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Cooperation, as a mutual collaboration, is a defining feature of human social life. Individual characteristics can influence cooperation. Recent studies have shown a quadratic relationship between cardiac vagal tone (CVT), an index of self‐regulation, and prosocial behaviors. Individual differences in cooperation might also vary as a function of people's environmental sensitivity (ES), i.e., may be influenced by individual differences in the perception and processing of inner and external stimuli. We tested the direct and interactive effect of CVT and ES on cooperative behaviors in two independent samples. We measured heart rate and engagement in cooperative acts in 80 young adults (M = 23.61; SD = 1.60) who were also asked to self‐report on ES. We found an inverted‐U relationship between CVT and cooperative behaviors. ES, on the other hand, did not predict differences in cooperative behaviors but moderated the relationships between CVT and cooperation, although the magnitude of this result was small. Specifically, only among individuals with higher ES cooperative behaviors change as a function of CVT. Highly sensitive individuals with lower or higher CVT, were less cooperative than low sensitive ones. Subsequently, we replicated the same study design in a second sample of 88 undergraduate students (M = 23.69; SD = 4.91). Once again, we found evidence supporting the presence of an inverted‐U relationship between CVT and cooperative behaviors, and we also found that ES moderated the relationships between the quadratic CVT term and cooperation. Our findings add new evidence on physiological self‐regulation as an underlying mechanism of prosocial behaviors, in particular cooperation. In two independent samples, our results showed a quadratic relationship between cardiac vagal tone (CVT) and cooperation. We found that this relationship is moderated by environmental sensitivity (ES). Specifically, only among individuals with higher ES, cooperative behaviors change as a function of CVT. To make the world more cooperative, people should learn how to regulate especially when they are highly sensitive. [ABSTRACT FROM AUTHOR]

Interoception, which refers to the perception of body's internal state, is implicated in emotional processes and psychopathological disorders. Over the last decades, different tools have been developed to measure interoceptive accuracy, or the ability to accurately perceive physiological signals. Most of these tools have focused on cardiac interoception, but respiratory interoception has been less investigated due to the more complex and less portable equipment required. In this study, we suggest a new duration discrimination respiratory (DDR) task that does not require complex equipment. Using an adaptive staircase procedure, this task aims to determine an individual's ability to detect exhalation longer than their resting reference duration. One hundred and twenty‐three healthy subjects completed the DDR task, an interoceptive task of heart rate discrimination, and filled out questionnaires on interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness), alexithymia (Toronto Alexithymia Scale [TAS]), affects (Positive and Negative Affect Scale [PANAS]), and anamnestic. Results demonstrated a good internal consistency (Cronbach's alpha =.93) of the DDR task. On average, subjects needed 99.22% (SD = 36.38) of their reference exhalation time in addition to reference exhalation to detect a prolonged exhalation. Higher self‐reported fitness levels, not counting during the DDR task and lower difficulty in describing feelings (TAS subscale), predicted higher respiratory discrimination duration. In conclusion, this study demonstrates the utility of the DDR task as a valid measure of interoception. Growing interest in interoception highlights the need for reliable measures. Respiratory interoception is understudied compared to cardiac interoception. Non‐portable equipment for respiratory measures is limiting clinical research. Our task provides a portable and ecological measure of respiratory interoception. [ABSTRACT FROM AUTHOR]

Transcranial magnetic stimulation (TMS) is pivotal in the field of major depressive disorder treatment. Due to its unsatisfied response rate, an increasing number of researchers have turned their attention towards optimizing TMS site localization. Since the influence of TMS in reducing heart rate (HR) offers insights into its regulatory impact on the autonomic nervous system, a novel approach, called neurocardiac‐guided TMS (NCG–TMS), has been proposed to pinpoint the brain region eliciting the maximal individual reduction in HR as a personalized optimal stimulation target. The present study intends to systematically explore the effects of stimulation frequency, left and right hemispheres, stimulation positions, and individual differences on HR modulation using the NCG–TMS method. In experiment 1, low‐frequency TMS was administered to 30 subjects, and it was found that low‐frequency NCG–TMS significantly downregulated HR, with more significant effects in the right hemisphere than in the left hemisphere and the prefrontal cortex than in other brain areas. In experiment 2, high‐frequency NCG–TMS stimulation was administered to 30 subjects, showing that high‐frequency NCG–TMS also downregulated HR and had the greatest modulatory effect in the right prefrontal region. Simultaneously, both experiments revealed sizeable individual variability in the optimal stimulation site, which in turn validated the feasibility of the NCG–TMS method. In conclusion, the present experiments independently replicated the effect of NCG–TMS, provided an effect of high‐/low‐frequency TMS stimulation to downregulate HR, and identified a right lateralization of the HR modulation effect. This study independently validated the neuro‐cardiac‐guided transcranial magnetic stimulation (TMS) technique through high‐frequency and low‐frequency TMS. The findings not only unveiled the group‐level heart rate regulatory effects of the right prefrontal cortex but also uncovered individual differences in regulatory responses. These results offer novel theoretical support for the personalized clinical application of TMS in modulating the autonomic nervous system. [ABSTRACT FROM AUTHOR]

Why should researchers measure psychophysiological processes repeatedly over time? The study of psychophysiology inherently involves sampling biological processes as they manifest over time. The most common approach is to use a brief sample to make conclusions about how individuals or groups differ. Although these types of between‐subject comparisons have utility for understanding individual and group differences, many of the important conceptual questions in the field involve processes that are dynamic, varying within individuals over time. Using examples from the literature on affect regulation, this conceptual review contrasts three types of study designs: the classic single‐observation design and the aggregated and temporally linked repeated observation designs, which have great promise for measuring variables that fluctuate dynamically over time. Importantly, these designs can be integrated to elucidate research questions about risk (when and for whom will the likelihood of an unwanted outcome occurring increase?), mechanisms (how and why does a change in psychophysiology contribute to a change in another process of interest?), and interventions (how and when should interventions take place to modify an outcome?). Researchers are encouraged to implement intensive sampling in their research, which can be conducted in traditional laboratory settings (e.g., fMRI, event‐related brain potentials, and heart rate variability) and in ecologically valid contexts in everyday life using ambulatory assessment. Many important conceptual questions in the field of psychophysiology involve dynamic processes that vary within individuals over time. This article highlights research designs for measuring psychophysiological processes that can be integrated to elucidate research questions about risk (when and for whom will the likelihood of an outcome occurring increase?), mechanisms (how and why does a change in psychophysiology contribute to a change in another process of interest?), and interventions (how and when should interventions take place?). [ABSTRACT FROM AUTHOR]

This study investigated the role of arousal and effort costs in the cognitive benefits of alternating between sitting and standing postures using a sit‐stand desk, while measuring executive functions, self‐reports, physiology, and neural activity in a 2‐h laboratory session aimed to induce mental fatigue. Two sessions were conducted with a one‐week gap, during which participants alternated between sitting and standing postures each 20‐min block in one session and remained seated in the other. In each block, inhibition, switching, and updating were assessed. We examined effects of time‐on‐task, acute (local) effects of standing versus sitting posture, and cumulative (global) effects of a standing posture that generalize to the subsequent block in which participants sit. Results (N = 43) confirmed that time‐on‐task increased mental fatigue and decreased arousal. Standing (versus sitting) led to acute increases in arousal levels, including self‐reports, alpha oscillations, and cardiac responses. Standing also decreased physiological and perceived effort costs. Standing enhanced processing speed in the flanker task, attributable to shortened nondecision time and speeded evidence accumulation processes. No significant effects were observed on higher‐level executive functions. Alternating postures also increased heart rate variability cumulatively over time. Exploratory mediation analyses indicated that the positive impact of acute posture on enhanced drift rate was mediated by self‐reported arousal, whereas decreased nondecision time was mediated by reductions in alpha power. In conclusion, alternating between sitting and standing postures can enhance arousal, decrease effort costs, and improve specific cognitive and physiological outcomes. We studied the impact of standing on executive functions and physiology using a unique multi‐method approach that investigated the effect of alternating between sitting and standing on cardiac physiology, neural oscillations, and executive functions. Standing improved neural and physiological arousal, enhanced overall task performance in a flanker task, while also decreasing physiological and perceived effort costs, and increasing heart rate variability over time. These findings emphasize the benefits of alternating between seated and standing postures for the body and the brain. [ABSTRACT FROM AUTHOR]

The ability to flexibly transition between defensive states is crucial for adaptive responding in life‐threatening situations. Potentially threatening situations typically induce a sustained feeling of apprehension in association with hypervigilance, while acute threat is usually characterized by an intense and transient response to cope with the imminent danger. While potential and acute threat states have traditionally been viewed as mutually exclusive, this distinction is being challenged by a growing body of evidence suggesting a more complex interplay during simultaneous activation of these states. However, the interaction between potential and acute threat on a psychophysiological level remains elusive. To fill this gap, 94 healthy individuals participated in one of two contextual fear‐conditioning paradigms. In both paradigms, a differential fear‐learning phase was conducted, followed by a test phase in which the conditioned stimuli were presented in front of either conditioned or inherently aversive contextual images compared to neutral contexts. To capture defensive responses, we recorded subjective (threat and expectancy ratings) and physiological (electrodermal and cardiovascular) activity to the conditioned stimuli as a function of contextual threat. Besides indices of successful fear conditioning, our results revealed stronger threat and unconditioned stimulus expectancy ratings, cardiac deceleration, and skin conductance responses for threat and safety cues presented in inherently aversive compared to neutral contexts. Conditioned contexts had less impact on physiological responses to threat and safety cues than inherently aversive contexts. These findings provide new insights into the additive nature of defensive responses to fear cues and situations of contextual threat. Recent research challenges the idea that defensive states induced by potential and acute threat are mutually exclusive. In this study, we observed enhanced defensive responses to acute threat stimuli during aversive contexts as indexed by heart rate and skin conductance responses, indicating an interplay between potential and acute threat states that is influenced by contextual threat levels. [ABSTRACT FROM AUTHOR]

