Use of acoustic cardiography to assess left ventricular electromechanical synchronization during left bundle branch pacing.

Background: Left bundle branch pacing (LBBP) is a physiological pacing that captures the main left bundle or its proximal branch. Electromechanical activation time (EMAT) is an acoustic cardiographic metric that provides a simple method for evaluating left ventricular (LV) synchrony. Prolonged EMAT reflects impaired LV electromechanical coupling. Objective: The purpose of this study was to explore whether EMAT can confirm that LBBP produces more satisfactory LV electromechanical synchronization than conventional right ventricular pacing modalities. Methods: Patients with standard pacing indications and narrow QRS duration were recruited for this study. Unipolar pacing under 3 different modalities-right ventricular apical pacing (RVAP), right ventricular high septal pacing (RVHSP), and LBBP-were successively performed in each patient. Pacing parameters, echocardiographic characteristics, and acoustic cardiographic parameters at different pacing modalities and during normal rhythm were collected. Results: A total of 55 patients were enrolled, and all had successful LBBP. Left ventricular activation time (LVAT) was significantly associated with EMAT, with LVAT vs EMAT correlation coefficient of 0.665 (P <.001). LVAT during LBBP was shorter than that during RVHSP (51.93 ± 2.732 ms vs 85.59 ± 2.240 ms; P <.001). EMAT of LBBP was significantly lower than either RVAP or RVHSP (95.44 ± 1.794 ms vs 143.32 ± 2.376 ms, and 132.22 ± 1.872 ms; both P <.001) but was similar to that of intrinsic rhythm (95.37 ± 2.271 ms; P = .862). Conclusion: We found EMAT significantly prolonged in RVHSP and RVAP but not in the LBBP mode. This finding indicates superior electromechanical synchronization in patients having LBBP. EMAT measurement could be an additional method for identifying the ideal pacing position.

Characterization of the substernal space with computed tomography imaging in patients with and without median sternotomy: Assessing a novel implant location for extravascular defibrillation lead placement.

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) provide clinically significant therapy for the prevention of sudden cardiac death. This study aimed to characterize the substernal space using computed tomography (CT) in patients with and without prior midline sternotomy to investigate the feasibility of substernal ICD lead implantation in post-sternotomy patients. METHODS: High-quality electrocardiogram-gated CT images from 100 patients (71% male, average body mass index 23.5 ± 2.9) were retrospectively collected, including 50 patients with prior midline sternotomy (S-group) and 50 patients with no prior sternotomy (NS-group). Distances were measured from the retrosternal surface to the epicardial surface of the heart and segmented into four regions from the xiphoid tip and superiorly along the sternum. RESULTS: Results generally showed a measurable but narrower average sternum-to-heart distance in the prior sternotomy group compared to the non-sternotomy group in all four regions (p < .05). In the S-group, the sternum-to-heart distances across all regions ranged from 0 to 32.0 mm, while in the NS-group, the distances ranged from 0 to 39.9 mm. CONCLUSION: Small but measurable separations between the heart and sternum were observed in patients with prior sternotomy, particularly near the xiphoid region, indicating the potential viability of extravascular substernal ICD lead implantation in post-sternotomy patients.

Body Donation Registration in Taiwan: Reasons and Associated Psychological Factors.

Dissection is an essential element of medical training and depends on the availability of cadavers. However, traditional Chinese culture widely regards the body as a gift from one's parents that should remain intact after death, resulting in a shortage of cadavers for medical training and research. This situation changed in Taiwan when Master Cheng Yen, the founder of the Buddhist Tzu Chi Medical Foundation, supported the donation of bodies to medical science. This study aimed to investigate the current situation of body donation in Taiwan, including donors' motivation and psychological characteristics. A questionnaire was conducted with 681 adult participants, including 336 people who pledged to donate their bodies to medical science after death and a control group comparable in age, gender, and level of education. All participants answered questions regarding anxiety over death, purpose in life, gratitude, altruism, and life satisfaction. In addition, the registered donor group answered questions regarding the motivation for donating their bodies to science. The main influencing factors were to help advance medical science, make a positive contribution to society, and release attachment from the body. Further, many male participants indicated the desire to reduce trouble and expenses that their families would incur in making funeral and burial or cremation arrangements. The main predictors of donating one's body to medical science were low anxiety concerning death, a high level of altruism, and gratitude.

Development and preliminary testing of a virtual reality measurement for assessing intake assessment skills.

