Poor Below Knee Runoff Impacts Femoropopliteal Stent Failure and Fluoropolymer Antithrombotic Effect in Healthy Swine Model.

OBJECTIVE: Poor below knee (BTK) runoff is a predictor of stent failure after endovascular femoropopliteal artery treatment; however, lack of pathological evaluation has prevented characterisation of stent failure. The study aimed to investigate the impact of poor BTK runoff and the antithrombotic effect of the polymer of fluoropolymer coated paclitaxel eluting stents (FP-PESs) in a healthy swine femoropopliteal artery model. METHODS: FP-PESs and bare metal stents (BMSs) and FP-PES and polymer free paclitaxel coated stents (PF-PCSs) were implanted in the bilateral femoral arteries of healthy swine (n = 6, respectively) following coil embolisation in both tibial arteries to induce poor BTK runoff. Histological assessment and intravascular imaging device evaluation were performed at one month. The Japanese Association for Laboratory Animal Science approved the study protocol (reference number: IVT22-90). RESULTS: Optical coherence tomography showed significantly lower percent area stenosis in FP-PES compared with BMS (37.3%, [interquartile range (IQR), 25.6 - 54.3] % vs. 92.5% [IQR, 75.5 - 96.1] %, respectively, p = .031), and PF-PCS (8.3% [IQR, 4.5 - 27.0] % vs. 31.2% [IQR, 23.3 - 52.2] %, respectively, p = .031). Histopathological evaluation demonstrated that thin fibrin attachment without re-stenosis was the most dominant neointimal tissue characteristic in FP-PES. On the other hand, neointimal tissue characteristics with significant restenosis of BMS and PF-PCS were mainly organising or organised thrombus. CONCLUSION: Organising and or organised thrombus attachment due to poor BTK runoff was the main cause of in stent restenosis of the swine femoral artery. FP-PES demonstrated the least percent area stenosis, suggesting the importance of the antithrombotic effect of polymer.

Relationship status and gender-related differences in response to infidelity.

Introduction: The sexual imagination hypothesis suggests that responses to a partner's infidelity emerge from the sociocultural factors that affect individuals' imagining of that occurrence irrespective of biological sex, including relationship status (i.e., the experience of a serious, committed relationship). Nevertheless, evolutionary psychological perspectives predict that responses to a partner's infidelity emerge from a sex-specific evolved innate mechanism. Methods: A lower 2D:4D digit ratio is associated with more robust responses to a partner's sexual infidelity. In this study, participants (660 males and 912 females) were requested to measure finger lengths, reactions to their partners' sexual and emotional infidelity, and relationship status. Results: A logistic regression and multiple regression analyses revealed that relationship status was uniquely associated with responses to a partner's sexual and emotional infidelity beyond the effects of sex and 2D:4D. Those in committed relationships were more upset or distressed over their partners' infidelity, particularly over sexual infidelity, than those not in committed relationships. Discussion: The results supported the sexual imagination hypothesis indirectly, while evolutionary psychological perspectives were met with skepticism. Our findings implied that sex differences in jealousy result from relationship status, and that responses to partners' infidelity are more alike than different.

Asymptomatic Coarctation of the Aorta in Adults with Preserved Exercise Capacity.

We herein report a case of coarctation of the aorta (CoA) in an asymptomatic adult who had a preserved exercise capacity. A 56-year-old man with mild hypertension exhibited left ventricular hypertrophy on an electrocardiogram during an annual medical checkup. Echocardiography showed a bicuspid aortic valve and cor triatriatum sinister, and subsequent computed tomography revealed CoA with developed collaterals. Cardiopulmonary exercise testing showed a good exercise capacity. He refused surgical repair and has been asymptomatic for five years. This case is of special interest, as CoA is usually rarely noticed during adulthood if there are no severe congenital anomalies, and in addition, this patient had good exercise capacity.

Adaptation and validation of the Chinese version of the Sleep Quality Questionnaire.

