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Abstract BACKGROUND Post-traumatic stress disorder is a severe psychobiological disorder associated with hyperactivity of the amygdala, particularly on the right side. Highly selective laser ablation of the amygdalohippocampal complex is an effective neurosurgical treatment for medically refractory medial temporal lobe epilepsy that minimizes neurocognitive deficits relative to traditional open surgery. OBJECTIVE To examine the impact of amygdalohippocampotomy upon symptoms and biomarkers of post-traumatic stress disorder. METHODS Two patients with well-documented chronic post-traumatic stress disorder who subsequently developed late-onset epilepsy underwent unilateral laser amygdalohippocampotomy. Prospective clinical and neuropsychological measurements were collected in patient 1. Additional prospective measurements of symptoms and biomarkers were collected pre- and post-surgery in patient 2. RESULTS After laser ablation targeting the nondominant (right) amygdala, both patients experienced not only reduced seizures, but also profoundly abated post-traumatic stress symptoms. Prospective evaluation of biomarkers in patient 2 showed robust improvements in hyperarousal symptoms, fear potentiation of the startle reflex, brain functional magnetic resonance imaging responses to fear-inducing stimuli, and emotional declarative memory. CONCLUSION These observations support the emerging hypothesis that the right amygdala particularly perpetuates the signs and symptoms of post-traumatic stress disorder and suggests that focal unilateral amydalohippocampotomy can provide therapeutic benefit.

Background Exposure to a traumatic event leads to posttraumatic stress disorder in 10% to 20% of exposed individuals. Predictors of risk are needed to target early interventions to those who are most vulnerable. The objective of the study was to test whether a noninvasive mobile device that measures a physiological biomarker of autonomic nervous system activation could predict future posttraumatic stress disorder symptoms. Methods Skin conductance response was collected during a trauma interview in the emergency department within hours of exposure to trauma in 95 individuals. Trajectories of posttraumatic stress disorder symptoms over 12-month posttrauma were identified using latent growth mixture modeling. Results Skin conductance response was significantly correlated with the probability of being in the chronic posttraumatic stress disorder trajectory following trauma exposure in the emergency department (r = 0.489, p < 0.000001). Lasso regression with elastic net was performed with demographic and clinical measures obtained in the emergency department, demonstrating that skin conductance response was the most significant predictor of the chronic posttraumatic stress disorder trajectory (p < 0.00001). Conclusions This study is the first prospective study of posttraumatic stress disorder showing skin conductance response in the immediate aftermath of trauma predicts subsequent development of chronic posttraumatic stress disorder. This finding points to an easily obtained, and neurobiologically informative, biomarker in emergency departments that can be disseminated to predict the development of posttraumatic stress disorder.