Objective structured clinical examinations (OSCEs) have been widely used in health care education to simultaneously assess knowledge, skill and attitude. Due to the high cost of running an OSCE, its application in professional psychology is still limited. To solve this problem, virtual standardised patient (VSP) implementations in creating psychology OSCEs can be a cost-effective method for administering a psychology OSCE regularly. This study aimed to develop and examine the psychometric properties of the VSP version of the Intake OSCE (VSP-Intake OSCE) in measuring psychologists' psychological assessment competencies (PACs) from entry to early practice. The initial development of the VSP-Intake OSCE contains a VSP station and a follow-up written station to measure PACs when conducting an intake assessment. To administer the VSP station, we built a new VSP system that allows psychologists to interact with a VSP verbally. A sample of 36 participants, including 27 graduate students and nine psychologists, were recruited to examine the psychometric properties of the VSP-Intake OSCE. As a newly developed instrument, the VSP-Intake OSCE revealed good inter-rater reliability and construct validity. We believe using VSP implementations to develop psychology OSCEs will be essential in promoting OSCE applications in professional psychology.

Emotion Regulation in Close Relationships: The Role of Individual Differences and Situational Context.

A substantial amount of research has examined the role of individual differences in the regulation of emotion and the impact of emotion regulation on mental health; however, few studies have covered the role of situational context in the selection of emotion regulation strategies. In this paper, we investigate the extent to which an individual's choice of emotion regulation strategy is affected by factors such as emotional intelligence, the person with whom one is in conflict, situational sense of control, and the individual's aim in dealing with the conflict. A total of 300 participants (46.67% female) between the ages of 21 and 35 were recruited from the community (female's mean age = 28.14, SD = 4.49; male's mean age = 28.12, SD = 4.32). Participants filled out a set of questionnaires related to their emotion intelligence and emotion regulations they used in two interpersonal incidents with parents and partner. Structural equation modeling was used for data analyses. Results showed that positive correlation between emotional intelligence and cognitive reappraisal, in contrast to previous studies, a positive correlation between emotional intelligence and repression was found. Moreover, the person one is interacting with influences the degree to which one's sense of control impacts the choice of emotion regulation strategy. For example, in the event of conflict with one's parents, the degree of situational control has little impact on emotion regulation; however, in conflicts with spouses or partners, women have more situational control and are more likely to use cognitive reappraisal or suppression. Regarding the relationship between the goal of emotion regulation and the strategies used, this study found that they are moderated by gender and the persons involved; for example, when maintaining the relationship is the primary goal of emotion regulation, cognitive reappraisal is more likely the strategy of choice for men involved in a conflict with their partner and for women involved in a conflict with their parents. Overall, the results confirm that emotion regulation is affected by both individual and situational factors, indicating the importance of adopting a dynamic approach when investigating emotion regulation.

The Immune Subtypes and Landscape of Gastric Cancer and to Predict Based on the Whole-Slide Images Using Deep Learning.

Background: Gastric cancer (GC) is a highly heterogeneous tumor with different responses to immunotherapy. Identifying immune subtypes and landscape of GC could improve immunotherapeutic strategies. Methods: Based on the abundance of tumor-infiltrating immune cells in GC patients from The Cancer Genome Atlas, we used unsupervised consensus clustering algorithm to identify robust clusters of patients, and assessed their reproducibility in an independent cohort from Gene Expression Omnibus. We further confirmed the feasibility of our immune subtypes in five independent pan-cancer cohorts. Finally, functional enrichment analyses were provided, and a deep learning model studying the pathological images was constructed to identify the immune subtypes. Results: We identified and validated three reproducible immune subtypes presented with diverse components of tumor-infiltrating immune cells, molecular features, and clinical characteristics. An immune-inflamed subtype 3, with better prognosis and the highest immune score, had the highest abundance of CD8+ T cells, CD4+ T-activated cells, follicular helper T cells, M1 macrophages, and NK cells among three subtypes. By contrast, an immune-excluded subtype 1, with the worst prognosis and the highest stromal score, demonstrated the highest infiltration of CD4+ T resting cells, regulatory T cells, B cells, and dendritic cells, while an immune-desert subtype 2, with an intermediate prognosis and the lowest immune score, demonstrated the highest infiltration of M2 macrophages and mast cells, and the lowest infiltration of M1 macrophages. Besides, higher proportion of EVB and MSI of TCGA molecular subtyping, over expression of CTLA4, PD1, PDL1, and TP53, and low expression of JAK1 were observed in immune subtype 3, which consisted with the results from Gene Set Enrichment Analysis. These subtypes may suggest different immunotherapy strategies. Finally, deep learning can predict the immune subtypes well. Conclusion: This study offers a conceptual frame to better understand the tumor immune microenvironment of GC. Future work is required to estimate its reference value for the design of immune-related studies and immunotherapy selection.

