor gains its value through learned associations. Processes related to responding to erotic versus monetary rewards have been identified in the lateral orbitofrontal cortex (lOFC) along a postero-anterior axis, but it is less clear whether these processes are also active during the appreciation of sexual humor. Results showed the processing of sexual humor appreciation in the amygdala. Psychophysiological interaction (PPI) analysis further identified functional connectivity in the amygdala-midbrain coupling during sexual humor versus monetary gains appreciation. The present study provides evidence demonstrating roles for the posterior OFC (pOFC) and anterior OFC (aOFC) in distinguishing between sexual (sexual humor and erotic) and non-sexual (monetary) rewards. The experience of sexual pleasure induced by erotic rewards involves phylogenetically and ontogenetically older regions in the pOFC, while the experience of receiving monetary gains involves the aOFC. This study also provides additional insights into sexual humor appreciation in the pOFC, with findings of a postero-anterior dissociation in the processing of sexual humor appreciation. PPI analysis revealed functional connectivity in the pOFC-amygdala coupling in response to both types of sexual rewards versus monetary rewards. Together, our results suggest that the amygdala serves as a reward hub, especially in processing sexual humor versus monetary gains appreciation. Functional connectivity analysis showed amygdala-midbrain and pOFC-amygdala coupling during the appreciation of sexual humor. DATA AVAILABILITY STATEMENT: The data underlying this article is available from the corresponding author upon request.

Low-temperature synthesis of high-quality graphene by controlling the carbon-hydrogen ratio of the precursor

A furnace-free inductively coupled plasma chemical vapor deposition (ICP-PECVD) system, which does not require sample heating, was used to grow graphene at a temperature below 300 °C. This studies have found that under low-temperature PECVD growth conditions, liquid precursors are more suitable for preparing low-temperature graphene precursors than gaseous precursors.​​​​ Hence, benzene is used as a carbon precursor to obtain a sheet resistance of approximately 1.24 kΩ sq−1. In this research, it was discovered that the carbon-hydrogen ratio of the precursor molecule is an important factor while using PECVD to grow graphene. This factor affects the quality of graphene and the sheet resistance value —when the carbon–hydrogen ratio for the precursor molecule is 1:1, graphene has the high quality and lowest sheet resistance; when it is less than 1:2, the graphene that cannot be deposited has the worst quality and sheet resistance. Furthermore, we found that methane, a precursor often used to deposit graphene, will etch graphene under low-temperature conditions, and that acetylene can be used as a precursor to deposit graphene. It was further proven that the carbon–hydrogen ratio of the precursor molecules in the PECVD process caused the reduction in the graphene temperature.

Neurocognitive Mechanism of Remote and Close Associations: An fMRI Study

Remote association is the ability to combine seemingly unrelated components into new concepts and is evaluated via the Remote Associates Test (RAT). The RAT has generally been used to examine brain activation during insight problem solving but not remote association. Moreover, little is known about the neural correlates of remote association and close association. To address this issue, we used the associative distance in the development of the RAT and designed remote associated items and close associated items. We collected brain images during observation of remote and close associated items from 30 adult participants and analyzed the activation of brain regions involved in remote and close associations. The results showed that processing of remote and close association occurred in the posterior cingulate cortex. After controlling for the influence of other associations, we found that the rostromedial prefrontal cortex, precuneus, and middle temporal gyrus were involved exclusively in remote association. These results showed that remote association has conjunctive and disjunctive neurocognitive mechanisms. Our results contribute to the understanding of the neurocognitive mechanisms of different associations and provide empirical support for the associative theory of creativity.

Lo, the ever confounding nipple shadow!

The discovery of a solitary pulmonary nodule (SPN) on chest imaging can be alarming for both the clinician and the patient. In the absence of a uniform guideline, managing SPN is nothing short of challenging for primary care physicians (PCPs). We present a case here of a patient presenting with prolonged cough who also displayed unilateral SPN on her chest radiograph. Through further examination, this presence was later shown to be a nipple shadow simulating SPN, and the patient was spared unnecessary testing and psychological distress.

Methods and clinical outcomes of in situ fenestration for aortic arch revascularization during thoracic endovascular aortic repair

OBJECTIVE

Despite endovascular advances in fenestrated and branched devices, thoracic endovascular aortic repair (TEVAR) for arch pathologies remains challenging. The aim of this study was to provide a contemporary review on the current evidence for in situ fenestration during TEVAR and to evaluate its short- and mid-term clinical outcome in the management of arch pathology.

