Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque - an agatston score propensity-matched CT radiomics study.

BACKGROUND: Coronary artery calcification (CAC) burden assessed by Agatston score (AS) is currently recommended to stratify patients at risk for future acute coronary syndrome (ACS). Besides the CAC burden, the biostructure of CAC may also play a vital role in the vulnerability of CAC, which CT radiomics could reveal. Propensity-score matching of the traditional risk factors and CAC burden between the ACS and asymptomatic groups could radically remove biases and allow the exploration of characteristic features of CAC in ACS. METHODS: We retrospectively identified 77 patients with ACS who had a CAC scan before percutaneous coronary intervention between 2016 and 2019. These 77 patients were one-to-two propensity-score matched for traditional risk factors of ACS and AS ranks to select 154 subjects from 2890 asymptomatic subjects. A validation cohort of 30 subjects was also enrolled. Radiomics features of each plaque were extracted and averaged in each person. Conditional logistic regression and area-under-curve analysis were used for statistical analysis. RESULTS: A higher number of coronary segments involved, lower mean, median, first quartile, and standard deviation of attenuation, and increased kurtosis of attenuation of CAC were associated with the ACS group compared to the control group (p < 0.05 for all). Multivariable analysis showed that the lower median attenuation (OR = 0.969, p < 0.001) and higher Kurtosis (OR = 18.7, p < 0.001) were associated with the ACS group. The median attenuation and kurtosis significantly increase across AS ranks 1 to 4 (p = 0.001). The AUC of kurtosis (0.727) and median attenuation (0.66) were both significantly higher than that of the standard AS (AUC = 0.502) and the number of TRF (AUC = 0.537). The best cut-off of kurtosis at 2.74 yielded an accuracy of 74%, and the cut-off of median attenuation at 196 yielded an accuracy of 68%. The accuracy of kurtosis was 64%, and the accuracy of median attenuation was 55% in the validation cohort. CONCLUSION: After propensity-matching traditional risk factors and CAC burden, CT radiomics highlighted that lower median attenuation and higher kurtosis were the CAC characteristics of vulnerable plaques. These features improve the understanding of the biomechanics of CAC evolution and enhance the value of CAC scan in ACS risk assessment.

Escaping from worries: Comparing the effectiveness of focusing on one's breath, a neutral and a positive distractor in worry control.

Focused-distraction strategies are commonly used for thought control, but their effectiveness in handling personal worries with different types of distractors has rarely been examined. To examine this issue, 101 undergraduate and graduate students whose depression levels fell below mild depression were recruited (64.4% female, M age = 20.27) and were randomly assigned to one of the three strategy conditions: 34 participants for the focused-breathing strategy (FBS), 34 for the focused-positive-distractor strategy (FPS), and 33 for the focused-neutral-distractor strategy (FNS). After a short introduction and practice, they applied the assigned strategy during a 5-min worry control session to prevent thoughts regarding a recent worrying event. The number of worry intrusions was measured using an online self-caught method. Participants rated their emotional states before and after the worry control session. Their working memory capacities (WMCs) and depressive tendency were comparable across conditions. The results showed the FBS and FPS groups exhibited fewer worry intrusions than did the FNS group. Furthermore, worry intrusions were negatively related to WMC for the FNS group but independent of WMC for the other two. The above findings together indicate that the FBS and FPS are relatively effective and effortless methods for reducing worry intrusions. Negative emotions decreased after the worry control session for all groups. However, decoupling of negative emotions from worry intrusions was only observed for the FBS and FNS groups. Overall, FBS outperforms FPS and FNS in managing worries from the above aspects. Several theoretical and practical implications of the study were discussed.

Who is prone to wander and when? Examining an integrative effect of working memory capacity and mindfulness trait on mind wandering under different task loads.

