Effects of attentional deployment training for relieving negative emotion in individuals with subthreshold depression.

OBJECTIVE: As a prodromal stage to major depressive disorder (MDD), subthreshold depression (StD) has a higher prevalence in the population, resulting in a greater healthcare burden. StD individuals' current negative emotion could be moderated by attentional deployment. However, it remains unclear whether attentional deployment training can mitigate subsequent negative emotion in StD individuals. METHODS: Based on 160 participants, we combined decision task (Experiment 1, N = 69), eye-tracking (Experiment 2, N = 40), and EEG (Experiment 3, N = 51) techniques to investigate how one-week attentional deployment (gain-focus, GF) training modulated the emotional processing of negative stimulus and its underlying neural correlates in StD individuals. RESULTS: After one-week GF training, StD individuals significantly reduced the first fixation time and total fixation time on the negative part (missed opportunities) of decision outcome and showed a decrease in emotional sensitivity to missed opportunities. An increase in N1 and decrease in P3 and LPP (late positive potentials) amplitudes, as well as a decrease in alpha oscillation, were observed when StD individuals faced missed opportunities after training. Additionally, the extent of reduction in StD individuals' emotional sensitivity to missed opportunities could be significantly predicted by the degree of decrease in alpha oscillation. CONCLUSION: One-week attentional deployment training could modulate negative emotion in StD individuals and the degree of change in alpha oscillation might act as an objective indicator for the effectiveness of training. SIGNIFICANCE: Our study provides a convenient and effective approach to alleviate the negative emotion of StD individuals.

The effects of sleep deprivation on risky decision making.

Sleep deprivation stands as a major threat to both physical and mental well-being, disrupting normal work and life. Given the ubiquity of risky decision making, it is crucial to comprehend how individuals make risky decisions when sleep-deprived. Although research on the effects of sleep deprivation on risky decision making has increased in recent years, it remains limited and lacks a unified conclusion. The current review attempted to elucidate the effects of sleep deprivation on risky decision making in healthy adults and clarify the regulatory mechanisms. The review showed that sleep deprivation had complex effects on risky decision making; that is, whether sleep deprivation led to riskier or more conservative decision-making behavior depended on factors such as sex, gain-loss frame, use of psychotropic drugs, time interval of sleep elimination, duration of sleep deprivation, and others. Additionally, the complexity of these effects might partly arise from the use of different tasks to measure risk-taking behavior. The review also discussed some limitations of existing research and put forth practical recommendations for future studies, aiming to resolve inconsistencies in the effects of sleep deprivation on risky decision making and enhance the ecological validity of conclusions.

"One for two" strategy to construct an organic-inorganic polymer colloid for flame-retardant modification of flax fabric and rigid polyurethane foam.

Polymeric materials such as fabric and foam have high flammability which limits their application in the field of fire protection. To this end, an organic-inorganic polymer colloid constructed from carboxymethyl chitosan and ammonium polyphosphate was used to improve the flame retardancy of flax fabric (FF) and rigid polyurethane foam (RPUF) based on a "one for two" strategy. The modification processes of FF and RPUF relied on pad-dry-cure method and UV-curing technology, respectively, and the modified FF and RPUF were severally designated as CMC/APP-FF and RFR-RPUF. Flame retardancy studies showed that CMC/APP-FF and RFR-RPUF exhibited limiting oxygen index values as high as 39.4 % and 42.6 %, respectively, and both achieved self-extinguishing behavior when external ignition source was removed. Thermogravimetric analysis and cone calorimetry test confirmed that CMC/APP-FF and RFR-RPUF had good charring ability and demonstrated reduced peak heat release rate values of 90.1 % and 10.8 %, respectively, distinct from before they were modified. In addition, condensed phase analysis showed that after burning, CMC/APP-FF became an integration char structure, whereas RFR-RPUF turned into a sandwiched char structure. In summary, the "one for two" strategy reported in this work provides a new insight into the economical fabrication of flame-retardant polymeric materials.

An Empirical Investigation of the Relationships Among Self-Esteem, Depression and Self-Serving Bias in People with Internet Gaming Disorder.