Regulating anger in different relationship contexts: A comparison between psychiatric outpatients and community controls.

BACKGROUND: The capacity to regulate emotion is important for individuals' ability to adapt to society, the long-term lack of which can lead to related emotional disorders. However, evaluating whether an emotion-regulation strategy is appropriate requires consideration of the individual's distinct culture and situation. In this study, we compared the anger regulation strategies employed in various interpersonal situations by psychiatric outpatients and a community control group in Taiwan. METHODS: We surveyed 150 psychiatric outpatients (mean age = 45.30, SD = 12.48, 73.3% female) and 150 community controls (mean age = 45.05, SD = 12.24, 73.3% female) congruent in age and sex. Participants evaluated their emotion regulation in two interpersonal contexts by completing a set of questionnaires related to a recent incident of anger they experienced with family and friends, respectively. RESULTS: Outpatients used the emotion-regulation strategies of cognitive reappraisal and expressive suppression equally in various relationships; while the community control group made more use of cognitive reappraisal to regulate anger, which arose in their relationships with both family and friends. Relationship intimacy influenced the strategy adopted, and the community control group was more likely to use suppression to regulate anger towards friends than family members, which reflected a cultural belief-maintaining harmony in social relationships. LIMITATIONS: Context-specific emotion regulation was assessed via a retrospective self-report measure, which is subject to recall bias. CONCLUSIONS: Our findings highlight the importance of considering interpersonal contexts when studying emotion regulation and developing psychological interventions that target anger or other negative emotion regulation.

Association between Emotion Dysregulation and Distinct Groups of Non-Suicidal Self-Injury in Taiwanese Female Adolescents.

Background: Previous studies revealed that female adolescents are more likely than males to engage in non-suicidal self-injury (NSSI) to regulate negative emotions; however, the dimensions of emotion regulation that are associated with NSSI behavior in adolescents require further examination. The present study aimed to identify Taiwanese female adolescent clusters with NSSI engagement frequency and to evaluate the association of specific forms of emotion dysregulation with NSSI. Methods: The participants were 438 female adolescents (mean age = 15.23 years, SD = 1.24, range between 13 and 18) recruited from 11 high schools. Self-report questionnaires assessing NSSI, difficulties in emotion regulation, and positive and negative affect were administered, and 37% of respondents reported a history of NSSI. Results: The analysis of NSSI frequency yielded three groups: severe, moderate, and non-NSSI. High negative affect, low positive affect, and difficulties in all aspects of emotion regulation differentiated female adolescents in the severe NSSI group from their counterparts in the non-NSSI group. The moderate and severe NSSI groups were further distinguished by age of onset, negative affect, emotion regulation strategies, and impulse control. Adolescents classified in the severe group reported earlier onset of NSSI, higher negative affect, less emotion regulation strategies, and more difficulty with impulse control. Conclusions: The results indicate that assessments of NSSI and emotion regulation should be incorporated in youth mental health screening. The clinical implications of NSSI behavior intervention require further discussion.

Internet-Delivered Cognitive Behavior Therapy for Young Taiwanese Female Nursing Students with Irritable Bowel Syndrome-A Cluster Randomized Controlled Trial.

Irritable Bowel Syndrome (IBS) is prevalent within the general population. Studies have shown that stress and anxiety co-exist with IBS. Young Taiwanese women commonly exhibit physical and psychological health problems caused by academic stress. The purpose of our current study was to evaluate the efficacy of short-term Internet-delivered cognitive-behavioral therapy (ICBT) on female nursing students in practicum. We performed a cluster randomized controlled trial comprised of 160 participants who met the inclusion criteria, which were divided into three groups: (1) ICBT, (2) expressive writing (EW), and (3) wait-list control. Treatment interventions lasted for 6 weeks. Levels of anxiety, depression, and IBS symptoms were assessed at four time points, baseline assessment at T0, 2 weeks after T0 (T1), at the end of practicum (T2), and at 3-month follow-up (T3). The results showed that ICBT and EW groups exhibited a significant, yet small, reduction in anxiety and depression at T2 and T3 compared to the wait-list control group. The EW group exhibited significantly greater reduction in anxiety and depression compared to the ICBT group at T2. However, the ICBT group demonstrated greater improvements in alleviating anxiety and depression at T3 compared to the EW group. These data indicate that ICBT and EW groups exhibited small effects on anxiety and depression reduction at T2 and T3 compared to the wait-list control group, with no effects on IBS symptoms in young Taiwanese female nursing students.