Background Traumatic events experienced in childhood can lead to increased risk of cardiovascular disorders in adulthood. Black Americans are disproportionately affected, as they are at increased risk for experiencing childhood trauma and cardiovascular diseases in adulthood. One of the hypothesized mechanisms of this association is through long-lasting dysregulation of the autonomic nervous system, a hallmark physiological biomarker of posttraumatic stress disorder (PTSD), which is twice as prevalent in women compared to men. Methods Ninety-one, majority Black American children, aged 9 were recruited to be a part of our longitudinal study of child development at research centers in Atlanta, GA and Detroit, MI. Resting HR was measured through a electrocardiogram (ECG) recording using the Biopac MP150. Self-report measures of violence exposure and PTSD symptoms were administered by research staff. Results Children with more violence exposure reported increased PTSS as well as lower resting HR. Regression analysis showed evidence of sex modifying this relationship, (B = -0.64, p  < 0.05), such that the association between resting HR and PTSS was stronger in girls than in boys. In our exploratory analysis with standard clinical cutoffs of resting HR, the normative HR group was found to significantly moderate the relationship between violence exposure and PTSS in boys, (B = -2.14, p  < 0.01), but not girls (B = -0.94, p  = 0.27). Conclusion In our sample of primarily Black urban children, we found that violence exposure was associated with slower, more adult-like HR, that girls showed greater PTSS associated with slower HR while boys did not, and that girls with lower than normative HR showed significantly higher PTSS compared to girls with normative HR. Our sample’s demonstration of psychological consequences in addition to the physiological implications could provide new information about a psychobiological sequelae of violence exposure. Plain English summary Experiencing traumatic events in childhood can lead to increased risk of heart disease in adulthood. One of the ways this might happen is through long-lasting changes of the autonomic nervous system. This system is dysregulated in posttraumatic stress disorder (PTSD), which is twice as common in women compared to men. We explored whether resting heart rate (HR), a measure of autonomic functioning was associated with violence exposure in children, and whether this relationship was different in boys and girls. We also explored whether categorizing our sample into resting HR groups based off standardized norms for HR predicted differing relationships between violence exposure and posttraumatic stress symptoms (PTSS). Because childhood trauma and heart disease impact Black Americans at greater rates, we recruited our sample of 92 nine-year-old children from research centers in Atlanta, GA and Detroit, MI. We measured their resting HR, exposure to violence, and PTSS. We found that violence exposure was associated with lower HR overall, that girls showed greater PTSS associated with lower HR when compared to boys, and that boys with lower than normative HR showed a stronger association between violence exposure and PTSS compared to boys with normative HR. Future studies should examine potential mechanisms underlying this sex difference to best understand the long-term cardiovascular consequences for sex-related health disparities. Specifically, longitudinal studies may be able to help researchers understand how reduced HR during adolescents might lead to future cardiovascular disease and psychopathology. Highlights • We explored whether resting heart rate (HR), a measure of autonomic functioning, was associated with violence exposure, whether this relationship differs in boys and girls, and whether resting HR modified the relationship between violence exposure and posttraumatic stress symptoms (PTSS). • In our sample of primarily urban children, we found that violence exposure was associated with lower HR, that girls showed greater PTSS associated with slower HR, and that boys with lower than normative HR showed a stronger association between violence exposure and PTSS compared to boys with normative HR. • Our results shed light on the psychobiological sequelae of violence exposure.

Background Increased psychophysiological reactivity is a hallmark intermediate phenotype of posttraumatic stress disorder (PTSD). Individuals with PTSD exhibit greater skin conductance (SC) responses to trauma scripts than trauma survivors without PTSD. However, trauma scripts require time for development and cannot be easily used in a single visit. Thus, there is a need for a low‐cost, easy‐to‐use, SC recording protocol for PTSD assessment. Methods Using a mobile device (eSense) connected to a portable tablet computer, we assessed SC reactivity to a standard trauma interview (STI) in 63 participants recruited from Grady Memorial Hospital in Atlanta, GA, approximately 1 year after trauma exposure. SC response (SCR) was calculated by subtracting the SC level (SCL) at the end of the baseline recording from the maximum SCL during the STI. Results SCL was significantly higher during the STI compared to baseline (P < .001), and individuals with PTSD showed significantly greater SCR than individuals without PTSD (P = .006). Logistic regression using SCR with PTSD diagnosis as the outcome showed an odds ratio of 1.76 (95% CI: 1.11–2.78). Lastly, higher SCR during the STI was also significantly associated with PTSD symptom total score controlling for demographics and trauma severity (b = 0.42, P = .001). Conclusions The current study demonstrated feasibility of the use of a mobile device for assessing psychophysiological reactivity in those with PTSD. The use of this low‐cost, easy‐to‐use mobile device to collect objective physiological data in concert with a STI can be easily disseminated in clinical and research settings.

Considerable racial/ethnic disparities persist in exposure to life stressors and socioeconomic resources that can directly affect threat neurocircuitry, particularly the amygdala, that partially mediates susceptibility to adverse posttraumatic outcomes. Limited work to date, however, has investigated potential racial/ethnic variability in amygdala reactivity or connectivity that may in turn be related to outcomes such as post-traumatic stress disorder (PTSD). Participants from the AURORA study ( n  = 283), a multisite longitudinal study of trauma outcomes, completed functional magnetic resonance imaging and psychophysiology within approximately two-weeks of trauma exposure. Seed-based amygdala connectivity and amygdala reactivity during passive viewing of fearful and neutral faces were assessed during fMRI. Physiological activity was assessed during Pavlovian threat conditioning. Participants also reported the severity of posttraumatic symptoms 3 and 6 months after trauma. Black individuals showed lower baseline skin conductance levels and startle compared to White individuals, but no differences were observed in physiological reactions to threat. Further, Hispanic and Black participants showed greater amygdala connectivity to regions including the dorsolateral prefrontal cortex (PFC), dorsal anterior cingulate cortex, insula, and cerebellum compared to White participants. No differences were observed in amygdala reactivity to threat. Amygdala connectivity was associated with 3-month PTSD symptoms, but the associations differed by racial/ethnic group and were partly driven by group differences in structural inequities. The present findings suggest variability in tonic neurophysiological arousal in the early aftermath of trauma between racial/ethnic groups, driven by structural inequality, impacts neural processes that mediate susceptibility to later PTSD symptoms.