METHODS

A systematic literature review on in situ fenestration of thoracic aortic stent-graft from January 2003 to September 2018 was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement.

RESULTS

Our initial search yielded 169 studies, of which 21 articles were relevant to the topic and were finally included. One hundred and forty-five in situ fenestration procedures in 99 patients were reviewed, involving 25 innominate arteries (17%), 33 left common carotid arteries (23%) and 87 left subclavian arteries (60%). Twelve patients (12/99, 12%) had two-vessel fenestration and three-vessel fenestration was performed in 17 patients (17/99, 17%). Technical success was achieved in 136 arteries (136/145, 93%). Talent/Valiant with monofilament twill woven polyester fabric was the most common (50/99, 51%) stent-graft used for fenestration. Three methods reported for in situ fenestration were needle, laser and radiofrequency. Needle was the most frequently used device for fenestration, which was performed in 60 patients (60/99, 61%). Three patients (3/99, 3%) died with 30 days, none were in situ fenestration TEVAR procedure-related. Perioperative complications including one (1%) retrograde type A aortic dissection, two (2%) type II endoleaks, and three (3%) strokes were reported. The pooled estimate for overall technical success, perioperative mortality and stroke was 88.3% (95% CI, 78.6%-93.9%), 5.9% (95% CI, 2.5%-13.4%) and 9.5% (95% CI, 4.1%-20.6%), respectively. Four patients (4/96, 4%) died during follow-up, none were aortic-related. All the fenestration bridging stents were reportedly patent, with only 1 (1/96, 1%) asymptomatic left subclavian stent stenosis. Two patients (2/96, 2%) with type II endoleak from left subclavian artery required secondary intervention.

CONCLUSION

In situ fenestration appeared to be a feasible and effective method to extend proximal landing zone during TEVAR. It had an acceptable short-term result with high technical success and low fenestration related morbidity. Long-term durability data were lacking, and there was no high level evidence to recommend the routine use of in situ fenestration TEVAR for the management of arch pathology.

Clinical Toxicology and Overdose of Psychiatric Medications

This article reviews the poisoning epidemiology in Hong Kong, assessment and treatment of acute poisoning, and management of acute psychiatric medication overdose. In 2016, nearly 4000 poisoning cases involving approximately 6000 poisons were reported to Hong Kong Poison Information Centre. About 25% of the poisons involved were psychiatric-related medications. The initial medical assessment on poisoning includes history taking, vital signs monitoring, and focused physical examination. Approaches in managing acute poisoning include supportive measures, decontamination, antidote use, and enhanced elimination. Management on overdose of psychiatric medications (zopiclone, tricyclic antidepressants, selective serotonin reuptake inhibitor, antipsychotics, valproic acid, lithium, and methylphenidate) are discussed with practical tips highlighted.

Delayed open conversion after endovascular aortic repair

AIM

We present the clinical outcomes of patients who underwent delayed (>30 days) open surgical repair after endovascular aortic aneurysm repair.

METHODS

All patients receiving delayed open repair of infrarenal and juxtarenal aortic aneurysms after endovascular repair from July 2001 to December 2017 were retrospectively reviewed. Patients' baseline characteristics, indications for delayed open conversion, and time between endovascular repair and open conversion are described. Early outcomes included operative approach, morbidity, and mortality. Midterm outcomes included survival.

RESULTS

Twenty-two (3.3%) of 667 patients with prior infrarenal endovascular aortic aneurysm repair had delayed open conversion (20 elective and 2 emergency). The time from endovascular repair to open conversion was 60 ± 36 months. The indications were 6 (27%) type Ia endoleaks, 6 (27%) type II endoleaks with enlarging sac size, 2 (9%) endotensions, 7 (32%) unknown types of endoleak, and 1 (5%) graft infection. The 7 minutes unknown endoleaks were confirmed as lumbar leaks in 4 cases and fabric leaks in 3. Operative time was 222 ± 48 min with blood loss of 2211 ± 2057 mL. Hospital stay after conversion was 12 ± 8 days. There was no 30-day mortality. Estimated survival rates were 96%, 91%, 86%, 79% and 57% at 1, 2, 3, 4, and 5 years postoperatively.