Introduction: People are generally characterized by a self-serving bias which describes the tendency to ascribe positive outcomes or success to internal or personal causes (self-enhancement motivation) and ascribe negative outcomes or failure to external or situational causes (self-protection motivation). It has been found that the individuals with internet gaming disorder (IGD) who have low self-esteem and high depression exhibit an attenuated self-serving bias. However, the relationships among self-esteem, depression and self-serving bias are not clearly identified. Methods: A sample of 138 IGD participants completed self-esteem and depression scales and a causal attribution task (Study 1) to examine the relationships among self-esteem, depression and self-serving bias (both self-enhancement and self-protection). In follow-up Study 2, 28 IGD participants were recruited to undertake self-affirmation intervention which can affirm one's sense of global self-view and bolster self-esteem to explore whether self-affirmation would trigger a reduction of depression and a raise of self-serving bias. Results: The results of path analysis in Study 1 showed that the self-serving bias was predicted by self-esteem and depression, and the depression played a mediating role between self-esteem and self-serving bias. The results of Study 2 showed that the IGD participants reported higher self-esteem, lower depression and engaged in more self-protection motivation after affirming-self manipulation as compared with affirming-other manipulation. Conclusion: These findings suggest that self-esteem predicts self-serving bias through depression and self-affirmation could trigger an increase of self-esteem, further decrease depression and improve self-serving bias for the individuals with IGD. The present article clearly identified the relationships among these factors and provided a new approach to promote positive self-concept in individuals with IGD. Future research is warranted to explore the lasting benefits of self-affirmation on domains of education, relationships and gaming withdrawal for the individuals with IGD among different populations.

The effects of forewarning and divided attention on context retrieval in false recognition.

After studying a list of words that are semantically associated to a critical lure, participants are more likely to attribute a falsely recognised critical lure to the context of its strong than weak semantic associates. This is known as the source-strength effect. The current study investigated the roles of automatic and controlled processing in context retrieval in false recognition that is demonstrated by the source-strength effect. The results revealed that the source-strength effect was impervious to forewarning (Experiment 1) and remained intact when attentional resources at encoding were reduced (Experiment 2), suggesting that context retrieval in false recognition is based on automatic processes that are not amenable to conscious control and do not require many attentional resources. This interpretation is consistent with the associative activation theory, which proposes that context retrieval in false recognition is based on memory associations between contexts and critical lures that are automatically created when critical lures become automatically activated via spreading activation process.

Theta Signal Transfer from Parietal to Prefrontal Cortex Ignites Conscious Awareness of Implicit Knowledge during Sequence Learning.

Unconscious acquisition of sequence structure from experienced events can lead to explicit awareness of the pattern through extended practice. Although the implicit-to-explicit transition has been extensively studied in humans using the serial reaction time (SRT) task, the subtle neural activity supporting this transition remains unclear. Here, we investigated whether frequency-specific neural signal transfer contributes to this transition. A total of 208 participants (107 females) learned a sequence pattern through a multisession SRT task, allowing us to observe the transitions. Session-by-session measures of participants' awareness for sequence knowledge were conducted during the SRT task to identify the session when the transition occurred. By analyzing time course RT data using switchpoint modeling, we identified an increase in learning benefit specifically at the transition session. Electroencephalogram (EEG)/magnetoencephalogram (MEG) recordings revealed increased theta power in parietal (precuneus) regions one session before the transition (pretransition) and a prefrontal (superior frontal gyrus; SFG) one at the transition session. Phase transfer entropy (PTE) analysis confirmed that directional theta transfer from precuneus → SFG occurred at the pretransition session and its strength positively predicted learning improvement at the subsequent transition session. Furthermore, repetitive transcranial magnetic stimulation (TMS) modulated precuneus theta power and altered transfer strength from precuneus to SFG, resulting in changes in both transition rate and learning benefit at that specific point of transition. Our brain-stimulation evidence supports a role for parietal → prefrontal theta signal transfer in igniting conscious awareness of implicitly acquired knowledge.SIGNIFICANCE STATEMENT There exists a pervasive phenomenon wherein individuals unconsciously acquire sequence patterns from their environment, gradually becoming aware of the underlying regularities through repeated practice. While previous studies have established the robustness of this implicit-to-explicit transition in humans, the refined neural mechanisms facilitating conscious access to implicit knowledge remain poorly understood. Here, we demonstrate that prefrontal activity, known to be crucial for conscious awareness, is triggered by neural signal transfer originating from the posterior brain region, specifically the precuneus. By employing brain stimulation techniques, we establish a causal link between neural signal transfer and the occurrence of awareness. Our findings unveil a mechanism by which implicit knowledge becomes consciously accessible in human cognition.

