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Although the neural correlates of novelty and appropriateness of creative insight during cognitive tasks have been investigated in several studies, they have not been examined during mental distress in a psychotherapeutic setting. This study aimed to reveal the promoting effects of novelty and appropriateness processing on therapeutic insight in a micro-psychotherapeutic setting. We examined the effects of appropriateness (between-subject factor: appropriateness group, 20 participants; inappropriateness group, 21 participants) by manipulating the preceding negative scenarios that either fit or did not fit the subsequent solutions, and those of novelty (within-subject factor) by varying the linguistic expressions for describing solutions (metaphorical, literal, or problem-restatement). Event-related functional magnetic resonance images were collected. We found the following effects: an interactive effect of the two factors on insightfulness and activation in the bilateral hippocampus and amygdala, right superior frontal gyrus, and left superior/middle temporal gyrus; a simple effect of novelty on activation in the bilateral inferior frontal gyrus, fusiform gyrus, and inferior/middle occipital gyrus; and a simple effect of appropriateness on activation in the left inferior parietal lobule. Our findings indicate that solutions with high novelty and appropriateness generate the highest levels of therapeutic insightfulness as well as the strongest activation in the hippocampus and amygdala, which may be involved in episodic memory encoding.

Neonicotinoids (NEOs) are extensively applied in global agricultural production for pest control but have adverse effects on human health. In this study, the concentrations of six NEOs and three characteristic metabolites were investigated by collecting 200 serum samples from an elderly population in China. Results showed that the NEOs and their metabolites were widely detected (89%-98 %) in the serum samples from the osteoporosis (OP) (n = 120) and non-OP (n = 80) population, and their median concentrations ranged from 0.04 ng/mL to 5.99 ng/mL and 0.01 ng/mL to 2.02 ng/mL, respectively. N-desmethyl-acetamiprid (ACE-dm) was the most abundant NEOs in the serum samples. Gender-related differences were found in concentrations of most NEOs and their metabolites in serum, with males having higher target analytes than females. Significantly (p 0.05) positive correlations were observed among most NEO concentrations, suggesting that exposure source of these substances is common or related. However, associations between the concentrations of characteristic metabolites and their corresponding NEOs were insignificant, probably because the exogenous intake are the primary sources of metabolites of NEOs instead of the internal biotransformation. The associations between NEO concentrations (i.e., ACE-dm, dinotefuran, and olefin-imidacloprid) and OP (OR = 2.33-6.92, 95 % CI = 0.37-16.9, p-trend 0.05) indicate that NEO exposure is correlated with increased odds of prevalent OP. This study is the first to document the profiles of NEOs and their metabolites in serum samples collected from an elderly population in South China and examine the relationships between NEO exposure and OP.

This study was designed to determine whether metaphorical solutions to mental distress problems result in an insightful mental experience and activate the hippocampus and amygdala: areas associated with insight. We recruited 22 healthy university students. Trials presented 75 micro-counseling scenarios while event-related functional magnetic resonance imaging (fMRI) was applied to detect neural responses. Each scenario included a mental distress problem and one of the following solution types: metaphorical, literal, or problem-restatement. The results revealed that, compared with literal solutions or problem-restatement solutions, metaphorical solutions activated two neural networks: one associated with basic metaphorical language processing (i.e., the left inferior frontal gyrus and middle and superior temporal gyri), and a specific network associated with insightful problem solving (i.e., the bilateral hippocampus, amygdala, and fusiform gyrus). Our findings indicate that the use of metaphorical solutions to mental distress problems reliably produces salient neural activities for insight.

Background. Relative to nondiabetic patients, percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) is associated with inferior clinical outcomes. We aimed to evaluate the outcomes of drug-coated balloon (DCB) in diabetic versus nondiabetic patients. Methods and Results. In this observational, prospective, multicenter study, we compared the outcomes of patients with and without DM after undergoing PCI with DCBs. Target lesion failure (TLF) was analyzed as primary endpoint. Secondary endpoints were the rates of target lesion revascularization (TLR), major adverse cardiovascular events (MACE), cardiac death, myocardial infarction (MI), and any revascularization. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. Among 2,306 eligible patients, 578 with DM and 578 without DM had similar propensity scores and were included in the analyses. During follow-up ( 366 ± 46 days), compared with DM patients, patients without DM were associated with a lower yearly incidence of TLF (2.77% vs. 5.36%; OR, 1.991; 95% CI, 1.077 to 3.681; P = 0.025 ) and TLR (1.90% vs. 4.15%; OR, 2.233; 95% CI, 1.083 to 4.602; P = 0.026 ). No significant differences were observed with regards to rates of MACE (OR: 1.580, 95% CI: 0.912-2.735; P = 0.100 ), cardiac death (OR: 1.608, 95% CI: 0.523-4.946; P = 0.403 ), MI (OR: 4.042, 95% CI: 0.855-19.117; P = 0.057 ), and any revascularization (OR: 1.534, 95% CI: 0.983-2.393; P = 0.058 ). Conclusions. Diabetic patients experience higher TLF and TLR rates following DCB angioplasty without substantial increase in the risk of MACE, cardiac death, MI, or revascularization.