CONCLUSION

Delayed conversion to open surgery after endovascular aortic aneurysm repair by endograft explantation appears to be safe with good short- and mid-term outcomes. With careful preoperative assessment, open conversion remained a realistic and viable option in patients with failed endovascular treatment.

Appreciation of different styles of humor: An fMRI study

Humor styles are important in facilitating social relationships. Following humor styles theory, this functional magnetic resonance imaging (fMRI) study is the first to use “one-liner” humor to investigate the neural correlates involved in appreciating humor styles that differ in terms of target (self or other) and motivation (benign or detrimental). Interestingly, we observed greater activation in response to humor that facilitates relationships with others (self-defeating and affiliative humor) than to humor that enhances the self (self-enhancing and aggressive humor). Self-defeating humor may play an important role in Chinese culture in facilitating social relationships at one’s own expense. Psychophysiological interaction (PPI) analysis revealed temporal pole (TP)-frontal functional connectivity underlying the appreciation of self-directed humor, and temporo-parietal junction (TPJ)-frontal connectivity underlying the appreciation of other-directed humor. Amygdala-frontal coupling was observed during the appreciation of detrimental humor, while nucleus accumbens (NAc)-temporal coupling and midbrain-frontal coupling appear to play a role in the affective experience of amusement in response to benign humor. This study contributes to our understanding of the neural correlates of appreciating different humor styles, including humor that facilitates social relationships.

Dissociation between the processing of humorous and monetary rewards in the 'motivation' and 'hedonic' brains

Humor elicits feelings of amusement and can be thought of as a social reward. We identified distinct mesolimbic reward system (MRS) processing patterns for monetary and humorous rewards. During both the reward anticipation and outcome phases, the nucleus accumbens (NAc) and anterior cingulate cortex (ACC) were active in response to monetary cues and monetary gains, while the amygdala and midbrain showed a differential response to humorous rewards, apparently driven by the hedonic enjoyment and appreciation of humor consumption. Psychophysiological interaction analysis (PPI) further demonstrated the functional coupling of the amygdala-midbrain circuit in response to humorous gains during the reward outcome phase, while neural signaling was observed in the NAc-ACC circuit during both the reward anticipation and outcome phases in response to monetary rewards. This is consistent with a view in which the NAc plays a key role in the ‘motivation brain’, and the amygdala in the ‘hedonic brain’. The findings further suggest that the neural mechanisms underlying reward consumption are more modality-specific than those underlying reward anticipation. Our study contributes to a growing understanding of neural responses to social rewards and represent an important first step toward understanding the neural processing of humor as one significant type of social reward.

White-Matter Structural Connectivity in Relation to Humor Styles: An Exploratory Study

To investigate the potential relationship between white matter (WM) microstructure and humor styles, diffusion tensor images of brain WM and humor style tendencies were obtained from thirty healthy adults. Using connectivity efficiency measures from graph theoretical analysis and controlling for the influence of gender, age, educational level, and the big five personality traits, we preliminarily examined the prediction of humor styles from brain network efficiency. The results showed that the local efficiency within particular brain networks positively predicted a self-enhancing humor style and negatively predicted an aggressive humor style. The node efficiency of the left superior temporal gyrus distinguished the benevolent or hostile way that individuals coped with interpersonal embarrassment. These findings from this exploratory study support the hypothesis that WM structure influences humor styles, and provide the initial evidence and implications regarding the relationship between biological mechanisms and mental health for future research.

Gender differences on laugh-related traits: A cross-sectional study

People have different responses to being laughed at, including fear of being laughed at, joy from being laughed at and joy from hearing others laugh. Previous studies have indicated that men have a higher tendency of laughing at others, but there were no gender differences on terms of the other two responses. Socioemotional selectivity theory indicates that individuals pay less attention to negative stimuli as they get older. It is worth investigating whether the gender differences of gelotophobia and gelotophilia occur in certain developmental stages. The present study is a cross-sectional study, with a sample size of 1247 participants; we collected information regarding laugh-related traits among participants 11-66 years old, and we particularly focused on the moderation effect of age on gender differences on gelotophobia, gelotophilia and katagelasticism. The results showed that men had a stronger tendency for laughing at others, but there were no significant gender differences on terms of gelotophobia and gelotophilia; age not only moderated the relationship between gender and gelotophobia but also the relationship between gender and katagelasticism. Male adolescents had higher incidences of gelotophobia and katagelasticism than female adolescents, but this finding was not consistent in the middle adulthood sample. The present study found age to be a moderator between gender and laugh-related traits, and it indicated the influence of age on the fear of being laughed at during early adolescence, but there was no gender difference with respect to katagelasticism in middle adulthood.