Social distance of bystanders affects people's embarrassment via changing fear of negative evaluation and feelings of attachment security.

BACKGROUND: Embarrassment is a self-conscious emotion with important social functions, but it is not well understood. The perception of bystanders is considered a precondition for embarrassment, which makes it unique from other self-conscious emotions. Studies have shown that socially close bystanders can reduce individuals' embarrassment. However, whether and how the embarrassment of individuals varies with the changes in social distance between them and their bystanders remained unclear, which indicates the key characteristics of embarrassment. METHODS: The current research consists of two studies. Study 1 tested whether participants' embarrassment systematically varied with social distance by setting up three levels of social distance: close friends (i.e., short), casual friends (i.e., medium), and strangers (i.e., long), based on 159 participants. With two full mediation models, study 2 investigated whether and how the fear of negative evaluation and state attachment security mediated the influence of social distance on embarrassment based on 155 participants. CONCLUSIONS: The current findings revealed that the social distance between bystanders and protagonists systematically influenced the embarrassment of protagonists and this effect occurred via two parallel pathways, i.e., by increasing the fear of negative evaluation and by reducing state attachment security. The findings not only showed the unique role of bystander characteristics on embarrassment, but also two cognitive processes behind this unique self-conscious emotion: fearing negative evaluation and seeking attachment for security.

Event-related potential and behavioural evidence of goal-based expectations for consistent actions among group members.

PLACEHOLDER TEXT: ABSTRACT: People expect group members to act consistently. However, because actions are organized hierarchically, incorporating deep-level goals and shallow-level movements, it remains unclear what level of action is expected to be consistent among group members. We determined that these two levels of action representations can be dissociated in object-directed actions and measured the late positive potential (LPP), which indicates expectation. We found that participants identified a new agent's actions more quickly when this agent pursued a consistent goal while moving in a manner inconsistent with group members than when this agent pursued an inconsistent goal while moving in the same manner as group members. Moreover, this facilitation effect disappeared when the new agent was from a different group, revealing goal-based expectations for consistent actions among group members. The LPP amplitude during the action-expectation phase was greater for agents from the same group than for agents from a different group, suggesting that people implicitly generate clearer action expectations for group members than for other individuals. Additionally, the behavioural facilitation effect was observed when the goal of actions was clearly identifiable (i.e. performing rational actions to reach an external target) rather than when there was no clear association between actions and external targets (i.e. performing irrational actions). The LPP amplitude during the action-expectation phase was greater after observing rational actions than after observing irrational actions performed by two agents from the same group, and the expectation-related increase in LPP predicted the behavioural measurements of the facilitation effect. Hence, the behavioural and event-related potential evidence suggest that people implicitly expect group members to behave consistently according to goals rather than movements per se.

The neural correlates underlying the regulation of anticipation on regret.

Regret is a common negative emotion in daily life, and long-term immersion in regret affects mental health. Therefore, to regulate and reduce regret is of wide concern. The current fMRI study aimed to investigate whether outcome anticipation before decision-making could reduce regret and its neural correlates. In the task, participants were asked to anticipate the possible poor outcomes of subsequent decisions, such as missing rewards and meeting punishment, and then made sequential risk-taking decisions. Behavioral results showed that outcome anticipation before decision-making could decrease the intensity of regret, that is, participants felt less regret when they anticipated the outcome before decision-making (anticipation condition, Ant), compared to making sequential risk-taking decisions without any anticipation of the outcome in advance (non-anticipation condition, NAnt). Consistently, at the neural level, stronger activities of ventral striatum (VS) and dorsal medial prefrontal cortex (dmPFC), and greater VS-dmPFC functional connectivity were observed in Ant relative to NAnt. Moreover, the activity of dmPFC was negatively correlated with the intensity of regret in Ant. The current study highlighted that outcome anticipation before decision-making could regulate regret effectively, and dmPFC played a vital role in this process.

Abnormal functional connectivity in resting state contributes to the weaker emotional sensitivity to reward in depression.