Background Metaphors may provide clarity or identify hidden similarities between two ideas, and their use in cognitive restructuring can help maximise the effect of therapy information. This study aimed to determine whether metaphorical cognitive restructuring would produce a greater intervention effect in targeted mood and cognition than non-metaphorical restructuring. Methods Eighty-eight participants chose 25 problems of interest and wrote a self-report distress problem and were then randomly divided into a metaphorical restructuring group (N = 29), a literal restructuring group (N = 30), or a no restructuring problem restating group (N = 29). Participants first read a description of psychological distress ("problem") and then read a solution within one micro-counseling scenario. They were asked to evaluate their insightfulness during the intervention and evaluated mental distress and self-efficacy before and after the intervention. Results The mental distress of the metaphorical restructuring group significantly decreased after the intervention. Further, this group had greater insightfulness during the intervention, and this insightfulness could predict the reduction of negative affect after the intervention. Conclusions The use of metaphors can be of great value in eliciting a salient cognitive restructuring process and in alleviating mental distress.

Cardiac remodeling is a major early event of heart failure, which is regulated by multiple signaling pathways. Here, we demonstrate that TBC1D25 is upregulated during pathological cardiac remodeling. The aim of this study is to determine the role of TBC1D25 in cardiac remodeling and to illustrate the underlying molecular mechanism. Specifically, cardiac remodeling was induced in TBC1D25-KO mice and their wild-type control mice through partial transverse aortic constriction (TAC) of aortic arch. Knockout TBC1D25 exacerbated cardiac hypertrophy, fibrosis and dysfunction. Meanwhile, TBC1D25 overexpression in both H9C2 cells and NRCMs alleviate Angiotensin II-induced cardiomyocyte hypertrophy in vitro. Moreover, TBC1D25 deficiency increases the phosphorylation levels of TAK1 and its downstream molecular (JNK and p38), whereas overexpressed TBC1D25 inhibits phosphorylation of TAK1, JNK and p38. And TAK1 is the key molecule in this process. Furthermore, we demonstrated that TBC1D25 could directly interacts with TAK1 by immunoprecipitation assay and GST pull-down assay, and the interaction needs the amino acids from at least 138 to 226 in the C-terminal region of TBC1D25 and from 1 to 300 in the C-terminal region of TAK1. We conclude that TBC1D25 suppresses pathological cardiac remodeling via regulating TAK1-JNK/p38 signaling pathway, which suggests that TBC1D25 will likely become a promising therapeutic target for heart failure.

Although the effects of cognitive reappraisal in regulating negative emotion are generally well documented, its regulatory effects are usually not very strong because the ordinary reappraisals employed in previous studies were insufficient to overcome the mental set or response bias toward negative situations. In this study, we developed a new strategy employing creative reappraisals that provides an insightful reinterpretation of the negative stimulus. We believe this approach, through adopting a guided (creative) reappraisal rather than self-generation strategy, will greatly improve the emotion regulation effect of reappraisal through activating the neural networks representing the process of deep and structural mental representational change accompanied by the feeling of positive emotion and mental reward. The behavioral results suggested that 1) regarding the transient regulatory effect, creative reappraisal resulted in a positive rating for standardized negative pictures; 2) creative reappraisal had a long-lasting effect in reducing negative affect. In parallel with these behavioral results, the imaging data indicated that 1) creative reappraisal was specifically associated with greater engagement of the amygdala and hippocampus as well as regions in the ventral striatum, and 2) the engagement of the amygdala predicted the transient regulatory effect of creative reappraisal, while the involvement of the hippocampus and the ventral striatum predicted long-term regulatory effects. These findings suggest that the superior regulatory effect of creative reappraisal could be mediated by amygdala-based salient emotional arousal, hippocampus-based new association formation, and striatum-based mental rewarding to lead to a novel and positive experience that could be kept in long-term memory. This research indicates the key role of creative insight in reappraisal and presents a novel and highly efficient reappraisal strategy.