STUDY OBJECTIVES: Sleep quality is essential to health. The current study aimed to adapt and validate the Sleep Quality Questionnaire (SQQ) into Chinese language. METHODS: The Chinese version of the SQQ (SQQ-C) was created following the guidelines for cross-cultural adaptation. Compliant with the COSMIN methodology, baseline data (N = 13,325) examined three validity domains and internal consistency, including content validity using the content validity index (CVI) and the cognitive debriefing and focus group (relevance, comprehensiveness and comprehensibility), construct validity using structural validity and cross­sectional measurement invariance, and criterion validity using concurrent/convergent validity. Follow-up data (N = 3410) gathered within a mean of 168 (167-207) h interval were used to additionally assess longitudinal measurement invariance and test-retest reliability using intraclass correlation coefficient (ICC). RESULTS: Scale-level CVI/Average was equal to 0.922; Item-level CVIs ranged from 0.889 to 1.000 (excellent), except for item 2 (0.556-fair). A panel of local experts and local participants during cognitive debriefing and focus group stated that it had sufficient relevance and comprehensibility but a slight deficiency in comprehensiveness. Confirmatory factor analysis indicated a stable two-factor structure encompassing Daytime Sleepiness Subscale and Sleep Difficulty Subscale from baseline to follow-up data. The SQQ-C-9 (without item 2) outperformed the SQQ-C-10 (full form). The SQQ-C-9 provided evidence of measurement invariance (strict) across subgroups (cohorts, gender, and age) and across time. The SQQ-C was negatively correlated with the Chinese Nonrestorative Sleep Scale and the Chinese Sleep Condition Indicator. Cronbach's alpha (α), McDonald's Omega (ω), and ICC, respectively, ranged from 0.712 to 0.838, 0.723 to 0.840, and 0.738 to 0.764 for total scale and each subscale. CONCLUSION: The SQQ-C exhibits adequate psychometric properties and a stable two-factor structure, and should enable valuable assessments of sleep quality in clinical and research settings.

Pathological Analysis of Medial and Intimal Calcification in Lower Extremity Artery Disease: Impact of Hemodialysis.

Background: The prevalence and degree of lower extremity artery disease in hemodialysis (HD) patients is higher than in the general population. However, the pathological features have not yet been evaluated. Objectives: The aim of the study was: 1) to compare lesion characteristics of lower extremity artery disease in HD vs non-HD patients; and 2) to determine factors associated with severe medial calcification. Methods: Seventy-seven lower limb arteries were assessed from 36 patients (median age 77 years; 23 men; 21 HD and 15 non-HD) who underwent autopsy or lower limb amputation. Arteries were serially cut at 3- to 4-mm intervals creating 2,319 histological sections. Morphometric analysis and calcification measurements were performed using ZEN software. Calcification with a circumferential angle (arc) ≥180° was defined as severe calcification. Multivariable logistic regression was used to identify risk factors for severe medial calcification. Results: The degree of the medial calcification arc was significantly higher in the HD group compared to the non-HD group (P < 0.0001). In the multivariable analysis, HD was associated with severe medial calcification in below-the-knee lesions (OR: 17.1; P = 0.02). The degree of intimal calcification in above-the-knee lesions was also significantly higher in HD patients with a higher prevalence of advanced atherosclerotic plaque (P = 0.02). The prevalence of severe bone formation was more common in the HD patients (P = 0.01). Conclusions: Hemodialysis patients demonstrated a higher degree of medial and intimal calcification compared with non-HD patients. The difference was more prominent in the medial calcification of below-the-knee lesions.

Carotid Artery Revascularization Improves Cardiac Sympathetic Nerve Activity in Patients With Carotid Artery Stenosis.