Arch branch endografts for arch aneurysms associated with bovine anomaly

Bovine aortic arch is known to be associated with an increased rate of aortic arch expansion. The most frequently observed human variant of bovine aortic arch is a common origin of the innominate trunk and left common carotid artery. This is a report of two patients who had successful custom-made arch branch endograft treatment for an arch aneurysm associated with bovine arch anomaly. Modular endovascular repair of aortic arch aneurysms using an inner-branched device adds to the armamentarium of treatment options, and is a minimally invasive management modality without the need for sternotomy or intraoperative extracorporeal bypass.

Accidental Ecstasy Poisoning in a Five-Year-Old Boy

We report a 5-year-old child with fever and confusion after ingestion of a tablet of methylenedioxymethamphetamine (MDMA). He was treated successfully with supportive measures and titrated doses of benzodiazepine. In children with unexplained fever, sympathetic hyperactivity, confusion or convulsion, MDMA poisoning should be considered.

Hong Kong Poison Information Centre: Annual Report 2015

Objective

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2015.

Methods

In 2015, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis.

Results

A total of 3,960 poisoned cases were analysed. There were 1,770 male patients (44.7%), 2,176 female patients (55.0%) and 14 sex unspecified patients (0.4%). The majority of the cases (63.5%) were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (38.4%), unintentional exposure (17.4%) and abusive substances use (11.6%). Excluding the common co-ingestant ethanol, the five commonest types of poison were paracetamol, benzodiazepine, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 16.4% and 16.2% of them were treated by decontamination and antidotes respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 4.3% had major outcomes. Seven interesting cases and one outbreak were discussed.

Conclusions

This 10th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports.

Hong Kong Poison Information Centre: Annual Report 2008

Objective

To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2008.

Methods

From 1st January 2008 to 31st December 2008, all poisoning cases received by HKPIC were retrieved from its database (DATOX & PIC-MS) for analysis.

Results

4,029 poisoned cases were analyzed. There were 1,755 male patients (43.6%) and 2,262 female patients (56.1%). Nearly two-thirds of them were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Sedatives, household products, paracetamol, and ketamine were common poisons exposed and non-benzodiazepine sedative-hypnotics were involved in about one-seventh of the poisoning cases. The majority of the patients were managed conservatively, with 6.0% and 5.9% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.

Conclusions

This annual report provides updated epidemiological information on poisoning in Hong Kong in 2008 and highlights some changes in comparison with our previous reports. The increase in abusive substance poisoning, in particular ketamine, requires further attention.

Venomous Fish Sting Cases Reported to Hong Kong Poison Information Centre: A Three-Year Retrospective Study on Epidemiology and Management

Objective

To study the epidemiology of venomous fish sting injuries, management and clinical outcomes of injured patients reported to the Hong Kong Poison Information Centre (HKPIC).

Methods

All venomous fish sting cases reported to HKPIC from July 2005 to June 2008 were retrieved from its database (DATOX) and the Hong Kong Hospital Authority (HA) Electronic Patient Record (ePR) computer system for analysis.

Results

There were a total of 33 fish sting cases in this study. The average age of the patients was 43 years (range 20 to 84) and 24 patients were males. Most cases were injured by catfish (n=12), followed by stonefish (n=7) and lionfish (n=4). Ten cases sustained fish sting injury whilst at work. Five patients developed fish sting complications including cellulitis, subacute tenosynovitis, abscess formation and foreign body retention. No mortality was recorded. Within 7 cases of stonefish injury, 3 cases were classified as moderate effect outcome. Two patients received stonefish antivenom and none developed anaphylaxis.

Conclusion

The majority of marine envenomations did not result in significant morbidity and required only supportive management. However, stonefish injuries might be associated with an increased risk of severe local symptoms which therefore required aggressive treatment including antivenom.

Hong Kong Poison Information Centre: Annual Report 2007

Objective

To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2007.

Methods

From 1st January 2007 to 31st December 2007, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis.