Cognitive restructuring is an important strategy in cognitive behavioral therapy (CBT). The present study aimed to observe cognitive restructuring in major depressive disorder (MDD) patients using textual micro-counseling dialogue situations. A set of textual micro-counseling dialogues was used to trigger cognitive restructuring in 25 MDD patients and 27 healthy adults. The participants read descriptions ("problems") and explanations ("solutions") for psychologically distressing situations. High-, low-, and zero-restructuring solutions were randomly matched to the problems. The participants evaluated the adaptability and emotional valence of the problems and the insightfulness, adaptability, novelty, and emotional valence of the solutions. Insightfulness ratings for high-restructuring solutions were significantly higher relative to those of low-restructuring solutions in healthy adults, while adaptability ratings for low-restructuring solutions were significantly higher relative to those of high-restructuring solutions in MDD patients. Insightfulness ratings for the solutions were significantly predicted by novelty and adaptability in healthy adults and emotional valence in MDD patients. Lower insightfulness in high-restructuring solutions and higher adaptability in low-restructuring solutions in MDD patients may reflect deficits in cognitive control.

Posttraumatic stress disorder (PTSD) is linked to abnormal amygdala activities. This study measured amygdala functional connectivity using DSM-5 criteria. There were 33 participants in the PTSD group and 33 participants in a trauma-exposed control (TEC) group, who did not have PTSD according to the PTSD checklist of the DSM-5 (PCL-5). Our findings are as follows: (1) In the PTSD group, the amygdala had increased positive connectivity with the medial prefrontal cortex (mPFC) and hippocampus, and decreased positive connectivity with the inferior mPFC and insula. The amygdala had increased negative connectivity with the orbital prefrontal cortex and decreased negative connectivity with the insula in comparison with TEC group. (2) PCL of all participants was correlated with the connectivity between the amygdala and the mPFC, hippocampus, and insula. These regions overlapped with those identified in the between-group comparisons. However, there was no association between PCL of the PTSD group and connectivity in these regions. Abnormal functional connectivity between the amygdala and mPFC subdivisions, hippocampus, and insula reveals their importance in PTSD pathogenesis.

Background/Aims: Myeloid-derived suppressor cells (MDSCs) are increased in inflammatory and autoimmune disorders. This study aims to evaluate the significance of MDSCs in dilated cardiomyopathy (DCM) patients. Methods: In total, 42 newly hospitalized DCM patients and 39 healthy controls were enrolled in the study. The frequencies of circulating CD14+HLA-DR-/low MDSCs were determined by flow cytometry. Then, the functional properties of MDSCs in suppressing T cell proliferation and interferon-gamma (IFN-γ) production were measured in a co-culture model. Then, mRNA expression levels of various important molecules in peripheral blood mononuclear cells were measured by real time polymerase chain reaction. Furthermore, correlation analyses between MDSC frequencies and cardiac function parameters were also performed. Results: The frequencies of circulating CD14+HLA-DR-/low MDSCs were significantly elevated in DCM patients compared with healthy controls. It showed that MDSCs from DCM patients more effectively suppressed T cell proliferation and IFN-γ production compared with those from healthy controls, which was partially mediated by arginase-1 (Arg-1). In addition, the correlation analysis suggested that MDSC frequencies were negatively correlated with left ventricular ejection fraction (LVEF), while positively with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with DCM. Conclusions: Circulating activated MDSCs might play significant immunomodulatory roles in the pathogenesis of DCM.

Background: The placebo effect in relieving negative emotion arousal is poorly understood.Aims: We examined whether placebo expectation established with noise stimuli could have a transferable anxiolytic effect on negative emotion arousal.Methods: In Experiment 1, noise intensity was surreptitiously lowered during placebo condition in the preconditioning phase to reinforce placebo expectation, and the noise-relieving placebo effect was assessed in the testing phase. In Experiment 2, the same manipulation as in Experiment 1 was administered in the preconditioning phase, but the anxiolytic placebo effect was assessed in the testing phase using negative pictures.Results: Intensity and annoyance by the noise in Experiment 1 were significantly reduced, and unpleasantness in Experiment 2 was also significantly reduced in the placebo condition.Conclusion: Direct noise-relieving placebo effects and transferred anxiolytic placebo effects were found. The present study provides evidence that the placebo effect can be transferred from noise to emotion.