INTRODUCTION: Depression is one of the most prevalent mental diseases characterized by distortions in the affective sphere. By using resting-state functional magnetic resonance imaging (rs-fMRI) technique, the current study aimed to investigate neural mechanisms associated with emotional sensitivity to reward, which represented the variation of emotional responsiveness as the degree of reward changing in individuals with depressive symptoms. METHODS: We recruited 28 participants in elevated depressive symptoms (LD) group and 28 demographic-matched participants in low depressive symptoms (ED) group. After the rs-fMRI scan, participants were asked to complete a sequential risk-taking task, in which they might encounter both reward and loss. RESULTS: The resting-state functional connectivity (rs-FC) between ventral striatum (VS) and inferior frontal gyrus (IFG) was associated with the emotional sensitivity to reward in LD group. Compared with LD group, participants in ED group showed weaker emotional sensitivity to reward and stronger rs-FC between VS and prefrontal regions. CONCLUSIONS: The current study highlighted that the functional connectivity between VS and IFG in the resting state was related to the emotional sensitivity to reward in individuals with low depressive symptoms. However, individuals with elevated depressive symptoms exhibited altered functional connectivity between VS and IFG in the resting state, which might contribute to their weaker emotional sensitivity to reward.

Maternal choices and preferences for screening strategies of gestational diabetes mellitus: A exploratory study using discrete choice experiment.

Aims: This study aimed to investigate maternal preferences for gestational diabetes mellitus (GDM) screening options in rural China to identify an optimal GDM screening strategy. Methods: Pregnant women at 24-28 gestational weeks were recruited from Shandong province, China. A discrete choice experiment (DCE) was conducted to elicit pregnant women's preferences for GDM screening strategy defined by five attributes: number of blood draws, out-of-pocket costs, screening waiting-time, number of hospital visits, and positive diagnosis rate. A mixed logistic model was employed to quantify maternal preferences, and to estimate the relative importance of included attributes in determining pregnant women's preferences for two routinely applied screening strategies ("one-step": 75 g oral glucose tolerance test [OGTT] and "two-step": 50 g glucose challenge-test plus 75 g OGTT). Preference heterogeneity was also investigated. Results: N = 287 participants completed the DCE survey. All five predefined attributes were associated with pregnant women's preferences. Diagnostic rate was the most influential attribute (17.5 vs. 8.0%, OR: 2.89; 95%CI: 2.10 to 3.96). When changes of the attributes of "two-step" to "one-step" strategies, women's uptake probability from full "two-step" to "one-step" significantly increased with 71.3% (95%CI: 52.2 to 90.1%), but no significant difference with the first step of "two-step" (-31.0%, 95%CI: -70.2 to 8.1%). Conclusion: Chinese pregnant women preferred the "one-step" screening strategy to the full "two-step" strategy, but were indifferent between "one-step" and the first step of "two-step" strategies.

Neural Basis of the Implicit Learning of Complex Artificial Grammar with Nonadjacent Dependencies.

The capacity for the implicit learning/processing of complex grammar with nonadjacent dependencies is an important feature of human language learning. In this fMRI study, using an implicit AGL paradigm, we explored the neural basis of the implicit learning of the nonadjacent dependency rule, disentangling from sequence-based chunk knowledge (i.e., local sequential regularities or substring) by focusing on the low chunk strength items (which were naturally less similar to training strings), based on tracking neural responses during training and test phases. After listening to and memorizing a series of strings of 10 syllables generated from nonadjacent artificial grammar in the training phase, participants implicitly acquired the knowledge of grammar and chunks. Regarding grammaticality, Broca's area was specifically related to low chunk strength grammatical strings relative to nongrammatical strings in the test phase. This region showed decreased activity with time in the training phase, and a lesser decrease in activity was associated with higher performance in grammar learning. Furthermore, Broca's area showed significantly higher strength of functional connectivity with the left superior temporal gyrus in the low chunk strength grammatical string compared with nongrammatical strings, and this functional connectivity increased with the training time. For the chunks, the performance of accurate discrimination of high chunk strength from low chunk strength nongrammatical strings was predicted by hippocampal activity in the training phase. Converging evidence from the training and test phases showed that Broca's area and its functional connectivity with the left superior temporal gyrus were engaged in the implicit learning/processing of the nonadjacent dependency rule, separating the effects of chunks.

Punishment cost affects third-parties' behavioral and neural responses to unfairness.