Results

2842 poisoned cases were analyzed. There were 1199 male and 1610 female patients and more than two-thirds of the cases were between 20 and 59 years old. Common causes of exposure were suicidal attempt, accident and abusive use. Non-benzodiazepine sedative-hypnotic, household products and paracetamol were common poisons exposed. The majority of the patients were managed conservatively, with 8.4% and 6.4% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.

Conclusions

This 2007 annual report provided updated epidemiological information on the poisoning pattern in Hong Kong and highlighted some changes in comparison to the situation in 2006.

Extensive Bowel Ischaemia after Nifedipine Overdose

A 57-year-old woman presented with abdominal distension and vomiting two days after overdosing an unknown amount of sustained-release nifedipine tablets. She had refractory shock requiring calcium chloride, glucagon, insulin-glucose and multiple high-dose inotropic agent infusions in the intensive care unit. Her abdominal computed tomography showed features of bowel ischaemia and exploratory laporotomy reviewed non-salvageable massive bowel ischaemia. She finally succumbed after 22 days of hospital treatment. This case illustrates the importance of awareness of this potentially fatal complication of calcium channel blocker overdose, requiring early recognition and intervention.

Reliability and Validity of the “Extended - Hurt, Insult, Threaten, Scream” (E-Hits) Screening Tool in Detecting Intimate Partner Violence in Hospital Emergency Departments in Hong Kong

Objectives

To assess the reliability and validity of a brief screening instrument, “E-HITS” (Extended - Hurt, Insult, Threaten, Scream), for detecting female intimate partner violence (IPV) in Hong Kong emergency departments (EDs).

Method

Quantitative data were collected from a victim group (n=110) and a control group (n=116). Statistical properties of the instruments were analysed to ascertain its internal consistency, test/re-test reliability, concurrent validity and discriminant validity.

Results

Cronbach's alpha was 0.90 for the E-HITS. Two-week test/re-test reliability was 0.71 (p<0.001). Respondents' scores on the E-HITS positively correlated with those on psychological aggression, physical assault, sexual coercion and injury scales, and negatively correlated with the negotiation scale of the revised Conflict Tactics Scale at a statistically significant level. Subsequent Receiver Operating Characteristic (ROC) curve analysis revealed that E-HITS reached a sensitivity of 98.2% and a specificity of 94.8% at a cut-off of 8.5. The overall accuracy of the E-HITS indicated by the area under curve (AUC) in the ROC is 0.991.

Conclusion

These results show that the E-HITS has good internal consistency, test/re-test reliability, as well as concurrent and discriminant validity. The E-HITS is a valid and reliable tool for screening intimate partner violence in Hong Kong EDs.

Hong Kong Poison Information Centre: Annual Report 2009

Objective

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2009.

Methods

In 2009, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis.

Results

Totally 4338 poisoned cases were analysed. There were 1955 male patients (45.1%), 2,367 female patients (54.6%) and 16 patients with no gender specified. More than two-third of cases (68.6%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, abusive use and unintentional exposure. Paracetamol, ketamine, zopiclone, benzodiazepine and household products were the common poisons exposed. Majority of the patients were managed supportively, with 13.6% and 13.1% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.

Conclusions

The 2009 annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

Hong Kong Poison Information Centre: Annual Report 2010

Objective

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2010.

Methods

In 2010, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis.

Results

A total of 4,418 poisoned cases were analysed. There were 1,863 male patients (42.2%) and 2,540 female patients (57.5%). More than two-third of cases (68.3%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Benzodiazepine, paracetamol, ketamine, zopiclone, and Chinese herbal medicine were the common agents involved. Majority of the patients were managed supportively, with 10.2% and 9.7% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 5.3% of the exposure had major outcomes.

Conclusions

This fifth annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

A Case of Methanol Poisoning

A 29-year-old male took about 300 ml industrial alcohol in a suicidal attempt. The industrial alcohol was later confirmed to be methanol. He presented to the emergency department 10 hours post-ingestion with an anion gap metabolic acidosis and an osmol gap of 76.7 mOsm/kg. Ethanol infusion was started in the emergency department at 11 hours post-ingestion before the availability of serum methanol level. The clinical diagnosis of toxic alcohol ingestion was based on the history, arterial blood gases results and the presence of a significant osmol gap. The patient was then admitted to the intensive care unit for ethanol therapy and haemodialysis. Prompt initiation of ethanol therapy and the subsequent intensive care prevented the development of life-threatening complications of methanol poisoning in this case.