Aim: The aim of this study was to explore whether the circulating frequency and function of myeloid-derived suppressor cells (MDSCs) are altered in patients with acute coronary syndrome (ACS). Methods: The frequency of MDSCs in peripheral blood was determined by flow cytometry, and mRNA expression in purified MDSCs was analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR). The suppressive function of MDSCs isolated from different groups was also determined. The plasma levels of certain cytokines were determined using Bio-Plex Pro™ Human Cytokine Assays. Results: The frequency of circulating CD14+HLA-DR-/low MDSCs; arginase-1 (Arg-1) expression; and plasma levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and IL-33 were markedly increased in ACS patients compared to stable angina (SA) or control patients. Furthermore, MDSCs from ACS patients were more potent suppressors of T-cell proliferation and IFN-γ production than those from the SA or control groups at ratios of 1:4 and 1:2; this effect was partially mediated by Arg-1. In addition, the frequency of MDSCs was positively correlated with plasma levels of IL-6, IL-33, and TNF-α. Conclusions: We observed an increased frequency and suppressive function of MDSCs in ACS patients, a result that may provide insights into the mechanisms involved in ACS.

The IL-33/ST2 signaling pathway plays an important role in coronary artery disease (CHD), however, few studies have explored how variants in IL-33/ST2 genes influence CHD risk. Here, we examined the association between genetic variants in IL-33, ST2, and IL-1RAcP of the IL-33/ST2 axis and the risk of CHD. We conducted a case-controlled study with 1146 CHD cases and 1146 age- and sex-frequency-matched controls. Twenty-eight single nucleotide polymorphisms (SNPs) in IL-33, ST2, and IL-1RAcP were genotyped by Sequenom MassArray and TaqMan assay. Logistic regression was used to analyze these associations. The SNP rs4624606 in IL-1RAcP was nominally associated with CHD risk. The AA genotype was associated with a 1.85-fold increased risk of CHD (95% confidence interval (CI) = 1.01–3.36, p = 0.045) compared to the TT genotype. Further analysis showed that AA carriers also had a higher risk of CHD than TT + TA carriers (odds ratio (OR) = 1.85, 95% CI = 1.85–3.35, p = 0.043). However, no significant association was observed between variants in IL-33/ST2 genes and CHD risk. Further studies are needed to replicate our results in other ethnic groups with larger sample size.

Although long-term depression (LTD) is generally considered as one of the underlying mechanisms of learning and memory, the induction of it in vivo seems difficult. Evidence demonstrates that the total synaptic weight is associated with circadian rhythm, with up-regulation in wakefulness and down-regulation during sleep, suggesting that the induction of LTD may also be affected by it. In this study, we found that in two well-established rat models, low-frequency stimuli (LFS) induced LTD upon daytime anesthesia, but not at night. Upon further study, we found that the induction of LTD could not be blocked at night if we deprived sleep of the rats during the daytime. These results indicate that the induction of LTD is facilitated by daytime or sleep deprivation. Since rats both in the daytime and after sleep deprivation share the same character of high sleep pressure, our results suggest that LTD is actually facilitated by high sleep pressure. Our study also provides a possible explanation why some labs can induce LTD in vivo while others cannot. Sleep pressure should be taken into account as one of the key factors on the induction of LTD in vivo.

Past studies indicate that the placebo expectation established by analgesic treatment significantly relieves pain perception, while ataractic treatment significantly alleviates unpleasant arousal evoked by negative picture processing. But it is unclear whether the placebo effect can be transferred from one domain to the other, namely from pain to emotion. In this study we led participants to believe in the analgesic effect of magnetic treatment equipment (the placebo) by secretly reducing the intensity of pain stimulus. Then, we examined if this placebo could significantly alter participants' negative affect evoked by watching unpleasant pictures. Our results indicated a significant transferable placebo effect that alleviated negative feelings. EEG recordings showed the transferable placebo treatment induced decreased P2 amplitude and increased N2 amplitude, with source location near the posterior cingulate.