Chronic loneliness and low perceived social support have been recognized as risk factors for both mental and cardiovascular disorders. It has been proposed that their link to psychophysiological problems may involve changes in parasympathetic activity. However, the exact underlying psychopathological mechanisms and the moderating effects of gender are still not thoroughly examined. Thus, the present study investigated associations between perceived social functioning and resting vagal tone in the context of potential cognitive and subclinical mediators and gender differences. Three hundred twenty‐five young adults (aged 18–35, 180 women) underwent an electrocardiogram measurement of 6‐minute resting heart rate variability (HRV). They also completed questionnaires assessing loneliness, perceived social support, social cognitive biases, depressive and social anxiety symptoms, and general mental health. In men, HRV was significantly and negatively associated with poorer perceived social functioning, depressive symptoms, and self‐reported social cognitive biases, while in women, there was a quadratic link between HRV and depressive symptoms and HRV and general mental health. Moderated mediation analysis revealed that depressive symptoms fully mediated the relationship between perceived social functioning and HRV in men. The results suggest that decreased resting vagal tone in lonely individuals is linked to depressive symptomatology rather than to specific social cognitive biases and that this association is significant only in men. While previous work on the relationship between loneliness and parasympathetic activity has yielded mixed results, the present study provides evidence for an association between reduced resting vagal tone, loneliness, and perceived social support. Importantly, we showed that this association was mostly related to subclinical depressive symptoms and was only observed in men, which may help better understand individual differences related to maladaptive physiological processes in lonely individuals. [ABSTRACT FROM AUTHOR]

Sleep apnea (SA) is a prevalent disorder characterized by recurrent events of nocturnal apnea. Polysomnography (PSG) represents the gold standard for SA diagnosis. This laboratory-based procedure is complex and costly, and less cumbersome wearable devices have been proposed for SA detection and monitoring. A novel textile multi-sensor monitoring belt recording electrocardiogram (ECG) and breathing frequency (BF) measured by thorax excursion was developed and tested in a sleep laboratory for validation purposes. The aim of the current study was to evaluate the diagnostic performance of ECG-derived heart rate variability and BF-derived breathing rate variability and their combination for the detection of sleep apnea in a population of patients with a suspicion of SA. Fifty-one patients with a suspicion of SA were recruited in the sleep laboratory of the Cantonal Hospital St. Gallen. Patients were equipped with the monitoring belt and underwent a single overnight laboratory-based PSG. In addition, some patients further tested the monitoring belt at home. The ECG and BF signals from the belt were compared to PSG signals using the Bland-Altman methodology. Heart rate and breathing rate variability analyses were performed. Features derived from these analyses were used to build a support vector machine (SVM) classifier for the prediction of SA severity. Model performance was assessed using receiver operating characteristics (ROC) curves. Patients included 35 males and 16 females with a median age of 49 years (range: 21 to 65) and a median apnea-hypopnea index (AHI) of 33 (IQR: 16 to 58). Belt-derived data provided ECG and BF signals with a low bias and in good agreement with PSG-derived signals. The combined ECG and BF signals improved the classification accuracy for SA (area under the ROC curve: 0.98; sensitivity and specificity greater than 90%) compared to single parameter classification based on either ECG or BF alone. This novel wearable device combining ECG and BF provided accurate signals in good agreement with the gold standard PSG. Due to its unobtrusive nature, it is potentially interesting for multi-night assessments and home-based patient follow-up. [ABSTRACT FROM AUTHOR]

The widespread use of wearable devices has enabled continuous monitoring of biometric data, including heart rate variability (HRV) and resting heart rate (RHR). However, the validity of these measurements, particularly from consumer devices like Apple Watch, remains underexplored. This study aimed to validate HRV measurements obtained from Apple Watch Series 9 and Ultra 2 against the Polar H10 chest strap paired with the Kubios HRV software, which together served as the reference standard. A prospective cohort of 39 healthy adults provided 316 HRV measurements over a 14-day period. Generalized Estimating Equations were used to assess the difference in HRV between devices, accounting for repeated measures. Apple Watch tended to underestimate HRV by an average of 8.31 ms compared to the Polar H10 (p = 0.025), with a mean absolute percentage error (MAPE) of 28.88% and a mean absolute error (MAE) of 20.46 ms. The study found no significant impact of RHR discrepancies on HRV differences (p = 0.156), with RHR showing a mean difference of −0.08 bpm, an MAPE of 5.91%, and an MAE of 3.73 bpm. Equivalence testing indicated that the HRV measurements from Apple Watch did not fall within the pre-specified equivalence margin of ±10 ms. Despite accurate RHR measurements, these findings underscore the need for improved HRV algorithms in consumer wearables and caution in interpreting HRV data for clinical or performance monitoring. [ABSTRACT FROM AUTHOR]

In this paper, we present the design and fabrication of a novel chip-on-tip catheter, which uses a microcamera and optical fibres to capture in vivo images in a beating porcine heart thanks to a saline flush to clear the blood field. Here, we demonstrate the medical utility and mechanical robustness of this catheter platform system, which could be used for other optical diagnostic techniques, surgical guidance, and clinical navigation. We also discuss some of the challenges and system requirements associated with developing a miniature prototype for such a study and present assembly instructions. Methods of clearing the blood field are discussed, including an integrated flush channel at the distal end. This permits the capture of images of the endocardial walls. The device was navigated under fluoroscopic guiding, through a guiding catheter to various locations of the heart, where images were successfully acquired. Images were captured at the intra-atrial septum, in the left atrium after a trans-septal cross procedure, and in the left ventricle, which are, to the best of our knowledge, the first images captured in an in vivo beating heart using endoscopic techniques. [ABSTRACT FROM AUTHOR]

Mental distress-induced imbalances in autonomic nervous system activities adversely affect the electrical stability of the cardiac system, with heart rate variability (HRV) identified as a related indicator. Traditional HRV measurements use electrocardiography (ECG), but impulse radio ultra-wideband (IR-UWB) radar has shown potential in HRV measurement, although it is rarely applied to psychological studies. This study aimed to assess early high levels of mental distress using HRV indices obtained using radar through modified signal processing tailored to reduce phase noise and improve positional accuracy. We conducted 120 evaluations on 15 office workers from a software startup, with each 5 min evaluation using both radar and ECG. Visual analog scale (VAS) scores were collected to assess mental distress, with evaluations scoring 7.5 or higher classified as high-mental distress group, while the remainder formed the control group. Evaluations indicating high levels of mental distress showed significantly lower HRV compared to the control group, with radar-derived indices correlating strongly with ECG results. The radar-based analysis demonstrated a significant ability to differentiate high mental distress, supported by receiver operating characteristic (ROC) analysis. These findings suggest that IR-UWB radar could be a supportive tool for distinguishing high levels of mental stress, offering clinicians complementary diagnostic insights. [ABSTRACT FROM AUTHOR]

Oral contraceptive (OC) use can increase resting blood pressure (BP) in females as well as contribute to greater activation of group III/IV afferents during upper body exercise. It is unknown, however, whether an exaggerated BP response occurs during lower limb exercise in OC users. We sought to elucidate the group III/IV afferent activity-mediated BP and heart rate responses while performing lower extremity tasks during early and late follicular phases in young, healthy females. Females not taking OCs (NOC: n = 8; age: 25 ± 4 yr) and those taking OCs (OC: n = 10; age: 23 ± 2 yr) completed a continuous knee extension/flexion passive stretch (mechanoreflex) and cycling exercise with subsystolic cuff occlusion (exercise pressor reflex), which was followed by a 2-min postexercise circulatory occlusion (PECO) (metaboreflex). Data collection occurred on two occasions: once during the early follicular phase (days 1–4) and once during the late follicular phase (days 10–14) of their menstrual cycle (NOC) or during the placebo and active pill phases (OC). Resting mean arterial BP and heart rate were not different between phases in NOC and OC participants (P > 0.05). Hemodynamic responses to metaboreflex, mechanoreflex, and collective exercise pressor reflex activation were not different between phases in both groups (P > 0.05). In conclusion, although OCs are known to increase BP at rest, our findings indicate that neither endogenous nor exogenous (OC) sex hormones modulate BP during large, lower limb muscle exercise with or without group III/IV afferent activation in young, healthy females. NEW & NOTEWORTHY: Sex differences in the cardiovascular response to exercise have been demonstrated and may be dependent on sex hormone levels. Furthermore, oral contraceptives (OCs) have been shown to exaggerate the blood pressure response to upper extremity exercise. The results of this study indicate that neither endogenous nor exogenous (OC) sex hormones modulate BP during lower extremity dynamic exercise or with group III/IV afferent activation in young, healthy females. [ABSTRACT FROM AUTHOR]

The mammalian dive reflex, characterized by bradycardia and peripheral vasoconstriction, occurs in all mammals, including humans, in response to apnea. However, the dive reflex to a single, maximal, dry, dynamic apnea (DYN) and how it compares to a time-matched exercise control trial (EX) or dry static apnea (SA) has not been studied. We examined the hypotheses that, compared with EX and SA, the magnitude of the 1) cardiovascular response and 2) hematological response to DYN would be greater. Cardiovascular parameters [heart rate (HR), systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure] were continuously collected in 23 (F = 6 females) moderate and elite freedivers, first during a maximal DYN, then during a time-matched SA and EX on a swimming ergometer in randomized order. Venous blood draws were made before and following each trial. The change in calculated oxygen saturation (DYN: −17 ± 13%, EX: −2 ± 1%, ΔSA: −2 ± 1%; P < 0.05, all comparisons) was greater during DYN compared with EX and SA. During DYN, ΔSBP (DYN: 104 ± 31 mmHg; EX: 38 ± 23 mmHg; and SA: 20 ± 11 mmHg), ΔDBP (DYN: 45 ± 12 mmHg; EX: 14 ± 10 mmHg; and SA: 15 ± 8 mmHg), and ΔMAP (DYN: 65 ± 17 mmHg; EX: 22 ± 13 mmHg; and SA: 16 ± 9 mmHg) were increased compared with EX and SA, while ΔHR was greater during EX (DYN: −24 ± 23 beats/min; EX: 33 ± 13 beats/min; and SA: −1 ± 10 beats/min) than either DYN or SA (P < 0.0001, all comparisons). Females had a greater pressor response to EX (ΔSBP: 59 ± 30 mmHg; ΔDBP: 24 ± 14 mmHg; and ΔMAP: 35 ± 8 mmHg) than males (ΔSBP: 31 ± 15 mmHg; ΔDBP: 11 ± 6 mmHg; and ΔMAP: 18 ± 8 mmHg; P < 0.01, all comparisons). Together, these data indicate that DYN elicits a distinct, exaggerated cardiovascular response compared with EX or SA alone. NEW & NOTEWORTHY: This study performed a dry dynamic apnea with sport-specific equipment to closely mimic the physiological demands of competition diving. We found the cardiovascular and hematological responses to dynamic apnea were more robust compared with time-matched exercise and dry static apnea control trials. [ABSTRACT FROM AUTHOR]