A Prospective Epidemiological Study of Acute Poisoning in Hong Kong

Objective

To update our epidemiological knowledge of acute poisoning in Hong Kong.

Methods

A multi-centred prospective study was conducted for six months in six major accident and emergency departments in Hong Kong. A specially designed form was used to collect demographic data, type of poison involved, cause of poisoning, management, disposal as well as final outcome of the poisoned patients.

Results

A total of 1,467 patients (male: 588, female: 879) were included in the study. Most of them were young adults (32% were between 20 and 40 years old). Suicidal attempt (64%) was the most common cause of poisoning. Notably, 379 (26%) patients took more than one poison. Among the 2,007 counts of poison taken, sleeping pills (24%) and analgesics (18%) were the most commonly used drugs and paracetamol was the commonest single ingredient involved in poisoning. Most patients were treated with supportive measures, and about 40% and 15% of the patients were given gastrointestinal decontamination and specific antidotes respectively in their management, in which activated charcoal and N-acetylcysteine were the most common. Concerning disposal from the emergency department, 91% of the poisoned cases required in-patient management. Most patients had an uneventful recovery but 5 (0.3%) had significant disability and 21 (1.4%) died. Suicidal carbon monoxide poisoning was the leading cause of mortality in our study.

Conclusions

Most acute poisonings in Hong Kong were suicidal in nature and paracetamol was the commonest agent. Activated charcoal was the most commonly used decontamination method and most patients had an uneventful recovery.

Hong Kong Poison Information Centre: Annual Report 2013

Objective

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2013.

Methods

In 2013, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis.

Results

A total of 3,783 poisoned cases were analysed. There were 1,595 male patients (42.2%), 2,185 female patients (57.8%) and 3 sex unspecified patients (0.1%). Middle aged group (30-39 years) composed about one-fifth (20.8%) of the poisoning cases while about two-third (66.8%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (43%), unintentional exposure (15.3%) and abusive substances use (14.5%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, household products and Chinese herbal medicine. Majority of the patients were managed with supportive measures, and 13.2% and 10.8% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 4.3% had major outcomes.

Conclusions

This 8th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j. emerg.med. 2014;21:249-259)

Clinical Experience in the Use of Intravenous Lipid Emulsion in Hydroychloroquine and Chloroquine Overdose with Refractory Shock

Hydroxychloroquine overdose is a rare condition and often results in severe cardiovascular toxicities. We report 2 cases of fatal hydroxychloroquine overdose (1 patient had co-ingestion of chloroquine). Both patients developed refractory cardiovascular collapse and cardiac arrest soon after the drug overdose. Both of them were treated with high dose adrenaline and diazepam. However, they deteriorated rapidly despite the treatments. In view of similar toxicological profile of hydroxychloroquine to other lipophilic cardiotoxic medications, intravenous lipid emulsion was given as the last resort but both of them died eventually. Based on the clinical experience from these 2 cases, Intravenous lipid emulsion is not effective in reversing the cardiotoxic effects of hydroxychloroquine and chloroquine overdose.

Case Report: Paracetamol Poisoning in a 2-Year-Old Child – from International Overview to the Role of the Hong Kong Poison Information Centre

We report a 2-year-old girl suffering from acute liver failure as a result of paracetamol poisoning. The child successfully recovered after intensive care. We performed literature search for the past decade and found that the pathophysiological response in the child was different from that of the adult. Despite paracetamol poisoning being one of the most common poisonings in the world, there is still no consensus in the treatment protocol. Hence the role of the Hong Kong Poison Information Centre is briefly discussed.

Hong Kong Poison Information Centre: Annual Report 2011

Objective

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2011.

Methods

In 2011, all poisoning cases received by HKPIC were retrieved from its database: Poison Information and Clinical Management System (PICMS) for analysis.

Results

A total of 4,331 poisoned cases were analysed. There were 1,915 male patients (44.2%), 2,411 female patients (55.7%) and 5 patients with sex unknown. More than two-third (68%) of them were between 20 and 59 years old. Common causes of exposure were suspected self-harm/suicidal attempt, unintentional exposure and abusive use. Paracetamol, benzodiazepine, household product, zopiclone, and Chinese herbal medicine were the top five commonest poisons encountered. Majority of the patients were managed supportively, with 12.1% and 8.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 4.8% of the exposure had major outcomes.