Insight is a salient psychotherapeutic progress but has rarely been measured in a controlled experimental setting. This study aimed to assess whether textual micro-counseling dialogue could validly evoke insight and to explore the characteristics of insight. The guessing riddle of cognitive psychology was used as a reference of the experimental paradigm. Specifically, textual micro-counseling dialogues applying cognitive restructuring techniques were presented. The participant first read a description of a psychological distress ("problem") and then an explanation ("solution"). Zero-, low-, and high-restructuring solutions were randomly matched to the problems and it was expected that they would trigger different levels of insight experiences. Experts and students evaluated the adaptability and emotional valence of problems, and the insightfulness, novelty, adaptability, and emotional valence of solutions. For both experts and students, different intensities of insightfulness were produced across high-, low- and zero-restructuring solutions. Novelty significantly discriminated the high-restructuring solutions from the other two solution types. Adaptability and emotional valence could discriminate the high- and low-restructuring solutions types from the zero-restructuring solution. Insightfulness had high correlations with novelty and adaptability. These results indicated that textual micro-counseling dialogues with a high-restructuring solution could validly produce the greatest insightfulness and the features of high-restructuring solutions may have reference meaning for improving psychotherapeutic effect.

The present study compared learning-based placebo effect and cognition-based reappraisal, to reveal the common and unique neural mechanisms between the two emotion regulations. First, the anxiety-relieving effect was tested by conducting a behavioral experiment Next, the participants with the highest placebo or reappraisal effect were selected for the functional magnetic resonance imaging experiments. The results indicated that: (1) they both attenuated activity in the right amygdala and right insula, and (2) placebo effect activated the left subgenual cingulate whereas reappraisal activated the right dorsal prefrontal cortex (PFC) and the left inferior PFC. Our results show that learning-based placebo effect and cognition-based reappraisal have common anxiety-relieving effects. The placebo effect mainly depends on direct pathway subgenual cingulate-amygdala to regulate emotions, whereas the reappraisal may rely on both indirect pathways, such as the dorsal PFC-subgenual cingulate-amygdala, and direct pathways, such as the ventral lateral PFC-amygdala to regulate emotions. (c) 2012 Elsevier Inc. All rights reserved.

Placebo analgesia is one of the most robust and best-studied placebo effects. Recent researches suggest that placebo analgesia activated the µ-opioid receptor signalling in the human brain. However, whether other opioid receptors are involved in the placebo analgesia remains unclear. We have previously evoked placebo responses in mice (Guo et al.2010, 2011) and these mice may serve as a model for investigating placebo analgesia. In the present study, we tried to explore the site of action and types of opioid receptors involved in placebo response. Male Sprague–Dawley rats were trained with 10 mg/kg morphine for 4 d to establish the placebo analgesia model. This placebo analgesia can be blocked by injection of 5 mg/kg dose naloxone or by microinjection with naloxone (1, 3 or 10 µg/rat) into rostral anterior cingulate cortex (rACC). Then, animals were tested after intra-rACC microinjection of d-Phe-Cys-Tyr-d-Trp-Orn-Thr-Pen-Thr-NH2 (CTOP, a selective µ-opioid receptor antagonist) or naltrindole (NTI, a highly selective δ-opioid receptor antagonist) or nor-binaltorphimine (nor-BNI, a highly selective κ-opioid receptor antagonist). Our results showed that CTOP, but not NTI or nor-BNI, could reduce the pain threshold in placebo analgesia rats. It may be concluded that rACC is the key brain region involved in placebo analgesia and the opioid placebo analgesia is mediated exclusively through µ-opioid receptor in rat.

Normally long-term depression (LTD) is difficult to be induced in naive adult rats in vivo, but it can be induced in the juvenile females and acute-stressed adult males. Using these rats as LTD models, we find in our previous study that LTD induction by the classical low-frequency stimuli (LFS) may be associated with sleep. During sleep, endogenous field potential oscillations presented in the neocortical and hippocampal circuits play important roles in synaptic downscaling as well as memory consolidations. Generally, LTD can be considered as a special synaptic downscaling and the classical LFS is very similar to such endogenous oscillations. Thus, we speculate whether we can design a new LFS which is more similar to such oscillations and whether LTD can be induced by it in naive adult rats? In this study, we found that in the naive adult rats anesthetized in sleep stage, the classical LFS could not induce LTD, however, a low-intensity LFS, an endogenous oscillation-like one, could induce LTD. Furthermore, in the rats anesthetized in wakefulness stage, neither the classical nor the low-intensity LFS could induce LTD. Our study showed that in the naive adult rats, LTD could be induced by the oscillation-like LFS in the sleep stage anesthesia, suggesting that LTD may physiologically occur during sleep and be inhibited in wakefulness stage. Our study suggested that in the hippocampus LTD may be a potential long-term synaptic plasticity underlying sleep-dependent memory consolidations.