Third-party punishment plays a crucial role in fairness norm enforcement. The present study investigated how punishment cost would affect third-parties' behavioral and neural responses to unfairness using a modified Third-Party Dictator Game and functional magnetic resonance imaging (fMRI). Participants acted as third-parties and decided how many monetary units (MUs) to invest to punish norm violations in two punishment cost contexts. Participants' every MU investment reduced dictators' payoff by 6 MUs in the low punishment cost context and 3 MUs in the high one. Participants' invested MUs reflected the cost they would like to pay to punish dictators while dictators' reduced MUs represented the amount of punishment they received. Behavioral results showed participants' fairness ratings were not affected by punishment cost. However, punishment amount decreased in the high punishment cost context where participants invested more MUs and spent more time for decision-making. Neurally, left anterior insula (AI) and bilateral dorsolateral prefrontal cortex (dlPFC) showed stronger responses to unfair relative to fair allocations in both contexts. Moreover, dorsal anterior cingulate cortex (dACC) was more active during unfair allocations in the high punishment cost context than in the low one and the difference of dACC activity between these two conditions was positively correlated with the difference of reaction times. Overall, the present study demonstrated that punishment cost would not affect people's fairness perception but increase the conflicts between norm enforcement and self-interest. The decision for punishment was the outcome of integrating fairness and economic considerations.

The neural mechanisms underlying the modulation of attentional deployment on emotional stability.

Emotional stability, the change of emotion response among situations, was associated with mental illness, such as depression. The current study aimed to explore the modulation of attentional deployment on emotional stability by combining functional magnetic resonance imaging (fMRI) and a sequential risk-taking task. During the task, participants were asked to open a series of boxes consecutively and decided when to stop. Each box contained a reward, except one containing a devil to zero reward in the trial. When participants stopped, both collected gains and missed chances were revealed. The attentional deployment was manipulated during the outcome feedback, i.e., inducing participants to focus on the good part (GF context) or the bad part (MF context) of the decision outcome. Besides, the Control context was also set, in which the attentional deployment was not manipulated. The behavioral results showed that the emotional stability was stronger in GF context relative to MF and Control contexts. At the neural level, with outcomes getting better, activations of ventral striatum (VS) and superior frontal gyrus (SFG) increased faster in GF context than that in MF and Control contexts. In addition, in GF context, the changing of SFG activation with outcomes getting better was associated with emotional stability. The current study highlighted that focusing on the good part of decision outcomes could enhance emotional stability effectively and SFG played a vital role in this process.

Dissociating value-based neurocomputation from subsequent selection-related activations in human decision-making.

Human decision-making requires the brain to fulfill neural computation of benefit and risk and therewith a selection between options. It remains unclear how value-based neural computation and subsequent brain activity evolve to achieve a final decision and which process is modulated by irrational factors. We adopted a sequential risk-taking task that asked participants to successively decide whether to open a box with potential reward/punishment in an eight-box trial, or not to open. With time-resolved multivariate pattern analyses, we decoded electroencephalography and magnetoencephalography responses to two successive low- and high-risk boxes before open-box action. Referencing the specificity of decoding-accuracy peak to a first-stage processing completion, we set it as the demarcation and dissociated the neural time course of decision-making into valuation and selection stages. The behavioral hierarchical drift diffusion modeling confirmed different information processing in two stages, that is, the valuation stage was related to the drift rate of evidence accumulation, while the selection stage was related to the nondecision time spent in response-producing. We further observed that medial orbitofrontal cortex participated in the valuation stage, while superior frontal gyrus engaged in the selection stage of irrational open-box decisions. Afterward, we revealed that irrational factors influenced decision-making through the selection stage rather than the valuation stage.

Altered neural responses to missed chance contribute to the risk-taking behaviour in individuals with Internet gaming disorder.

Missed chance is a powerful factor in shaping risk-taking behaviour. The abnormal risk-taking behaviour is an obvious feature of individuals with Internet gaming disorder (IGD). However, the relationship between the neural responses to missed chance and risk-taking behaviour in IGD individuals remains unclear. In the current fMRI study, 28 IGD subjects (12 female, 23.04 ± 2.43 years old) and 26 healthy control (HC) subjects (13 female, 23.58 ± 2.67 years old) participated in fMRI scanning during performance of a sequential risk-taking task. The general linear model and the psycho-physiological interaction analyses were conducted to explore the difference in neural responses between the two groups. The results showed that IGD subjects reported more regret for the large missed chance and took more risk than HC subjects. Moreover, compared with HC subjects, IGD subjects exhibited greater activations in brain regions like ventral striatum (VS) and superior frontal gyrus (SFG), and stronger VS-thalamus functional connectivity for the large missed chance. Additionally, among IGD subjects, the SFG activation for the large missed chance was positively correlated with the risk-taking behaviour. Together, the results revealed the altered neural responses to missed chance contributed to the risk-taking behaviour in IGD individuals. The findings could help to clearly understand why IGD individuals continue playing online games despite the risks of widely known and could provide a new perspective for the intervention of IGD.