Conclusions

This 6th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

Two Cases of Anticholinergic Poisoning from Transdermal Scopolamine Patch

Scopolamine transdermal patch is a form of anticholinergic drug used to prevent motion sickness. We reported two cases of anticholinergic poisoning resulting from scopolamine transdermal patch. The first case experienced local toxicity and presented with right eye mydriasis for five days. The second case developed systemic anticholinergic toxidrome contributed by the scopolamine patch and presented with acute confusion. She was treated successfully by physostigmine, an anticholinergic antidote. The recommendation on physostigmine use was also discussed. We hope that these two case reports will raise the clinician awareness of the potential side effect of this kind of product.

Hong Kong Poison Information Centre: Annual Report 2006

Objective

To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2006.

Methods

From 1st January 2006 to 31st December 2006, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis.

Results

A total of 2555 poisoned cases were analysed. There were 1051 male and 1466 female patients and nearly 60% of the cases were between 20 and 49 years old. Common causes of exposure were suicidal attempts and accidents. Paracetamol, sedative-hypnotic and household products were common sources of poison exposure. The majority of the patients were managed conservatively, with 18.8% and 10.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Nearly half of the cases were managed in the accident & emergency department without hospitalisation.

Conclusions

This annual report provides updated epidemiological information on poisoning in Hong Kong. Subsequent annual reports would provide important information on the trend of poisoning pattern and may guide further strategies in poison control and prevention in Hong Kong.

A Study of Drug Radiopacity by Plain Radiography

Plain abdominal X-ray (AXR) may be helpful in the management of acute poisoning in the emergency department if the drugs involved are radiopaque. There are varying radiopacity among different medications and even for the same medication from different manufacturers. Therefore, we performed this study to detect local drug radiopacity in Hong Kong. A total of 430 drugs under the formulary of the United Christian Hospital were tested by standard AXR (75 kV, 23 mA) in a specially designed box which corresponded to the soft tissue density of the abdomen. Two different radiologists classified the drug radiopacity into three grades. Eight drugs (1.9%) were graded as definitely radiopaque (ranitidine bismuth citrate, tripotassium dicitratobismuthate, Drixoral SR, amiodarone, ferrous sulphate, sodium chloride, calcium carbonate, and Cafertamin). Another 129 drugs (30.0%) were slightly radiopaque, including slow release drugs, neuroleptics, antacids, ionic salts, beta-blockers, tricyclic antidepressants, antibiotics and others. The remaining 293 drugs were undetectable. As a significant number of drugs (31.9%) were detectable by plain AXR in vitro and some of them were potentially lethal, we should consider AXR as an adjunct in managing a suspected poisoned patient. Further study may be needed to evaluate these drugs' radiopacity in vivo with respect to the dosage and time of ingestion to assess its clinical application.

Hong Kong Poison Information Centre: Annual Report 2012

Objective

To report and analyze the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2012.

Methods

In 2012, all poisoning cases received by HKPIC were retrieved from its database: Poison Information and Clinical Management System (PICMS) for analysis.

Results

A total of 4,814 poisoned cases were analyzed. There were 1,771 male patients (42.3%), 2,399 female patients (57.3%) and 14 sex unspecified patients (0.3%). Middle aged group (30-39 years) contributed about one-fifth (20.1%) of the poisoning cases while more than two-third (67.7%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (45%), abusive substances use (13.9%) and unintentional exposure (13.0%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, bites and envenomation and household products. Majority of the patients were managed with supportive measures, and 15.7% and 11.9% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.6% of the poison exposure resulted in death and 4.7% of the exposure had major outcomes.

Conclusions

This seventh annual report provides updated epidemiological information on poisoning pattern in Hong Kong and highlights important changes in comparing with our previous reports. (Hong Kong j.emerg.med. 2013;20:371-381)

Maximizing T c by tuning nematicity and magnetism in FeSe1-x S x superconductors

A fundamental issue concerning iron-based superconductivity is the roles of electronic nematicity and magnetism in realising high transition temperature (T c). To address this issue, FeSe is a key material, as it exhibits a unique pressure phase diagram involving non-magnetic nematic and pressure-induced antiferromagnetic ordered phases. However, as these two phases in FeSe have considerable overlap, how each order affects superconductivity remains perplexing. Here we construct the three-dimensional electronic phase diagram, temperature (T) against pressure (P) and isovalent S-substitution (x), for FeSe1-x S x . By simultaneously tuning chemical and physical pressures, against which the chalcogen height shows a contrasting variation, we achieve a complete separation of nematic and antiferromagnetic phases. In between, an extended non-magnetic tetragonal phase emerges, where T c shows a striking enhancement. The completed phase diagram uncovers that high-T c superconductivity lies near both ends of the dome-shaped antiferromagnetic phase, whereas T c remains low near the nematic critical point.