Our previous study showed that placebo expectations can develop in a transferable manner; for example, a placebo expectation developed within an analgesic experience may lead to reduced anxiety. Considering that activities in such emotion-responsive areas as the amygdala and insula can be detected through functional magnetic resonance imaging (fMRI), we used fMRI to further study the transferable placebo anxiolytic effect. A main-effect analysis showed that activity in the amygdala and insula was reduced in the placebo condition, whereas an interaction analysis showed activity in the two regions was selectively attenuated in the placebo condition when unpleasant pictures were viewed. We also observed greater activity in the subgenual anterior cingulate cortex under placebo conditions when either emotionally negative or neutral pictures were viewed. These data suggest that the anxiety-relieving placebo effect arose from a reward-related response underpinned by the participants' expectations.

To investigate the clinical effect of the acetabular tridimensional memory alloy-fixation system (ATMFS) in treatment of posterior wall acetabular fractures with posterior dislocation of hip.From January 2004 to February 2006, 15 cases of posterior wall acetabular fracture with posterior dislocation of hip were treated. There were 11 males and 4 females, aged 21-68 years old with an average of 43.5 years old. Injury was caused by traffic accident in 8 cases, by falling from height in 5 cases and others in 2 cases. The locations were the left hip in 9 cases and the right hip in 6 cases. According to Thompson-Epstein' fracture classification, there were 6 cases of type II, 5 cases of type III, 2 cases of type IV and 2 cases of type V. Imaging showed the acetabular articular surface displacement of 2-5 mm (mean 3 mm). The time from injury to hospitalization was 6 hours to 2 weeks(mean 1.5 days). Skeletal traction on femoral condyle was given, manual reduction was performed in 12 patients and intra-operative reduction in 3 cases. ATMFS was used after 2-7 days of hospitalization, and 4 cases received autologous free ilium because of bone defect.The operative time was 90-390 minutes with an average of 210 minutes. Intraoperative blood loss was 350-2 500 mL with an average of 360 mL. The hospitalization days of the patients ranged from 7 to 21 days(mean 10 days). Epidermal infection occurred and was cured after symptomatic management in 1 case. Other incisions healed by first intention. No deep infections, pulmonary embolism, deep venous thrombosis and other complications occurred. The patients were followed up 1 to 3 years with an average of 1.6 years. Ischemic necrosis of femoral head occurred in 1 case. Heterotopic ossification in grade II occurred in 1 case. The hip function was still good without special treatment. According to Matta's X-ray fracture reduction assessment, the results were excellent in 7 cases, good in 5 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 80%. According to d'Aubigné clinical efficacy evaluation, the results were excellent in 8 cases, good in 5 cases, fair in 1 case, and poor in 1 case, the excellent and good rate was 86.7% at last followup.ATMFS can be used for the treatment of posterior wall acetabular fracture with posterior dislocation of hip, which can improve the anatomy corresponding rate of the femoral head and reduce the incidence of complications and restore the function of the hip.

The vast majority of decision-making research is performed under the assumption of the value maximizing principle. This principle implies that when making decisions, individuals try to optimize outcomes on the basis of cold mathematical equations. However, decisions are emotion-laden rather than cool and analytic when they tap into life-threatening considerations. Using functional magnetic resonance imaging (fMRI), this study investigated the neural mechanisms underlying vital loss decisions. Participants were asked to make a forced choice between two losses across three conditions: both losses are trivial (trivial-trivial), both losses are vital (vital-vital), or one loss is trivial and the other is vital (vital-trivial). Our results revealed that the amygdala was more active and correlated positively with self-reported negative emotion associated with choice during vital-vital loss decisions, when compared to trivial-trivial loss decisions. The rostral anterior cingulate cortex was also more active and correlated positively with self-reported difficulty of choice during vital-vital loss decisions. Compared to the activity observed during trivial-trivial loss decisions, the orbitofrontal cortex and ventral striatum were more active and correlated positively with self-reported positive emotion of choice during vital-trivial loss decisions. Our findings suggest that vital loss decisions involve emotions and cannot be adequately captured by cold computation of minimizing losses. This research will shed light on how people make vital loss decisions.