BackgroundCardiac autonomic neuropathy in type 2 dibetes mellitus (T2DM) patients is frequent and associated with high cardiovascular mortality. Heart rate variability (HRV) is the gold standard to measure cardiac autonomic neuropathy. We aimed to conduct a systematic review and meta–analysis to evaluate the impact of T2DM on HRV parameters.MethodsThe PubMed, Cochrane Library, Embase and Science Direct databases were searched on 1st October 2017 using the keywords “diabetes” AND (“heart rate variability” OR “HRV”). Included articles had to report HRV parameters in T2DM patients and healthy controls measured during 24 hours with a Holter–electrocardiogram. Measurements of HRV retieved were: RR–intervals (or Normal to Normal intervals—NN), standard deviation of RR intervals (SDNN), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), square root of the mean squared difference of successive RR intervals (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio, as per Task Force recommendations.ResultsWe included twenty-five case-control studies with 2,932 patients: 1,356 with T2DM and 1,576 healthy controls. T2DM patients had significantly (P<0.01) lower RR–intervals (effect size = –0.61; 95%CI –1.21 to –0.01), lower SDNN (–0.65; –0.83 to –0.47), lower RMSSD (–0.92; –1.37 to –0.47), lower pNN50 (–0.46; –0.84 to –0.09), lower total power (–1.52; –2.13 to –0.91), lower LF (–1.08; –1.46 to –0.69]), and lower HF (–0.79; –1.09 to –0.50). LF/HF did not differ between groups. Levels of blood glucose and HbA1c were associated with several HRV parameters, as well as Time from diagnosis of T2DMConclusionsT2DM was associated with an overall decrease in the HRV of T2DM patients. Both sympathetic and parasympathetic activity were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy.

The anticipation of favourable or unfavourable events is a key component in our daily life. However, the temporal dynamics of anticipation processes in relation to brain activation are still not fully understood.A modified version of the monetary incentive delay task was administered during separate functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG) sessions in the same 25 participants to assess anticipatory processes with a multi-modal neuroimaging set-up.During fMRI, gain and loss anticipation were both associated with heightened activation in ventral striatum and reward-related areas. EEG revealed most pronounced P300 amplitudes for gain anticipation, whereas CNV amplitudes distinguished neutral from gain and loss anticipation. Importantly, P300, but not CNV amplitudes, were correlated to neural activation in the ventral striatum for both gain and loss anticipation. Larger P300 amplitudes indicated higher ventral striatum blood oxygen level dependent (BOLD) response.Early stimulus evaluation processes indexed by EEG seem to be positively related to higher activation levels in the ventral striatum, indexed by fMRI, which are usually associated with reward processing. The current results, however, point towards a more general motivational mechanism processing salient stimuli during anticipation.

The feedback-related negativity (FRN) has been hypothesized to be most sensitive to unexpected negative feedback. The present study investigated feedback expectancy and valence using a probabilistic gambling paradigm where subjects encountered expected or unexpected positive and negative feedback outcomes. In line with previous studies, FRN amplitude reflected a negative reward prediction error, but to a minor extent also a positive reward prediction error. Moreover, the P300 amplitude was largest after unexpected feedback, irrespective of valence. We propose to interpret the FRN in terms of a reinforcement learning signal which is detecting mismatch between internal and external representations indexed by the ACC to extract motivationally salient outcomes.

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Our results reflect that during early anticipation uncertainty is strongly associated with affective mechanisms and seems to be a more salient event compared to certain anticipation. During the last 2 s before stimulation, attentional control mechanisms are initiated related to the increased salience of uncertainty. Furthermore, stimulus-specific preparatory mechanisms during certain anticipation also shaped the response to stimulation, underlining the adaptive value of stimulus-targeted preparatory activity which is less likely when facing an uncertain event.

Recent years have provided increasing insights into the factors affecting economic decision-making. Little is known about how these factors influence decisions that also bear consequences for other people. We examined whether decisions that also affected a third, passive player modulate the behavioral and neural responses to monetary offers in a modified version of the three-person ultimatum game. We aimed to elucidate to what extent social preferences affect early neuronal processing when subjects were evaluating offers that were fair or unfair to themselves, to the third player, or to both. As an event-related potential (ERP) index for early evaluation processes in economic decision-making, we recorded the medial frontal negativity (MFN) component in response to such offers. Unfair offers were rejected more often than equitable ones, in particular when negatively affecting the subject. While the MFN amplitude was higher following unfair as compared to fair offers to the subject, MFN amplitude was not modulated by the shares assigned to the third, passive player. Furthermore, rejection rates and MFN amplitudes following fair offers were positively correlated, as subjects showing lower MFN amplitudes following fair offers tended to reject unfair offers more often—but only if those offers negatively affected their own payoff. Altogether, the rejection behavior suggests that humans mainly care about a powerless third when they are confronted with inequality as well. The correlation between rejection rates and the MFN amplitude supports the notion that this ERP component is also modulated by positive events and highlights how our expectations concerning other humans' behavior guide our own decisions. However, social preferences like inequality aversion and concern for the well-being of others are not reflected in this early neuronal response, but seem to result from later, deliberate and higher-order cognitive processes.

Violent offending has often been associated with a lack of empathy, but experimental investigations are rare. The present study aimed at clarifying whether violent offenders show a general empathy deficit or specific deficits regarding the separate subcomponents. To this end, we assessed three core components of empathy (emotion recognition, perspective taking, affective responsiveness) as well as skin conductance response (SCR) in a sample of 30 male violent offenders and 30 healthy male controls. Data analysis revealed reduced accuracy in violent offenders compared to healthy controls only in emotion recognition, and that a high number of violent assaults was associated with decreased accuracy in perspective taking for angry scenes. SCR data showed reduced physiological responses in the offender group specifically for fear and disgust stimuli during emotion recognition and perspective taking. In addition, higher psychopathy scores in the violent offender group were associated with reduced accuracy in affective responsiveness. This is the first study to show that mainly emotion recognition is deficient in violent offenders whereas the other components of empathy are rather unaffected. This divergent impact of violent offending on the subcomponents of empathy suggests that all three empathy components can be targeted by therapeutic interventions separately.

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