This study investigated the long-term cardiovascular effects of coronavirus disease (COVID-19) in elite male athletes by comparing the heart rate variability (HRV), arterial stiffness, and other cardiovascular parameters between those with and without prior COVID-19 infection. Methods: This cross-sectional study evaluated 120 elite male athletes (60 post COVID-19, 60 controls) using anthropometric measurements, body composition analysis, pulmonary function tests, HRV analysis, arterial stiffness assessments, hemodynamic monitoring, and microcirculatory function tests. Results: Athletes post COVID-19 showed significantly higher lean mass (p = 0.007), forced vital capacity (p = 0.001), and forced expiratory volume in 1 s (p = 0.007) than controls. HRV parameters did not significantly differ between the groups. Post-COVID-19 athletes exhibited peripheral vascular resistance (p = 0.048) and reflection index (p = 0.038). No significant differences were observed in the blood pressure, cardiac output, oxygen saturation, or microcirculatory oxygen absorption. Conclusions: Elite male athletes showed notable cardiovascular resilience after COVID-19, with only minor differences in vascular function. The maintained cardiac autonomic function and improved lung parameters in post-COVID-19 athletes suggests an adaptive response. These findings support the cardiovascular health of elite athletes following COVID-19 but emphasize the importance of continued monitoring. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). However, its effects on autonomic function and underlying mechanisms remain poorly understood. This study investigated autonomic and haemodynamic changes following CA and explored their potential implications for patient outcomes. Methods: Seventy-eight patients with AF underwent CA and were followed up at one, three, and six months. Autonomic function was assessed using a combination of head-up tilt (HUT), handgrip (HG), and deep breathing (DB) manoeuvres along with baroreflex sensitivity (BRS) and baroreflex effectiveness index (BEI) evaluation. Heart rate (HR), blood pressure (BP), and their variability were measured at each time point. Results: Significant autonomic alterations were observed after ablation, particularly at one month, with reductions in parasympathetic tone and baroreflex function. These changes gradually normalised by six months. Both pulmonary vein isolation (PVI) and cryoablation (CryO) had similar effects on autonomic regulation. Improvements in quality of life, measured by the AFEQT scores, were consistent with these physiological changes. Conclusions: CA for AF induces significant time-dependent autonomic and haemodynamic changes with recovery over six months. These findings underscore the need for ongoing monitoring and personalised post-ablation management. Further research is required to explore the mechanisms driving these alterations and their long-term impacts on patient outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Cancer patients frequently encounter significant emotional and psychological challenges that can adversely affect their overall well-being and treatment outcomes. To address these challenges, we developed the Cancer Patient Empowerment Program (CancerPEP), a comprehensive, home-based intervention that incorporates physical exercise, nutritional guidance, and social support. CancerPEP builds on the success of the Prostate Cancer Patient Empowerment Program (PC-PEP), which has demonstrated positive effects on psychological well-being in prostate cancer patients. In this study, we also evaluated whether adding a Heart Rate Variability (HRV) biofeedback device could enhance the effectiveness of CancerPEP. Our findings indicate that while CancerPEP significantly reduced psychological distress and improved emotional well-being across cancer patients—including a breast cancer subgroup—at the end of the intervention (the 6-month point), the addition or lack of an HRV device did not significantly contribute to these improvements for the full sample. These results suggest that CancerPEP, similar to PC-PEP, is a valuable addition to standard cancer care, providing a holistic approach to support patients both mentally and emotionally. However, the inclusion of the HRV device may not be necessary to achieve these benefits. Background/Objectives: Psychological distress is a significant concern among cancer patients, negatively affecting their quality of life and adherence to treatment. The Cancer Patient Empowerment Program (CancerPEP) was developed as a comprehensive, home-based intervention aimed at reducing psychological distress by incorporating physical activity, dietary guidance, and social support. This study aimed to evaluate the feasibility, accrual and attrition rates, safety, and effectiveness of the CancerPEP intervention, with and without the biofeedback device, on psychological distress from baseline to 6 months, specifically focusing on the effects of group randomization and the difference between pre- and post-intervention results. Methods: This single-site, crossover randomized clinical trial included 104 cancer patients who were randomized to receive the CancerPEP intervention, with or without a Heart Rate Variability (HRV) biofeedback monitor. At 6 months, participants who did not receive the device were allowed to use one until the end of the year, while those who did receive the device were followed up to 12 months. Randomization was stratified by the presence or absence of clinically significant psychological distress and metastatic status. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10) at baseline, 6 months, and 12 months. The primary endpoint was the presence of nonspecific psychological distress, as measured by the K10 scale at 6 months from the trial start, based on group randomization. A secondary exploratory analysis assessed psychological distress at baseline, 6 months, and 12 months for both groups, while controlling for group randomization and prognostic covariates. Prognostic covariates included age; comorbidities; time between diagnosis and randomization; treatment modality; relationship status; and use of prescribed medications for anxiety, depression, or both. An exploratory sub-analysis was conducted for the breast cancer subgroup, based on the sample size available after recruitment. The trial is registered at ClinicalTrials.gov (NCT05508412). Results: The provision of the HRV biofeedback monitor in conjunction with the CancerPEP intervention did not significantly affect the primary outcome in either the full sample or the breast cancer subgroup, indicating that the HRV biofeedback provision was not beneficial in this trial. No self-reported or otherwise discovered adverse events at the 6-month mark were observed. About 10% of participants were lost to follow-up in both the early and late HRV monitor provision groups. Participation in the CancerPEP program led to a significant reduction in psychological distress over time. The odds of psychological distress were significantly higher at the start of the trial than at the end of the intervention (aOR = 2.64, 95% CI: 1.53–4.56) or 6 months after the intervention (aOR = 2.94, 95% CI: 1.62–5.30). Similarly, in the breast cancer subgroup, distress was higher at the trial's start than at 6 months, i.e., after the intervention (aOR = 2.25, 95% CI: 1.24–4.08), or at the end of the trial at 12 months (aOR = 2.73, 95% CI: 1.35–5.52). Conclusions: CancerPEP significantly reduces psychological distress in cancer patients, with consistent improvements noted across various cancer types and stages, including benefits specifically for breast cancer patients. These findings build upon the success of the Prostate Cancer Patient Empowerment Program (PC-PEP), indicating that a similar comprehensive intervention can be advantageous for all cancer patients and may be further tailored to address specific needs. With its holistic approach—encompassing physical, dietary, and psychosocial support—CancerPEP shows promise as a vital component of survivorship care. Ongoing 24-month evaluations will yield critical data on its long-term benefits. Additionally, a randomized trial with a control group (usual care without intervention) for breast cancer patients is currently under way and could potentially guide the integration of CancerPEP into standard oncology care to enhance patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

This study compared cardiovascular and metabolic responses during concentric and eccentric stepping. Eight participants (5 m, 3f; 22 ± 2 years) performed maximal concentric and eccentric ramp incremental tests on a modified stepping ergometer. Subsequently, three randomized 15‐min constant‐power tests were performed (1) concentric stepping at 90% of the concentric lactate threshold (LT), (2) eccentric stepping at the same power, and (3) eccentric stepping at the same oxygen uptake (V̇O2). At equivalent power (36 ± 6 W, p = 0.62), eccentric stepping resulted in 46 ± 8% lower V̇O2, 16 ± 6% lower heart rate (HR), and 11 ± 5% lower mean arterial blood pressure compared to concentric (p < 0.01). Matching V̇O2 required 65 ± 19% more power during eccentric stepping (p < 0.01). During this test, eccentric V̇O2 and HR continued to increase, resulting in a 22 ± 29% higher V̇O2 and 19 ± 16% higher HR in the final minute (p < 0.001). Reduced cardiorespiratory demand during eccentric stepping at the same power as concentric demonstrates a higher eccentric power is required to produce the same V̇O2. However, despite being below the concentric LT, eccentric V̇O2 and HR continued to increase past the predicted steady state, indicating a higher exercise intensity. [ABSTRACT FROM AUTHOR]

Hypotension is one of the main characteristics of the systemic inflammation, basically caused by endothelial dysfunction. Studies have shown that the amino acid L‐kynurenine (KYN) causes vasodilation in mammals, leading to hypotensive shock. In hypotensive shock, when activated by the KYN, the voltage‐gated potassium channel encoded by the family KCNQ (Kv7) gene can cause vasodilation. Fructose‐1,6‐bisphosphate (FBP) it is being considered in studies an anti‐inflammatory, antioxidant, immunomodulator, and a modulator of some ion channels (Ca2+, Na+, and K+). We analyzed the effects of KYN and FBP on mean blood pressure (MBP), systolic and diastolic (DBP) blood pressure, and heart rate variability (HRV) in Wistar rats. Results demonstrated that the administration of KYN significant decreased MBP, DBP, and increased HRV. Importantly, the FBP treatment reversed the KYN effects on MBP, DBP, and HRV. Molecular Docking Simulations suggested that KYN and FBP present a very close estimated free energy of binding and the same position into structure of KCNQ4. Our results did demonstrate that FBP blunted the decrease in BP, provoked by KYN. Results raise new hypotheses for future and studies in the treatment of hypotension resulting from inflammation. [ABSTRACT FROM AUTHOR]