We proposed an integration hypothesis of mind wandering in which the tendency of mind wandering is only related to working memory capacity (WMC) when a self-regulation process is required (i.e., under a high task load); however, this tendency is related to mindfulness regardless of task load. A within-group experiment with 160 participants was conducted. Task load was manipulated as high or low using modified 0-back and 2-back tasks, during which participants' self-caught mind wanderings and the types of mind wandering (aware vs. unaware; intentional vs. unintentional) were measured. The results supported our hypothesis that WMC was negatively associated with mind wandering only in demanding tasks, and mindfulness scores were negatively associated with mind wandering across tasks. Furthermore, we also determined how WMC and the mindfulness trait were related to different types of mind wandering. Theoretical implications were discussed.

Better control with less effort: The advantage of using focused-breathing strategy over focused-distraction strategy on thought suppression.

It has been suggested that unwanted thoughts usually intrude during mind wandering due to a shortage of mental resources. However, strategies for suppressing such thoughts have never been examined from a mind wandering perspective. Here, we compare the effectiveness of two types of attention distraction strategies that either redirect users' attention to their own breathing (focused-breathing strategy, FBS) or to a mental image (focused-distraction strategy, FDS) as related to working memory capacities. Eighty-two undergraduates were randomly assigned into a FBS or FDS group. They completed a concentration task and a thought suppression task, in which mind wandering and thought intrusions were each measured. Our results support the hypothesis that mind wandering is positively correlated to thought intrusions and shows that FBS is more effective than FDS in reducing mind wandering and thought intrusions. Moreover, in contrast to FDS, the effect of FBS is independent of users' mental resources.

Reliable categorisation of visual scoring of coronary artery calcification on low-dose CT for lung cancer screening: validation with the standard Agatston score.

OBJECTIVES: To validate the reliability of the visual coronary artery calcification score (VCACS) on low-dose CT (LDCT) for concurrent screening of CAC and lung cancer. METHODS: We enrolled 401 subjects receiving LDCT for lung cancer screening and ECG-gated CT for the Agatston score (AS). LDCT was reconstructed with 3- and 5-mm slice thickness (LDCT-3mm and LDCT-5mm respectively) for VCACS to obtain VCACS-3mm and VCACS-5mm respectively. After a training session comprising 32 cases, two observers performed four-scale VCACS (absent, mild, moderate, severe) of 369 data sets independently, the results were compared with four-scale AS (0, 1-100, 101-400, >400). RESULTS: CACs were present in 39.6 % (146/369) of subjects. The sensitivity of VCACS-3mm was higher than for VCACS-5mm (83.6 % versus 74.0 %). The median of AS of the 24 false-negative cases in VCACS-3mm was 2.3 (range 1.1-21.1). The false-negative rate for detecting AS ≥ 10 on LDCT-3mm was 1.9 %. VCACS-3mm had higher concordance with AS than VCACS-5mm (k = 0.813 versus k = 0.685). An extended test of VCACS-3mm for four junior observers showed high inter-observer reliability (intra-class correlation = 0.90) and good concordance with AS (k = 0.662-0.747). CONCLUSIONS: This study validated the reliability of VCACS on LDCT for lung cancer screening and showed that LDCT-3mm was more feasible than LDCT-5mm for CAD risk stratification. KEY POINTS: • Low-dose computed tomography (LDCT) rarely misses significant coronary artery calcification (CAC). • Visual scoring of CAC on LDCT is highly concordant with Agatston scoring. • LDCT-3mm is more feasible than LDCT-5mm for CAD risk stratification. • CAC assessment enriched the screening information for LDCT lung cancer screening.

Development of a Rasch-calibrated emotion recognition video test for patients with schizophrenia.