Background Safety and immunogenicity of a new formulation of PCV-15 (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19F, 19A, 22F*, 23F, 33F*) was evaluated in adults ≥65 years of age previously vaccinated with PPV23. Methods Study subjects who received PPV23 at least 1 year prior to study entry received a single dose of either PCV-15 or PCV-13 (125/arm) and were followed for safety for 14 days postvaccination. Serotype-specific Immunoglobulin G (IgG) geometric mean concentrations (GMCs) and opsonophagocytic activity (OPA) geometric mean titers (GMTs) were measured immediately prior and 30 days postvaccination. NCT02573081 Results Safety profiles were comparable between PCV-15 and PCV-13 recipients. Following vaccination, serotype- specific antibody responses for the 13 shared serotypes were generally comparable between recipients of PCV- 15 and PCV-13 for IgG GMCs and geometric mean fold rises (GMFRs), OPA GMTs and GMFRs, and percentages of subjects with ≥4-fold-rise from baseline. Recipients of PCV-15 had numerically higher IgG GMCs and OPA GMTs than PCV-13 recipients for two serotypes unique to PCV-15 (22F, 33F). Conclusion PCV-15 was generally well tolerated when given as a single dose to adults ≥65 years of age previously vaccinated with PPV23. Following vaccination, serotype-specific IgG GMCs and OPA GMTs were comparable between recipients of PCV-15 and PCV-13 for 13 shared serotypes. *Not shared serotypes with PCV-13 Disclosures U. Buchwald, Merck: Employee and Shareholder, Salary and stock options. J. Peterson, Merck: Investigator, Research grant. H. Stacey, Merckl: Investigator, Research grant. K. Julien, Merck: Investigator, Research grant. T. Sterling, Merck: Employee and Shareholder, Salary and stock options. M. Bruch, Merck: Employee and Shareholder, Salary and stock options. G. Tamms, Merck: Employee and Shareholder, Salary and stock options. J. Li, Merck: Employee and Shareholder, Salary and stock options. A. Pedley, Merck: Employee and Shareholder, Salary and stock options. K. Nolan, Merck: Employee and Shareholder, Salary and stock options. P. Benner, Merck: Employee and Shareholder, Salary and stock options. C. Abeygunawardana, Merck: Employee and Shareholder, Salary and stock options. M. Winters, Merck: Employee and Shareholder, Salary and stock options. M. Kosinski, Merck: Employee and Shareholder, Salary and stock options. J. Stek, Merck: Employee and Shareholder, Salary and stock options. L. Musey, Merck: Employee and Shareholder, Salary and stock options.

Vacuum ultraviolet (VUV) light is critical for the study of molecules and materials, but the generation of femtosecond pulses in the VUV region at high repetition rates has proven difficult. Here, we demonstrate the efficient generation of VUV light at MHz repetition rates using highly cascaded four-wave mixing processes in a negative-curvature hollow-core fiber. Both even and odd order harmonics are generated up to the 15th harmonic (69 nm, 18.0 eV), with high energy resolution of ~40 meV. In contrast to direct high harmonic generation, this highly cascaded harmonic generation process requires lower peak intensity and therefore can operate at higher repetition rates, driven by a robust ~10 W fiber-laser system in a compact setup. Additionally, we present numerical simulations that explore the fundamental capabilities and spatiotemporal dynamics of highly cascaded harmonic generation. This VUV source can enhance the capabilities of spectroscopies of molecular and quantum materials, such as photoionization mass spectrometry and time , angle , and spin-resolved photoemission.