The present cross-sectional study aimed to compare climacteric symptoms and arterial stiffness indices between perimenopausal and postmenopausal women. The study sample comprised 70 healthy female participants, including 27 perimenopausal (49.8 ± 3.8 years) and 43 postmenopausal (55.7 ± 4 years) individuals. Validated methods were used to assess physical activity level, quality of life, climacteric symptoms, and anthropometric data. Arterial stiffness parameters were measured using Mobil-O-Graph. Pulse wave velocity (PWV) had a higher mean in the postmenopausal group than in the perimenopause group [8.04 m/s (SD 0.79) vs 7.01 m/s (SD 0.78), p <.001). PWV was strongly correlated with peripheral (r = 0.619) and central (r = 0.632) Systolic Blood Pressure (SBP) in postmenopausal group and an even stronger correlation was observed in perimenopausal group (r = 0.779 pSBP and 0.782 cSBP). BMI was a risk predictor in the perimenopausal group contributing positively to increase Pulse Pressure Amplification (PPA) (0.458, p <.05). In postmenopausal women, heart rate (HR) was a stronger predictor for central SBP, cardiac output, and total vascular resistance, whereas perimenopausal women HR influenced central diastolic blood pressure and PPA. Vascular changes initiating during perimenopause may contribute to the development of cardiovascular pathologies in the postmenopausal period. Further research with larger, representative samples is warranted to corroborate these findings. [ABSTRACT FROM AUTHOR]

Effective regulation of emotions is essential in coping with everyday stressors. Although cognitive reappraisal and acceptance are both commonly employed to downregulate negative emotions, they differ in many aspects. Their effectiveness in real‐life situations can also be influenced by prior stress or a person's trait preferences for certain emotion regulation (ER) strategies. In the present study, we compared the effectiveness of both ER strategies in a laboratory setting, while focussing on the effect of stress and trait moderators. Ninety‐eight healthy participants aged 18–40 were randomly divided into three groups with instructions to use reappraisal, acceptance, or nothing while viewing distressing pictures from the IAPS database. Half of the participants in each group underwent a laboratory stressor (socially evaluated cold pressor test) 20–30 min before the ER task. The effectiveness of ER was measured subjectively on the visual analog scale, and by measuring heart rate, skin conductance, and pupil responses. The data show that cognitive reappraisal lowered subjectively experienced negative emotion, while acceptance did not. These group differences were however not supported by psychophysiological indicators. Secondly, although the laboratory stressor elicited cortisol stress responses in our participants, we did not find any effect on ER. Furthermore, the data has not supported the moderation effect by trait reappraisal and acceptance. The present findings show that deliberate usage of ER strategies when viewing emotionally charged pictures leads to a decrease in experienced emotion. On the other hand, the effects of stress and trait moderators were not supported, therefore they may be smaller and more variable than expected. [ABSTRACT FROM AUTHOR]

Although trauma is closely linked with hyperarousal and cardiovascular health, little research has examined the effects of posttraumatic stress symptoms (PTSS) on cardiovascular reactivity to trauma reminders among sexual trauma survivors. One type of negative appraisal after trauma, self‐blame, is common after sexual trauma, but its relation to cardiovascular reactivity is unknown. The present study aimed to examine the influence of both PTSS and self‐blame on blood pressure and heart rate (HR) reactivity to a trauma reminder. Cardiovascular reactivity was measured before, during, and after a laboratory‐based sexual trauma reminder among 72 young adult women who have experienced sexual trauma. Higher PTSS predicted lower diastolic blood pressure (DBP) reactivity during the trauma reminder. Higher levels of self‐blame predicted higher HR and systolic blood pressure (SBP) reactivity during and after the trauma reminder. Overall, these findings suggest that survivors of sexual trauma with higher levels of PTSS experience a blunting reaction of DBP when exposed to trauma reminders, as opposed to a more typical cardiovascular stress reaction that may elevate and then extinguish to baseline levels. Meanwhile, individuals with higher levels of self‐blame have heightened cardiovascular SBP and HR responses during trauma reminders that do not return to baseline levels, perhaps due to self‐blame leading individuals to be more 'on guard' to prevent future threats. Longitudinal studies are needed to explore the potential long‐term cardiovascular impacts of heightened self‐blame and PTSS and their associated cardiovascular reactivity patterns. [ABSTRACT FROM AUTHOR]

Laboratory‐based studies have shown that psychological stress caused by response to various stressors triggers acute changes in the cardiovascular system. A better understanding is needed of the emerging evidence on temporal associations between psychological stress and cardiovascular responses in natural settings. This study examined the association of psychological stress and heart rate variability (HRV) in daily life, at high resolution over 2 weeks, taking the effect of physical activity into account. Participants (n = 34) completed ecological momentary assessments (EMA) 6 times per day, reporting levels of perceived stress, low‐arousal negative affect (LNA), and high‐arousal negative affect. Chest‐mounted heart‐rate monitors were worn to assess HRV. Multilevel models were used to examine the association between psychological stress levels and preceding/subsequent HRV. Reduced time domain HRV measures (mean and standard deviation of R‐wave to R‐wave intervals) during the prior hour predicted higher levels of perceived stress. Frequency domain HRV measures higher low to high frequency (LF/HF) and lower HF to total power (HF nu) ratios during the preceding 10 min predicted higher perceived stress levels, suggesting the dominance of sympathetic nervous system activity. EMA reports of higher perceived stress levels were associated with reduced time domain HRV measures during the following 10 min. On the other hand, higher LNA were related to increased HRV measures, such as lower LF/HF and higher HF nu during the following hour. The dynamic associations observed may have therapeutic implications for 'just‐in‐time' interventions in the management of daily stress and cardiovascular health. [ABSTRACT FROM AUTHOR]

Purpose: The involvement of central command in central hemodynamic regulation during exercise is relatively well-known, although its contribution to peripheral hemodynamics at the onset of low-intensity contractions is debated. This study sought to examine central and peripheral hemodynamics during electrically-evoked muscle contractions (without central command) and voluntary muscle activity (with central command). Methods: Cyclic quadriceps isometric contractions (1 every second), either electrically-evoked (ES; 200 ms trains composed of 20 square waves) or performed voluntarily (VC), were executed by 10 healthy males (26 ± 3 years). In both trials, matched for force output, peripheral and central hemodynamics were analysed. Results: At exercise onset, both ES and VC exhibited equal peaks of femoral blood flow (1276 ± 849 vs. 1117 ± 632 ml/min, p > 0.05) and vascular conductance (15 ± 11 vs. 13 ± 7 ml/min/mmHg, p > 0.05), respectively. Similar peaks of heart rate (86 ± 16 bpm vs. 85 ± 16 bpm), stroke volume (100 ± 20 vs. 99 ± 27 ml), cardiac output (8.2 ± 2.5 vs. 8.5 ± 2.1 L/min), and mean arterial pressure (113 ± 13 vs. 113 ± 3 mmHg), were recorded (all, p > 0.05). After ~ 50 s, all the variables drifted to lower values. Collectively, the hemodynamics showed equal responses. Conclusion: These results suggest a similar pathway for the initial (first 40 s) increase in central and peripheral hemodynamics. The parallel responses may suggest an initial minimal central command involvement during the onset of low-intensity contractions, likely associated with a neural drive activation delay or threshold. [ABSTRACT FROM AUTHOR]

Independently, both prolonged uninterrupted sitting and the onset of menopause negatively impact markers of cardiovascular risk. Whether their combination augment these responses additively remains unknown. This study assessed whether prolonged uninterrupted sitting causes greater central and peripheral cardiovascular dysfunction in post-menopausal women compared to pre-menopausal women. To address this, 23 healthy women (13 pre-menopausal [43.77 ± 4.30 years] and 10 post-menopausal [57.20 ± 8.55 years]) sat uninterrupted for 2-h. Carotid-femoral pulse wave velocity (cf-PWV), pulse wave analysis (PWA), lower limb venous pooling (HHb), and calf circumference were assessed pre-and post-sitting using general linear mixed models, with age as a covariate. Changes in MAP over time (both between and within groups) was assessed using a two-way repeated-measures-ANOVA. There were no significant interactions for any outcome measures. However, for cf-PWV, there was a significant main effect of group (Δ = 0.854 ± 0.354 m s−1; p = 0.026, ηp2 = 0.707). For PWA, only heart rate (HR) and pressure forwards (Pf) showed significant main effects 13 of time [Δ = 6 ± 1 bts-min−1, p < 0.001, ηp2 = 0.861] and group [Δ = 3.893 ± 1.450 mmHg, p = 0.016, ηp2 = 0.271], respectively. Both HHb (Δ = 2.737 ± 0.952, p = 0.009, ηp2 = 0.742) and calf circumference (Δ = 0.812 ± 0.128 cm, p < 0.001, ηp2 = 0.863) significantly increased over time. Whilst post-menopausal women demonstrated greater overall arterial stiffness (increased cf-PWV at baseline), there was no difference in cardiovascular response (central or peripheral) to 2-h of prolonged sitting between the pre- and post-menopausal women. [ABSTRACT FROM AUTHOR]

Introduction: Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation‐induced CANS changes, as assessed via variations in heart rate (HR) postablation. Methods: Consecutive paroxysmal AF patients undergoing first‐time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12‐month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24‐h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV‐SVC distance). Results: A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV‐SVC distance (odds ratio [OR]: 0.49, CI: 0.34–0.71, p value <.001), and age (OR: 0.94, CI: 0.89–0.98, p value =.003). Conclusions: Thermal balloon‐based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV‐SVC distance. [ABSTRACT FROM AUTHOR]

Introduction: Early‐onset atrial fibrillation (AF) has already been observed in approximately 2% of patients with genetically proven long QT syndrome (LQTS). This frequency is higher than population‐based estimates of early‐onset AF. However, the concomitant expression of AF in LQTS is likely underestimated. The purpose of this study was to examine the clinical presentation, genetic background, and outcomes of a cohort of patients with LQTS and early‐onset AF referred to a single tertiary center. Methods: Twenty‐seven patients diagnosed with congenital LQTS were included in the study based on the documentation of early‐onset (age ≤50 years) clinical or subclinical AF episodes in all available medical records, including standard electrocardiograms, wearable monitor or cardiac implantable electronic devices. Results: Seventeen patients experienced clinical AF during the follow‐up period. Subclinical AF was detected in 10 patients through insertable or wearable cardiac monitors. In our series, the mean heart rate during AF episodes was found to be relatively low despite the patients' young age and the low or minimal effective doses of beta‐blockers used for QTc interval control. All patients exhibiting LQTS and early‐onset AF were genotype positive, carrying mutations in the KCNQ1 (66%), KCNH2, KCNE1, and SCN5A genes. Notably, most of these patients carried the same p.(R231C) mutation in the KCNQ1 gene (59%) and were from the same families, suggesting concurrent expression of familial AF and LQTS. Conclusion: LQTS patients are prone to developing clinical and subclinical AF, even at a younger age. The occurrence of early‐onset AF in the LQTS population could be more frequent than previously assumed. AF should be considered as a potential dysrhythmia related to LQTS. Our study emphasizes the importance of carefully researching clinical and/or subclinical episodes of AF through strict heart rhythm monitoring in the LQTS population. [ABSTRACT FROM AUTHOR]