Resting-state functional connectivity within orbitofrontal cortex and inferior frontal gyrus modulates the relationship between reflection level and risk-taking behavior in internet gaming disorder.

Internet gaming disorder (IGD) has become an increasing mental health issue worldwide. Previous studies indicated that IGD was related to maladaptive risk-taking behavior. However, the relationship among risk-taking behavior, reflection level, and resting-state functional connectivity (rsFC) between brain regions in IGD individuals remains unclear. The current study combined resting-state fMRI and the Devil task to investigate this issue. The behavioral results suggested that IGD participants exhibited increased risk-taking behavior in the Devil task than healthy controls. Moreover, IGD participants' risk-taking behavior was positively correlated with their reflection level. As for fMRI results, IGD participants showed stronger rsFC between orbitofrontal cortex (OFC) and inferior frontal gyrus (IFG) than healthy controls. Additionally, the mediation analyses revealed that, among IGD participants, the rsFC between OFC and IFG fully mediated the relationship between reflection level and risk-taking behavior. Together, the current study highlighted that the altered rsFC between OFC and IFG in IGD individuals modified the relationship between their reflection level and risk-taking behavior, which might contribute to the understanding of neural mechanisms underlying risk-taking behavior in IGD individuals.

Evidence-Based Classification in Powerchair Football: Determining the Determinants.

The purpose of this study was to initiate the development of an evidence-based sport classification system for powerchair football, a sport that serves athletes with physical impairments. Sport classification is designed to increase participation by minimizing the impact of impairment on competition outcome, and powerchair football lacks an evidence-based system of classification which is required of Paralympic sports. A number of approaches were used to build the theoretical model of sport performance (Step 2 of the International Paralympic Committee model). Key sport activities were identified through surveys of stakeholders and underlying determinants of those key activities were identified through game and database analyses. Current findings support drive control, ball control, communication, and adjustment to the ball as key activities in powerchair football with joint-specific strength and range of motion, sensory, and neurological variables identified as underlying determinants.

Effect of Electrical Impedance Tomography-Guided Early Mobilization in Patients After Major Upper Abdominal Surgery: Protocol for a Prospective Cohort Study.

Background: Pulmonary complications are common in patients after upper abdominal surgery, resulting in poor clinical outcomes and increased costs of hospitalization. Enhanced Recovery After Surgery Guidelines strongly recommend early mobilization post-operatively; however, the quality of the evidence is poor, and indicators for quantifying the effectiveness of early mobilization are lacking. This study will evaluate the effectiveness of early mobilization in patients undergoing an upper abdominal surgery using electrical impedance tomography (EIT). Specifically, we will use EIT to assess and compare the lung ventilation distribution among various regions of interest (ROI) before and after mobilization in this patient population. Additionally, we will assess the temporal differences in the distribution of ventilation in various ROI during mobilization in an effort to develop personalized activity programs for this patient population. Methods: In this prospective, single-center cohort study, we aim to recruit 50 patients after upper abdominal surgery between July 1, 2021 and June 30, 2022. This study will use EIT to quantify the ventilation distribution among different ROI. On post-operative day 1, the nurses will assist the patient to sit on the chair beside the bed. Patient's heart rate, blood pressure, oxygen saturation, respiratory rate, and ROI 1-4 will be recorded before the mobilization as baseline. These data will be recorded again at 15, 30, 60, 90, and 120 min after mobilization, and the changes in vital signs and ROI 1-4 values at each time point before and after mobilization will be compared. Ethics and Dissemination: The study protocol has been approved by the Institutional Review Board of Liaocheng Cardiac Hospital (2020036). The trial is registered at chictr.org.cn with identifier ChiCTR2100042877, registered on January 31, 2021. The results of the study will be presented at relevant national and international conferences and submitted to international peer-reviewed journals. There are no plans to communicate results specifically to participants. Important protocol modifications, such as changes to eligibility criteria, outcomes, or analyses, will be communicated to all relevant parties (including investigators, Institutional Review Board, trial participants, trial registries, journals, and regulators) as needed via email or in-person communication.