Patients with schizophrenia tend to have deficits in emotion recognition (ER) that affect their social function. However, the commonly-used ER measures appear incomprehensive, unreliable and invalid, making it difficult to comprehensively evaluate ER. The purposes of this study were to develop the Computerized Emotion Recognition Video Test (CERVT) evaluating ER ability in patients with schizophrenia. This study was divided into two phases. First, we selected candidate CERVT items/videos of 8 basic emotion domains from a published database. Second, we validated the selected CERVT items using Rasch analysis. Finally, the 269 patients and 177 healthy adults were recruited to ensure the participants had diverse abilities. After the removal of 21 misfit (infit or outfit mean square > 1.4) items and adjustment of the item difficulties of the 26 items with severe differential item functioning, the remaining 217 items were finalized as the CERVT items. All the CERVT items showed good model fits with small eigenvalues (≤ 2) based on the residual-based principal components analysis for each domain, supporting the unidimensionality of these items. The 8 domains of the CERVT had good to excellent reliabilities (average Rasch reliabilities = 0.84-0.93). The CERVT contains items of the 8 basic emotions with individualized scores. Moreover, the CERVT showed acceptable reliability and validity, and the scores were not affected by examinees' gender. Thus, the CERVT has the potential to provide a comprehensive, reliable, valid, and gender-unbiased assessment of ER for patients with schizophrenia.

Consistency Analysis in Medical Empathy Intervention Research.

Various studies have examined the effectiveness of interventions to increase empathy in medical professionals. However, inconsistencies may exist in the definitions, interventions, and assessments of empathy. Inconsistencies jeopardize the internal validity and generalization of the research findings. The main purpose of this study was to examine the internal consistency among the definitions, interventions, and assessments of empathy in medical empathy intervention studies. We also examined the interventions and assessments in terms of the knowledge-attitude-behavior aspects. We conducted a literature search for medical empathy intervention studies with a design of randomized controlled trials and categorized each study according to the dimensions of empathy and knowledge-attitude-behavior aspects. The consistencies among the definitions, interventions, and assessments were calculated. A total of 13 studies were included in this study. No studies were fully consistent in their definitions, interventions, and assessments of empathy. Only four studies were partially consistent. In terms of knowledge-attitude-behavior aspects, four studies were fully consistent, two studies were partially consistent, and seven studies were inconsistent. Most medical empathy intervention studies are inconsistent in their definitions, interventions, and assessments of empathy, as well as the knowledge-attitude-behavior aspects between interventions and assessments. These inconsistencies may have affected the internal validity and generalization of the research results.

Renal artery involvement in acute aortic dissection: Prevalence and impact on renal atrophy in non-interventional treatment patients.

BACKGROUND: To evaluate the frequency of renal artery dissection (RAD) and renal hypoperfusion in aortic dissection (AD) and its effect on subsequent renal atrophy in patients who did not undergo therapeutic intervention. METHODS: Initial CT data of 155 patients with acute AD (Stanford type A = 88, B = 67) were retrospectively analyzed. The false lumen statuses were patent (n = 94), partially thrombosed (n = 25), and completely thrombosed (n = 36) (also called as intramural hematoma (IMH)). Follow-up CT images of the surviving 122 patients (6-62.6 months, median, 28.9 months) were reviewed for analysis of sequential changes in renal volume. A regional decrease of ≧20 Hounsfield units in the renal cortex was defined as a renal hypo-enhancement sign (RHS). Simplified CT estimations of renal volume and estimated glomerular filtration rates (eGFR) were calculated. The generalized estimating equations (GEE) method was used to predict renal atrophy. RESULTS: Fifty of the 122 patients presented with 59 RAD in the current study, and a positive RHS was noted in 33.9% (20/59) of these involved kidneys. GEE analysis showed hypertension, surgical treatment for AD, presence of RAD, and positive RHS as significant risk factors for renal atrophy. Patients with RHS had the most severe form of renal atrophy. The severity of renal atrophy was mildly correlated with GFR change (γ2 = 0.044, p < 0.001). CONCLUSION: Renal atrophy in AD was predicted by the CT findings of RAD and RHS. The severity of renal atrophy was weakly reflected by eGFR.