Background: The ergonomic advantages and potential challenges that robotic surgery poses to the well-being of surgeons are mainly unexplored. The most recent surgical robot introduced on the European market is the Hugo™ RAS System by Medtronic. This study aims to evaluate the ergonomic benefits of the Hugo™ RAS System, which is available in our training laboratory, CeMIT (Center for Medical Innovation and Technology Cologne). Methods and procedures: Using the previously established Cologne Ergonomic Measurement Setup for Robotic Surgery (CEMRobSurg), we measured three parameters related to ergonomic posture from subjects with different levels of surgical expertise (laypeople, medical students, surgical residents, and expert robotic surgeons). The heart rate was measured continuously using a polar band. The noise level was measured while using the Hugo™ RAS System, and automated photographs using our locally developed methodology were captured of the participant every 2 s to assess body posture. The ergonomic measurements were conducted while the subject performed the same standardized robotic training exercises (Peg Board, Rope Walk, and Ring Walk). Results: A total of 53 participants were enrolled in this study. The average noise level during all measurements was 54.87 dB. The highest stress level was measured in surgical residents with a sympathetic nervous system index (SNS index) of 1.15 (min − 1.43, max 3.56). The lowest stress level was measured in robotic experts with an SNS index of 0.23 (min − 0.18, max 0.91). We observed a risk-prone positioning of the neck and elbow in medical students (mean 39.6° and 129.48°, respectively). Robotic experts showed a risk positioning in the knee and hip region (mean 107.89° and 90.31°, respectively). Conclusion: This is the first study to analyze and objectify the ergonomic posture of medical students, surgical trainees, surgeons, and laypeople using the open console, modular Hugo™ RAS System. Our findings offer recommendations for operating surgeons and allow for a comparative analysis between the different robotic systems. Further evaluations in real-time operative scenarios will follow. [ABSTRACT FROM AUTHOR]

Background: Managing exercise in type 1 diabetes is challenging, in part, because different types of exercises can have diverging effects on glycemia. The aim of this work was to develop a classification model that can classify an exercise event (structured or unstructured) as aerobic, interval, or resistance for the purpose of incorporation into an automated insulin delivery (AID) system. Methods: A long short-term memory network model was developed with real-world data from 30-min structured sessions of at-home exercise (aerobic, resistance, or mixed) using triaxial accelerometer, heart rate, and activity duration information. The detection algorithm was used to classify 15 common free-living and unstructured activities and relate each to exercise-associated change in glucose. Results: A total of 1610 structured exercise sessions were used to train, validate, and test the model. The accuracy for the structured exercise sessions in the testing set was 72% for aerobic, 65% for interval, and 77% for resistance. In addition, we tested the classifier on 3328 unstructured sessions. We validated the session-associated change in glucose against the expected change during exercise for each type. Mean and standard deviation of the change in glucose of −20.8 (40.3) mg/dL were achieved for sessions classified as aerobic, −16.2 (39.0) mg/dL for sessions classified as interval, and −11.6 (38.8) mg/dL for sessions classified as resistance. Conclusions: The proposed algorithm reliably identified physical activity associated with expected change in glucose, which could be integrated into an AID system to manage the exercise disturbance in glycemia according to the predicted class. [ABSTRACT FROM AUTHOR]

Ultrarunning is gaining in popularity but no information is available on the physiological and psychological responses during backyard ultrarunning events. The aim of this study was to determine changes in cognitive function, markers of physiological resilience, and running performance during a backyard‐running event. Twelve male ultrarunners (38 ± 8 years old, BMI: 23.5 ± 1.6 kg/m2, and VO2max: 60.8 ± 4.7 mL/min/kg) were monitored before, during, and after the event. Cognitive performance was determined using a cognitive test battery before, during, and after the event. During the event, the rating of perceived exertion (RPE), blood lactate concentration, and heart rate (HR) were assessed. Physical performance was investigated using the total number of completed laps and running speed per lap. Athletes completed 34 ± 17 laps equaling 227.8 ± 113.9 km with average speeds starting at 9.0 km/h and slowing down to 7.5 km/h at the end of the event. Physiological resilience (estimated using HR/speed) varied between athletes, with significantly lower values in the more proficient backyard runners at the end of the event (p < 0.05). HR and lactate levels remained constant, whereas a progressive increase in RPE was noticed (p ≤ 0.001). A significantly worsened reaction time was observed for several cognitive tasks after the event compared to baseline measures (p ≤ 0.05). These observations show that physiological resilience differs depending on the level of endurance performance of the athletes. Furthermore, the backyard ultrarunning event negatively impacted psychomotor speed. Therefore, the results suggest that implementing strategies that enhance physiological resilience and/or psychomotor speed could potentially have a positive effect on performance in ultraendurance activities. Highlights: Backyard running events showcase varying physiological resilience, emphasizing its role in differentiating top‐performing athletes.Pacing dynamics and cognitive decline during ultraendurance events highlight the complex interplay between physical and mental fatigues.Exploring resilience and cognitive functioning during ultraendurance events is important for optimizing training and other interventions in extreme endurance challenges. [ABSTRACT FROM AUTHOR]

Background: Exercise fear and low exercise self-efficacy are common in patients attending cardiac rehabilitation (CR). This study tested whether exercise prescription methods influence exercise fear and exercise self-efficacy. We hypothesized that the use of graded exercise testing (GXT) with a target heart rate range exercise prescription, relative to standard exercise prescription using rating of perceived exertion (RPE), would produce greater reductions in exercise fear and increase self-efficacy during CR. Method: Patients in CR (N = 32) were randomized to an exercise prescription using either RPE or a target heart rate range. Exercise fear and self-efficacy were assessed with questionnaires at three time points: baseline; after the GXT in target heart rate range group; and at session 6 for the RPE group and CR completion. Items were scored on a five-point Likert-type scale with higher mean scores reflecting higher fear of exercise and higher self-efficacy. To analyze mean differences, a mixed effects analysis was run. Results: There were no significant changes in exercise self-efficacy between baseline and discharge from CR; these were not statistically significant (mean differences baseline − 0.63; end − 0.27 (p = 0.13)). Similarly, there was no change in fear between groups (baseline 0.30; end 0.51 (p = 0.37)). Conclusion: Patients in the RPE and target heart rate groups had non-significant changes in exercise self-efficacy over the course of CR. Contrary to our hypothesis, the use of GXT and target heart rate range did not reduce fear, and we noted sustained or increases in fear of exercise among patients with elevated baseline fear. A more targeted psychological intervention seems warranted to reduce exercise fear and self-efficacy in CR. [ABSTRACT FROM AUTHOR]

Background: Duchenne muscular dystrophy (DMD)-related cardiomyopathy is associated with hemodynamic and conduction abnormalities and begins at an early age with subtle symptoms. Methods: The study population included 55 patients with DMD and 54 healthy controls. We compared electrocardiogram (ECG), conventional echocardiography, and tissue Doppler imaging (TDI) assessments between patients with DMD and healthy controls. Also, we investigated atrial electromechanical delay, which has not been previously studied in DMD patients. Mitral, septal, and tricuspid segments were analyzed by TDI. Results: The mean age was 13.6 ± 2.5 years (range, 9.3-17.9 years) in the patient group and 12.8 ± 2.6 years (range, 8-17.5 years) in the control group (P = .1). Patients had higher heart rates, longer QTc intervals, and P-wave dispersion (PWD) than controls (P < .001, P = .004, P < .001, respectively). The patient group had larger left ventricular end-systolic dimension (P < .001), lower left ventricular ejection fraction (EF) (P < .001), MAPSE (P < .001), TAPSE (P < .001), and mitral-E/A (P = .029) values than control subjects. Myocardial performance index (P < .001) was higher, and the E'/A' ratio (P < .001) was lower at all 3 segments in the patient group. Also, atrial electromechanical delay was longer in the patient group at these segments (P < .001). Patients had significantly longer inter-atrial (P = .033) electromechanical conduction delays. EF was negatively correlated with atrial conduction time variables. Conclusion: We have shown deterioration in systolic and diastolic function in both ventricles, PWD, and atrial conduction in children with DMD. Patients with DMD may be at risk of atrial arrhythmias due to disturbed atrial conduction. [ABSTRACT FROM AUTHOR]