Spontaneous Retroperitoneal Hematoma Simulating Ruptured Infrarenal Aortic Aneurysm in a Patient with End-Stage Renal Disease

We reported a case of spontaneous retroperitoneal hematoma (SRH) simulating a ruptured infrarenal aortic aneurysm. A 72-year-old man with a history of infrarenal aortic aneurysm and end-stage renal disease on hemodialysis presented with malaise and nonspecific central abdominal pain and left loin discomfort. An emergency computed tomography scan showed a large retroperitoneal hematoma and clinical suspicion of ruptured infrarenal aortic aneurysm. However, the hematoma was discontinuous with the aneurysm sac and raised the clinical suspicion on dual pathology. The SRH was treated conservatively with transfusion of blood products, and the aneurysm was treated with nonemergency endovascular repair electively. This case demonstrates the importance of recognizing different clinical and radiological characteristics and be aware of dual pathology.

Neural Correlates of Hostile Jokes: Cognitive and Motivational Processes in Humor Appreciation

Hostile jokes (HJs) provide aggressive catharsis and a feeling of superiority. Behavioral research has found that HJs are perceived as funnier than non-hostile jokes (NJs). The purpose of the present study was to identify the neural correlates of the interaction between type and humor by comparing HJs, NJs, and their corresponding hostile sentences (HSs) and non-hostile sentences (NSs). HJs primarily showed activation in the dorsomedial prefrontal cortex (dmPFC) and midbrain compared with the corresponding hostile baseline. Conversely, NJs primarily revealed activation in the ventromedial PFC (vmPFC), amygdala, midbrain, ventral anterior cingulate cortex, and nucleus accumbens (NAcc) compared with the corresponding non-hostile baseline. These results support the critical role of the medial PFC (mPFC) for the neural correlates of social cognition and socio-emotional processing in response to different types of jokes. Moreover, the processing of HJs showed increased activation in the dmPFC, which suggested cognitive operations of social motivation, whereas the processing of NJs displayed increased activation in the vmPFC, which suggested social-affective engagement. HJs versus NJs primarily showed increased activation in the dmPFC and midbrain, whereas NJs versus HJs primarily displayed greater activation in the amygdala and midbrain. The psychophysiological interaction (PPI) analysis demonstrated functional coupling of the dmPFC-dlPFC and midbrain-dmPFC for HJs and functional coupling of the vmPFC-midbrain and amygdala-midbrain-NAcc for NJs. Surprisingly, HJs were not perceived as funnier than NJs. Future studies could further investigate the neural correlates of potentially important traits of high-hostility tendencies in humor appreciation based on the psychoanalytic and superiority theories of humor.

White-Matter Structural Connectivity Underlying Human Laughter-Related Traits Processing

Most research into the neural mechanisms of humor has not explicitly focused on the association between emotion and humor on the brain white matter networks mediating this connection. However, this connection is especially salient in gelotophobia (the fear of being laughed at), which is regarded as the presentation of humorlessness, and two related traits, gelotophilia (the enjoyment of being laughed at) and katagelasticism (the enjoyment of laughing at others). Here, we explored whether the topological properties of white matter networks can account for the individual differences in the laughter-related traits of 31 healthy adults. We observed a significant negative correlation between gelotophobia scores and the clustering coefficient, local efficiency and global efficiency, but a positive association between gelotophobia scores and path length in the brain's white matter network. Moreover, the current study revealed that with increasing individual fear of being laughed at, the linking efficiencies in superior frontal gyrus, anterior cingulate cortex, parahippocampal gyrus, and middle temporal gyrus decreased. However, there were no significant correlations between either gelotophilia or katagelasticism scores or the topological properties of the brain white matter network. These findings suggest that the fear of being laughed at is directly related to the level of local and global information processing of the brain network, which might provide new insights into the neural mechanisms of the humor information processing.