Background: This prospective, double-blinded, randomized study aimed to compare the efficacy of dexmedetomidine and fentanyl infusions in maintaining hemodynamics during head and neck free flap surgery, as well as their impact on the relative amount of blood loss. Methods: Twenty patients with American Society of Anesthesiologists physical status I and II scheduled for elective head and neck free flap surgery were enrolled. The patients were randomly assigned to receive either dexmedetomidine (1 µg/kg over 10 min at anesthesia induction, followed by 0.2 to 0.75 µg/kg per hour infusion during maintenance) or fentanyl (1 to 2 µg/kg per hour infusion during maintenance). Intraoperative hemodynamic parameters, blood loss, blood transfusion requirements, surgeon satisfaction, adverse drug effects, and free flap survival up to 7 days were recorded. Results: The dexmedetomidine group achieved a mean arterial pressure (MAP) value between 60 and 70 mmHg at multiple time points (15 min, 3rd, 4th, 5th, and 6th hours), while the fentanyl group did not reach this range at any time point. The intergroup statistical analysis revealed a significant difference only at the 5th hour with (95% CI: -16.17 to -0.62) and P = 0.036. Additionally, the dexmedetomidine group exhibited lower heart rates (< 70/min) at several time points (15 min, 2nd, 3rd, 4th, 5th, and 6th hours) compared to the fentanyl group. The intergroup comparison indicated a statistically significant difference only at the 3rd hour with (95% CI: -20.94 to -0.45) and P = 0.042. Conclusion: Dexmedetomidine can be a useful adjuvant of GA for inducing controlled hypotension and decreasing bleeding in free flap surgery of the head and neck region without any detrimental effect on the free flap survival. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is one of the most frequent causes of conductive hearing loss in adults. Surgical treatment is considered to be the gold standard for this disease. Endoscopic stapedectomy is a new approach for the treatment of otosclerosis that requires a bloodless field. Aim of the Study: To determine whether the routine use of β blockers as a premedication can improve the operative field in endoscopic stapedectomy or not. Patients and Methods: Sixty patients aged from 18 to 50 years, undergoing endoscopic stapedectomy, were included in this prospective, randomized, double blinded, placebo-controlled study. Patients were randomly assigned to receive either metoprolol 100 mg (group 1) or a placebo, vitamin tablet, (group 2) 60 min before surgery. Results: The age, gender, body weight and ASA physical status were comparable between the two groups. The average blood loss in the placebo group was significantly greater than in the metoprolol group, but the time of operation in the metoprolol group was not significantly shorter. The surgical field was assessed using the Fromme-Boezaart scale, and those who received metoprolol had considerably cleaner (p0.001) surgical fields. The mean arterial pressure (MAP) didn't differ statistically significant at basal measurement up to 30 min after anesthesia induction while it was significantly lower in the metoprolol group after 30 min of induction up to end of surgery (p < 0.001). The heart rate was also significantly lower (p < 0.001) in patients who received metoprolol from prior to anesthesia induction up to end of surgery. Conclusion: metoprolol significantly improves visual clarity and hemodynamics during endoscopic stapedectomy. [ABSTRACT FROM AUTHOR]

Background: The exponential growth in mobile phone usage has raised concerns about electromagnetic field (EMF) exposure and its health risks. Blood pressure and BMI, which impair heart function due to decreased adrenoreceptor responsiveness, parasympathetic tone withdrawal, and increased sympathetic activity, may further exacerbate these risks. However, the effects of radiofrequency electromagnetic (RF‐EM) exposure from mobile phones on electrocardiograms (ECGs) and heart rate variability (HRV) in individuals remain unclear. Purpose: Building upon our previous findings on HRV changes due to mobile phone proximity, this study is aimed at significantly enhancing the analytical approach used to assess the effects of mobile phones on cardiac parameters. This study exploits data from a previous study but with a different purpose. The aim of this study is twofold: (a) to examine whether exposure to mobile phones changes the five variables (P‐R, QRS, QT, ST, and HR) in a multivariate manner and (b) to examine whether the blood pressure and/or the body mass index (BMI), which acts as a proxy for obesity, have an effect on the change of these five variables. For both aspects of the study, four cycles are performed. Method: We conducted multivariate analysis on previously collected electrical cardiac measurement data from 20 healthy male subjects exposed to mobile phone EMF, with the mobile phones placed at four different body locations. The one‐sample Hotelling T2 test on the mean vector of differences was utilised instead of multiple paired t‐tests. This multivariate method comprehensively analyzes data features and accounts for variable correlations, unlike multiple univariate analyses. Given our small sample size, we employed the MMPC variable selection algorithm to identify predictor variables significantly related to mean changes. Results: Significant alterations in ECG intervals and heart rate were noted in the subjects before and after the first EMF exposure cycle, independent of their BMI. Notably, heart rate, P‐R, and QRS intervals fell postexposure while QT and ST intervals increased. These changes were influenced by variations in systolic blood pressure, with BMI showing no significant effect. Conclusion: The observed modifications in cardiac electrical measurements due to mobile phone EMF exposure are attributed to the effects of EMF itself, with no impact from BMI on the extent of these changes. [ABSTRACT FROM AUTHOR]

We recently explored the cardiopulmonary interactions during partial unloading of the respiratory muscles during exercise. Expanding upon this work, we present a noteworthy case study whereby we eliminated the influence of respiration on cardiac function in a conscious but mechanically ventilated human during exercise. This human was a young healthy endurance-trained male who was mechanically ventilated during semi-recumbent cycle exercise at 75 Watts (W) (∼30% Wmax). During mechanically ventilated exercise, esophageal pressure was reduced to levels indistinguishable from the cardiac artefact which led to a 94% reduction in the power of breathing. The reduction in respiratory pressures and respiratory muscle work led to a decrease in cardiac output (−6%), which was due to a reduction in stroke volume (−13%), left ventricular end-diastolic volume (−15%), and left-ventricular end-systolic volume (−17%) that was not compensated for by heart rate. Our case highlights the influence of extreme mechanical ventilation on cardiac function while noting the possible presence of a maximal physiological limit to which respiration (and its associated pressures) impacts cardiac function when the power of breathing is maximally reduced. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine if sedation with medetomidine-vatinoxan (Zenalpha; Dechra Veterinary Products) and midazolam (Alvogen) (ZM) would cause less cardiovascular depression and maintain similar depth and duration of sedation in pigeons (Columba livia domestica) compared to dexmedetomidine and midazolam (DM). METHODS In a blinded crossover study, 15 healthy adult domestic pigeons were sedated IM with either dexmedetomidine (0.08 mg/kg) and midazolam (2 mg/kg) or medetomidine (0.16 mg/kg), vatinoxan (3.2 mg/kg), and midazolam (2 mg/kg) from November through December 2023. Each subject was monitored for 60 minutes, then the sedation was reversed with atipamezole (0.8 mg/kg) and flumazenil (0.1 mg/kg) as needed. Sedation scores, heart rates, and respiratory rates were compared. RESULTS There was no significant difference in the peak sedation score between DM and ZM groups, with both exhibiting median scores of 4 (heavy sedation). Mean heart rate was significantly higher for ZM than DM at 5, 10, 20, 30, 45, 60, and 65 minutes postinjection. Bradycardia occurred in both groups at 5 and 10 minutes postinjection and persisted for DM until reversal with atipamezole. Arrhythmias were auscultated in both groups. Bradypnea was not observed in either group, and all birds resumed normal behavior following recovery and the following day. CONCLUSIONS Medetomidine-vatinoxan-midazolam provides a similar depth of sedation to DM but with less incidence of bradycardia. Further study is needed to determine the clinical applicability of this sedative in birds. CLINICAL RELEVANCE Medetomidine-vatinoxan may be considered for short-term sedation and restraint in cardiovascularly stable pigeons. [ABSTRACT FROM AUTHOR]

AbstractIn recent years, social media platforms, such as Facebook and Twitter have seen rapid growth and are favored by users of all ages. However, in the age of information overload, the quality of interactions on social media platforms varies significantly, leading to negative feelings among users and affecting their overall experience and loyalty. This study takes the Flow theory as its starting point and investigates the needs of social media users at various stages of the flow experience. We propose modifications to the flow theory model with the aim of enhancing user experience and satisfaction. Firstly, based on literature review, we identify micro-level issues of the product, propose hypotheses, and construct validation experiments in the context of social media. The experiment collects Electrodermal Activity (EDA) and heart rate variability (HRV) data of 31 participants using a multi-channel physiological instrument and collects their emotional experience data using the Pleasure-Arousal-Dominance (PAD) scale. Results indicate that a combined textual-graphical interface layout is superior to other layouts in positively inducing flow and emotional experiences. Positive content tonality is more effective at eliciting positive flow and emotional experiences than negative or neutral content. Video presentations have a stronger sense of immersion and emotional expression, making them more conducive to inducing flow experiences and positive emotional feedback. This study, grounded in user psychology, provides a theoretical framework based on flow and emotional experiences for social media product design, quantitatively examining the positive psychological activities of users when using social media. [ABSTRACT FROM AUTHOR]

Purpose: Excessive tachycardia in resuscitated septic shock patients can impair hemodynamics and worsen patient outcome. We investigated whether heart rate (HR) control can be achieved without increased vasopressor requirements using the titratable highly selective, ultra-short-acting β1-blocker landiolol. Methods: This randomized, open-label, controlled trial was conducted at 20 sites in 7 European countries from 2018 to 2022 and investigated the efficacy and safety of landiolol in adult patients with septic shock and persistent tachycardia. Patients were randomly assigned to receive either landiolol along with standard treatment (n = 99) or standard treatment alone (n = 101). The combined primary endpoint was HR response (i.e., HR within the range of 80−94 beats per minute) and its maintenance without increasing vasopressor requirements during the first 24 h after treatment start. Key secondary endpoints were 28-day mortality and adverse events. Results: Out of 196 included septic shock patients, 98 received standard treatment combined with landiolol and 98 standard treatment alone. A significantly larger proportion of patients met the combined primary endpoint in the landiolol group than in the control group (39.8% [39/98] vs. 23.5% [23/98]), with a between-group difference of 16.5% (95% confidence interval [CI]: 3.4–28.8%; p = 0.013). There were no statistically significant differences between study groups in tested secondary outcomes and adverse events. Conclusion: The ultra-short-acting beta-blocker landiolol was effective in reducing and maintaining HR without increasing vasopressor requirements after 24 h in patients with septic shock and persistent tachycardia. There were no differences in adverse events and clinical outcomes such as 28-day mortality vs. standard of care. The results of this study, in the context of previous trials, do not support a treatment strategy of stringent HR reduction (< 95 bpm) in an unselected septic shock population with persistent tachycardia. Further investigations are needed to identify septic shock patient phenotypes that benefit clinically from HR control. [ABSTRACT FROM AUTHOR]

Background: Heart rate is crucial for patients with septic shock, but there are few studies on the scope of heart rate. Therefore, we studied the relationship between different heart rates and mortality of critically ill patients with septic shock, and explored the optimal heart rate range, in order to provide new insights for clinical treatment of septic shock. Methods: This retrospective study utilized time-series heart rate data from the Medical Information Mart for Intensive Care (MIMIC) IV database. Patients with septic shock were identified as the Sepsis 3.0 criteria and received vasopressor therapy in the first 24 h since ICU admission. We calculated the time-weighted average heart rate (TWA-HR) based on the time-series data. The restricted cubic spline (RCS) analysis was employed to investigate the nonlinear relationship between heart rate and 28-day mortality, aiming to explore the optimal heart rate control target for septic patients and using this target as the exposure factor. The primary outcome was 28-day mortality, and the secondary outcome were ICU and in-hospital mortality. For the original cohort, we applied the log-rank test to infer the relationship between heart rate and mortality. To control for bias introduced by confounders, we utilized propensity score matching (PSM) to reduce imbalances between normal TWA-HR and high TWA-HR groups, and we established a series of models [the multivariable Cox model, matching weight (MW)-adjusted Cox model, multivariable logistic regression, MW-adjusted logistic regression, and doubly robust model] as sensitivity analyses and subgroup analyses to demonstrate the robustness of our findings. Results: A total of 13492 patients were included in our study. The RCS analysis based on Cox and logistic regression showed increased risk of mortality (P < 0.001, non-linear P < 0.001) when TWA-HR > 85 beats per minute (bpm). The log-rank test revealed in terms of the 28-day mortality, the hazard ratio (HR) (95% confidence interval [CI]) was 1.92 (1.78—2.06, P < 0.001) for patients with high TWA-HR compared to normal TWA-HR group. Similarly, for the ICU mortality, the HR (95% CI) was 1.64 (1.52—1.78, P < 0.001), and for the in-hospital mortality, the HR (95% CI) was 1.61 (1.48—1.76, P < 0.001). Collectively, the sensitivity analysis consistently demonstrated higher 28-day mortality, ICU mortality, and in-hospital mortality in patients with TWA-HR > 85 bpm. Conclusion: Patients with septic shock whose heart rate was controlled no more than 85 bpm during ICU stay received survival benefit in terms of 28-day, ICU and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Aim: To assess heart rate variability (HRV) as a measure to assess job stress and sleep quality among nurses in the post‐COVID‐19 period. Background: The COVID‐19 pandemic significantly affected nurses, with heightened job stress and impaired sleep quality impacting their well‐being and effectiveness in patient care. HRV could offer insights for supporting strategies in the pandemic aftermath. Design: A quantitative cross‐sectional study. Methods: This study involved 403 clinical nurses recruited from a teaching hospital in Taiwan. Data on job stress, work frustration, sleep quality and HRV were collected and analysed. Results: Among the nurses surveyed during the COVID‐19 pandemic, 72.7% reported poor sleep quality (PSQI = 9.369). Job stress emerged as a strong predictor of work frustration. High stress levels and poor sleep quality were correlated with significantly decreased HRV, indicating a potential physiological impact of stress on the nurses' health and well‐being. Conclusions: HRV is a valuable and cost‐effective measure for monitoring and managing nurses' well‐being in the post‐COVID‐19 era. Targeted interventions can be implemented to support nurses' overall performance and promote their well‐being by identifying those at high risk of job stress and poor sleep quality. Summary statement: What is already known about this topic? The COVID‐19 pandemic significantly impacted medical care capacity, leading to heightened physical and mental distress among frontline nurses. This has resulted in a marked increase in job stress, presenting a significant challenge to occupational health.The substantial changes in the medical environment caused by the pandemic are likely to induce job stress, which, in turn, can detrimentally affect sleep quality. This aspect is crucial, as sleep quality is a key determinant of nurses' ability to deliver optimal medical care to patients. What this paper adds? Job stress significantly impacts nurses' sleep quality and is a key predictor of work frustration, surpassing the sole influence of work frustration.The study highlights a significant link between high stress levels, reduced sleep quality and decreased heart rate variability in nurses. It further reveals that nurses with moderate COVID‐19‐related anxiety show heightened heart rate variability, indicating sympathetic nervous system activation to maintain alertness in emergency medical situations. The implications of this paper: Moderate anxiety as a positive factor: moderate levels of anxiety among nurses can contribute to maintaining alertness, reducing errors and lowering the risk of contracting COVID‐19.HRV as a monitoring and management measure: heart rate variability is a valuable and cost‐effective measure for monitoring and managing the health of nurses in the post‐COVID‐19 era. By identifying nurses with high work stress and poor sleep quality, targeted interventions can be implemented to support their overall performance and promote their well‐being.Targeted interventions for improved well‐being: the implementation of specific interventions aimed at supporting nurses' overall performance and enhancing their well‐being is crucial in maintaining a high standard of patient care. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the effectiveness of the bladder stimulation technique (BST) to collect urine samples from newborns and its effects on physiological parameters and comfort of the newborn. Design: This was a randomized controlled trial conducted in a NICU. A total of 64 newborns were divided into 2 groups: 32 newborns in the experimental group and 32 newborns in the control group. Methods: Newborns in the experimental group (EG) were subjected to the BST, and in the control group (CG), urine collection was via sterile urine bags, which is routine practice. Procedural success was defined as the collection of urine samples within 3 min of beginning the stimulation technique in the experimental group and of placing the sterile urine bag in the control group. Results: The success rate of the procedure in 3 min was 62.5% in the EG and 28% in the CG (P = 0.006, absolute difference: 35%, 95% confidence interval 27% to 42%, NNT: 3). According to the comparison of the overall mean COMFORTneo scale and pain and distress subscale scores at the 1‐ and 3‐min marks, there was a significant difference between the EG and CG (p < 0.05). The mean scores in the EG were higher than those in the CG. The mean oxygen‐saturation was significantly lower in the EG than in the CG (p < 0.05), and the increase in heart rate was significantly higher in the EG (p = 0.018). Conclusions: BST is a more successful method within 3 min for collecting urine samples from newborns compared to sterile urine bags. However, the newborns' comfort levels minimally decreased at 3 min, and they had moderate pain and distress, while the BST was being implemented. This increase in physiologic parameters was statistically significant but not clinically significant. Summary statement: What is already known about this topic? Urinary tract infection is a commonly diagnosed bacterial infection in young infants with fever. However, the symptoms of this infection are non‐specific, so urine samples are needed to accurately diagnose and exclude it.There are multiple methods available for collecting urine samples, each with its own advantages and disadvantages.The bladder stimulation technique is a noninvasive and efficient method for collecting urine samples. However, few studies have examined the pain and distress effects of this technique, and these studies have reported varying results. What this paper adds? This study found that bladder stimulation techniques were more effective than sterile urine bags in collecting urine samples within 3 min from newborns.The bladder stimulation technique led to decreased saturation and comfort levels, increased heart rate, and increased pain and distress in the newborns during urine sampling; these increases in physiologic parameters were statistically significant but not clinically significant. The implications of this paper: The bladder stimulation technique is an effective noninvasive method for quickly collecting urine samples.Considering the pain and distress‐increasing properties of the technique, it may be recommended before invasive interventions (bladder catheterization and suprapubic aspiration) when urine sample collection with urine bags is not possible; it can be used in cases where urgent urine collection is required. [ABSTRACT FROM AUTHOR]

Acute ingestion of exogenous ketone supplements in the form of a (R)‐3‐hydroxybutyl (R)‐3‐hydroxybutyrate (R‐BD R‐βHB) ketone monoester (KME) can attenuate declines in oxygen availability during hypoxic exposure and might impact cognitive performance at rest and in response to moderate‐intensity exercise. In a single‐blind randomized crossover design, 16 males performed assessments of cognitive performance before and during hypoxic exposure with moderate exercise [2 × 20 min weighted ruck (∼22 kg) at 3.2 km/h at 10% incline] in a normobaric altitude chamber (4572 m, 11.8% O2). The R‐BD R‐βHB KME (573 mg/kg) or a calorie‐ and taste‐matched placebo (∼50 g maltodextrin) were co‐ingested with 40 g of dextrose before exposure to hypoxia. The R‐βHB concentrations were rapidly elevated and sustained (>3 mM; P < 0.001) by KME. The decline in oxygen saturation during hypoxic exposure was attenuated in KME conditions by 2.4%–4.2% (P < 0.05) compared with placebo. Outcomes of cognitive performance tasks, in the form of the Defense Automated Neurobehavioral Assessment (DANA) code substitution task, the Stroop color and word task, and a shooting simulation, did not differ between trials before and during hypoxic exposure. These data suggest that the acute exogenous ketosis induced by KME ingestion can attenuate declining blood oxygen saturation during acute hypoxic exposure both at rest and during moderate‐intensity exercise, but this did not translate into differences in cognitive performance before or after exercise in the conditions investigated. What is the central question of this study?Can exogenous ketosis act as a countermeasure to declines in blood oxygen saturation and cognitive performance during acute hypoxic exposure while performing a weighted ruck exercise?What is the main finding and its importance?Acute exogenous ketosis via ingestion of a drink containing the (R)‐3‐hydroxybutyl (R)‐3‐hydroxybutyrate ketone monoester prior to acute hypoxic exposure attenuated hypoxia‐induced declines in blood oxygen saturation but had no effect on cognitive performance during exercise. [ABSTRACT FROM AUTHOR]

Background: New-onset postoperative atrial fibrillation (nPOAF) is a common complication after cardiac surgery (30–50%), being associated with unfavorable long-term outcomes. Using the Society of Thoracic Surgeons National Adult Cardiac Database, we used machine learning (ML) to predict nPOAF and related 30-day outcomes following mitral valve (MV) surgery. A total of 27,856 MV operations were performed at 910 centers between 7/1/2017 and 6/30/2020 on patients without AF or a prior permanent pacemaker. The primary endpoint was nPOAF postoperatively. ML techniques utilized included penalized logistic regression, gradient boosting, decision trees, and random forests. Results: The overall incidence of nPOAF was 35.4% and that of new pacemaker insertion was 5.6%. Patients who developed nPOAF were older (67 ± 10 vs 60 ± 13 years), had more mitral valve stenosis (14.1% vs 11.7%), and hypertension (72.1% vs 63.3%). They underwent more mitral valve replacement (39.1% vs 32.7%) and coronary artery bypass grafting (23.9% vs 16%). For predicting nPOAF, ML methods offer sensitivity, specificity and precision superior to logistic regression. The accuracy rate was identical with penalized and non-penalized logistic regression (0.672). Conclusions: Predicting nPOAF and its short-term sequelae following MV surgery remains highly challenging. Machine learning methods offer a moderate degree of improvement in predicting nPOAF even in large national-level studies, in the absence of multi-modal data, such as real-time wearables data, electrocardiograms, heart rhythm monitoring, or cardiac imaging. [ABSTRACT FROM AUTHOR]

With a growing interest in head-mounted display (HMD)-based virtual reality (VR) environments, there have been lots of studies enhancing user experience (UX) in the context. In particular, the study of motion sickness (MS) symptoms, which are a major barrier to providing a positive UX, is of high importance. This study investigated the effects of degree of freedom (DOF) and field of view (FOV) of HMD on MS symptoms. A user experiment was designed based on a 2 × 2 mixed design with DOF as a between-subject design variable (3-DOF and 6-DOF) and FOV as a within-subject design variable (Narrow and Wide). Participants experienced VR game content in four conditions in random order. MS symptoms were captured using heart rate variability (HRV) and virtual reality sickness questionnaire (VRSQ) at the pre- and post-task moment. The results showed that MS symptoms occurred more in the 3-DOF condition than in the 6-DOF. Further, MS symptoms in DOF conditions were adjusted depending on the FOV. In the Wide condition, we found a significant difference in MS symptoms depending on the DOF, but in the Narrow condition, no significant differences were found. Through this finding, we were able to not only show the effectiveness of HRV as MS measures but also provide meaningful design insights into HMD-based VR practices. [ABSTRACT FROM AUTHOR]

Background Rising global temperatures due to climate change pose a health risk. Mortality and morbidity increase during heat events affects various organ systems. While warmer countries face higher risks, even colder regions show elevated mortality during hot periods. This study examines physiological responses to heat exposure using data from the general Danish population cohort Lolland–Falster Health Study (LOFUS) during the summers of 2016–2019. Methods In this cross-sectional study, we analysed health data from 3804 individuals aged ≥15 years. Data were analysed across organ systems: cardiovascular system, lung function, renal system, inflammation, coagulation, and liver function. Meteorological data from the Danish Meteorological Institute provided information on temperature and humidity. Heat exposure was defined as one day ≥28°C heat index the day prior to examination. Adjusted multiple linear regression was applied to analyse differences between the two groups. Results There were 46 of 368 days with temperatures ≥28°C heat index. In total, 396 participants were heat-exposed (exposure group), while 3408 constituted the unexposed group. Heat exposure was associated with lower systolic blood pressure (−3.82 mm Hg [−5.72; −1.93]), higher heart rate (1.71 beats/min [0.45; 2.98]), lower oxygen saturation (−0.28% [−0.45; −0.10]), higher sodium (0.56 mmol/l [0.33; 0.79]), and higher urine albumin (0.14 mg/l [0.02; 0.27]). No significant differences were observed in inflammation, coagulation, or liver function. Conclusion This study reveals early physiological responses to heat with one day of heat exposure ≥28°C, particularly in the cardiovascular, pulmonary, and renal systems. These findings underline the need for tailored strategies to mitigate health risks associated with rising temperatures. [ABSTRACT FROM AUTHOR]

Psychopathy in women has gained the attention of the scientific community, but research on the emotional processing in individuals with psychopathic traits and its role in criminal behavior is still scarce. The present systematic review aims to aggregate existing literature that analyze emotional processing in women with psychopathy traits. The search terms, conducted in six databases, identified 13 relevant studies, meeting the following criteria: women, 18 years or older, prison or community contexts, and written in English, Spanish, or Portuguese. Studies pointed to a compromise in the understanding, management, and categorization of emotions, especially those with negative valence, and the presence of alexithymia in women with higher scores of psychopathic traits. Some studies revealed that women with psychopathy had reduced limbic activation, cortical deficits in emotional processing, and an absence of aversive startle response when exposed to aversive stimuli. Significant relationships between psychopathic traits, heart rate, and skin conductance response were documented. Additionally, the interpersonal-affective facet of psychopathy was linked to emotion management difficulties, while the antisocial-impulsive dimension seems linked to alexithymia and deficits in the processing of negatively valenced emotions. These findings carry practical implications for interventions with psychopathic women. [ABSTRACT FROM AUTHOR]

Introduction: Vortioxetine is an antidepressant with a multimodal mechanism of action. It is used as a treatment option for patients with major depressive episodes. There have only been two previously reported non-fatal overdoses of vortioxetine; neither of these were analytically confirmed There has also been one case of serotonin syndrome potentially related to vortioxetine and two deaths where vortioxetine was detected. We report here a non-fatal analytically confirmed case of vortioxetine overdose. Case report: A 32-year-old male presented to the emergency department (ED) 12–13 h after oral ingestion of 1,260 mg of vortioxetine and 350 mg of diazepam. A family member reported that he had been drowsy after the overdose, but his level of consciousness and observations (heart rate, blood pressure and temperature) were normal on review by the pre-hospital emergency services and on arrival to the ED. During a period of observation, he did not develop any features of serotonin syndrome or any other significant toxicity. Toxicological analysis of a blood sample taken in the ED detected vortioxetine (plasma concentration 457 ng/mL 10 h after ingestion) and sub-therapeutic concentrations of diazepam and pregabalin. Discussion: Despite having a plasma vortioxetine concentration nearly 15-times therapeutic vortioxetine concentrations, this patient did not develop any significant toxicity. In particular he did not develop any clinical or biochemical features of serotonin toxicity that would be expected with this class of antidepressant. Additional reporting of analytically confirmed vortioxetine overdoses will allow clinicians and licensing authorities to further understand the safety of this medication in overdose. [ABSTRACT FROM AUTHOR]

Coronary artery aneurysms (CAAs) are morphologically classified as saccular and fusiform. There is still a great deal of clinical controversy as to which types of CAA are more likely to cause thrombosis. Therefore, the main objective of this study was to evaluate the trend of thrombus growth in CAAs with different morphologies and to assess the risk of possible long-term complications based on hemodynamic parameters. Utilizing computed tomography angiography (CTA) data from eight healthy coronary arteries, two distinct morphologies of coronary artery aneurysms (CAAs) were reconstructed. Distribution of four wall shear stress (WSS)-based indicators and three helicity indicators was analyzed in this study. Meanwhile, a thrombus growth model was introduced to analyze the thrombus formation in CAAs with different morphologies. The research results showed the distribution of most WSS indicators between saccular and fusiform CAAs was not statistically significant. However, due to the presence of a more pronounced helical flow pattern, irregular helical flow structure and longer time of flow stagnation in saccular CAAs during the cardiac cycle, the mean and maximum relative residence time (RRT) were significantly higher in saccular CAAs than in fusiform CAAs (P < 0.05). This may increase the risk of saccular coronary arteries leading to aneurysmal dilatation or even rupture. Although the two CAAs had similar rates of thrombosis, fusiform CAAs may more early cause obstruction of the main coronary flow channel where the aneurysm is located due to thrombosis growth. Thus, the risk of thrombosis in fusiform coronary aneurysms may warrant greater clinical concern. [ABSTRACT FROM AUTHOR]

Most studies about the menstrual cycle are laboratory-based, in small samples, with infrequent sampling, and limited to young individuals. Here, we use wearable and diary-based data to investigate menstrual phase and age effects on finger temperature, sleep, heart rate (HR), physical activity, physical symptoms, and mood. A total of 116 healthy females, without menstrual disorders, were enrolled: 67 young (18-35 years, reproductive stage) and 53 midlife (42-55 years, late reproductive to menopause transition). Over one menstrual cycle, participants wore Oura ring Gen2 to detect finger temperature, HR, heart rate variability (root mean square of successive differences between normal heartbeats [RMSSD]), steps, and sleep. They used luteinizing hormone (LH) kits and daily rated sleep, mood, and physical symptoms. A cosinor rhythm analysis was applied to detect menstrual oscillations in temperature. The effect of menstrual cycle phase and group on all other variables was assessed using hierarchical linear models. Finger temperature followed an oscillatory trend indicative of ovulatory cycles in 96 participants. In the midlife group, the temperature rhythm's mesor was higher, but period, amplitude, and number of days between menses and acrophase were similar in both groups. In those with oscillatory temperatures, HR was lowest during menses in both groups. In the young group only, RMSSD was lower in the late-luteal phase than during menses. Overall, RMSSD was lower, and number of daily steps was higher, in the midlife group. No significant menstrual cycle changes were detected in wearable-derived or self-reported measures of sleep efficiency, duration, wake-after-sleep onset, sleep onset latency, or sleep quality. Mood positivity was higher around ovulation, and physical symptoms manifested during menses. Temperature and HR changed across the menstrual cycle; however, sleep measures remained stable in these healthy young and midlife individuals. Further work should investigate over longer periods whether individual- or cluster-specific sleep changes exist, and if a buffering mechanism protects sleep from physiological changes across the menstrual cycle. [ABSTRACT FROM AUTHOR]

Relative uteroplacental insufficiency of labor (RUPI‐L) is a clinical condition that refers to alterations in the fetal oxygen "demand–supply" equation caused by the onset of regular uterine activity. The term RUPI‐L indicates a condition of "relative" uteroplacental insufficiency which is relative to a specific stressful circumstance, such as the onset of regular uterine activity. RUPI‐L may be more prevalent in fetuses in which the ratio between the fetal oxygen supply and demand is already slightly reduced, such as in cases of subclinical placental insufficiency, post‐term pregnancies, gestational diabetes, and other similar conditions. Prior to the onset of regular uterine activity, fetuses with a RUPI‐L may present with normal features on the cardiotocography. However, with the onset of uterine contractions, these fetuses start to manifest abnormal fetal heart rate patterns which reflect the attempt to maintain adequate perfusion to essential central organs during episodes of transient reduction in oxygenation. If labor is allowed to continue without an appropriate intervention, progressively more frequent, and stronger uterine contractions may result in a rapid deterioration of the fetal oxygenation leading to hypoxia and acidosis. In this Commentary, we introduce the term relative uteroplacental insufficiency of labor and highlight the pathophysiology, as well as the common features observed in the fetal heart rate tracing and clinical implications. [ABSTRACT FROM AUTHOR]