Background: The carotid sinus baroreceptor reflex controls the neural regulation of blood pressure. Baroreceptor disorders due to carotid sinus atherosclerosis have detrimental cardiovascular effects. This study investigated the medium-term effects of carotid artery revascularization (CAR) on sympathetic and cardiac function and systemic blood pressure variability in patients with carotid artery stenosis. Methods: This study included 21 consecutive patients (median age 70 years, 18 men) with carotid artery stenosis scheduled for CAR. 123I metaiodobenzylguanidine (MIBG) scintigraphy, echocardiography, brain natriuretic peptide levels, 24-h Holter electrocardiography (ECG), and ambulatory blood pressure monitoring assessed approximately 3 months postoperatively were compared to preoperative data. Results: All 21 enrolled patients underwent CAR. Carotid artery stenting was done in three patients with cardiovascular risk or anatomical difficult for carotid endarterectomy. The mean common carotid artery end-diastolic velocity improved significantly (P < 0.01) by 1.6-fold, from 10.8 ± 3.2 to 16.1 ± 7.1 cm/s. In 123I-MIBG scintigraphy, the heart-to-mediastinum (H/M) count ratio was significantly higher than preoperatively (from 2.66 ± 0.48 to 2.86 ± 0.56, P = 0.03). Holter ECG analysis revealed a significant decrease in the low-frequency/high-frequency (LF/HF) ratio compared to preoperatively (from 2.17 ± 1.20 to 1.62 ± 0.68, P = 0.04). These findings suggest decreased myocardial sympathetic activation. In echocardiography, the tissue Doppler-derived e' increased, and E/e' decreased significantly (P < 0.05) from 11.7 ± 5.1 to 10.1 ± 4.0, suggesting an improved left ventricular diastolic capacity. The mean 24-h and nighttime blood pressures were unchanged. Conclusions: CAR in patients with carotid stenosis may provide medium-term improvement in cardiac sympathetic nerve activity and left ventricular diastolic dysfunction.

Moderating effect of coping flexibility over waiting patiently as a coping strategy for interpersonal stressors and depressive symptoms.

Objective: The present study examined the moderating effect of coping flexibility on the association between the coping waiting patiently for interpersonal stressors and depression. Coping flexibility refers to devising and implementing suitable coping strategies according to the situation, coping was defined in this study as holding oneself back and not acting prematurely to address a stressful relationship. Participants: A total of 481 Japanese college students. Methods: Participants completed questionnaires to measure coping, coping flexibility, perceived stress, and depression using a longitudinal design. Results: Multiple regression analysis showed that an interaction between coping and coping flexibility was associated with depression. This result indicated that higher levels of coping was associated with lower depression 16 weeks later when coping flexibility was higher, but the association was not observed when coping flexibility was lower. Conclusions: Our findings contribute to elucidating the condition or process whereby the strategy of waiting patiently as a coping mechanism for interpersonal stressor reduces depression.

Effect of Relationship Status on Response Times to Sexual and Romantic Stimuli Among Japanese Undergraduates in a Memory Task.

This study examined the effects of relationship status on response times to sexual and romantic stimuli during a memory task, which has not been studied before. Based on previous studies on sexual attitudes and behaviors, we hypothesized that response times to sexual stimuli would be faster in individuals who were in a relationship, compared to those who were not. We also hypothesized that the response times to sexual stimuli of individuals who were not in a relationship would be slower than their response time to romantic stimuli. A total of 348 college students memorized 27 sexual, romantic, and neutral sentences and were later asked to recognize them. The students' response times to each sentence were recorded. The results of a 2 (gender) × 2 (stimulus type) × 2 (relationship status) ANOVA showed that response times to sexual sentences were faster in participants who were in a relationship, compared to those who were not. Furthermore, participants who were not in a relationship responded more slowly to sexual than to romantic sentences. Thus, our hypotheses were supported. Individuals' relationship status influenced their response times to sexual and romantic stimuli even after controlling for the effects of gender.

Moderation Effects of Coping Flexibility on the Association Between Depressive Symptoms and Suicidal Risk.

Background: This study focused on poor coping flexibility, which involves the perseveration of a failed coping strategy, as a moderator of the association between depression and suicidal risk; no study has previously examined the association between coping flexibility and suicidal risk. Aims: This study examined whether individuals with lower coping flexibility would have a stronger suicidal risk when experiencing depression above a certain level. Method: Participants, who were 682 college students, answered questionnaires regarding coping flexibility, depressive symptoms, and suicidal risk. Results: Hierarchical multiple regression analyses showed that in individuals with greater depressive symptoms, lower coping flexibility was associated with higher suicidal risk, but this was not the case in individuals without depressive symptoms. Our hypothesis was supported. Limitations: Our findings cannot indicate the causal direction of the association between coping flexibility and depressive symptoms and suicidal risk. Conclusion: Our findings may be useful in understanding the association between depression and suicidal risk through coping flexibility and contribute to reductions in suicidal risk, as coping flexibility can be improved through training.

Coping with Stress, Executive Functions, and Depressive Symptoms: Focusing on Flexible Responses to Stress.

Coping flexibility is conceptually similar to both inhibition and set-shifting. Though they serve different functions, all three are robustly associated with depression. Coping flexibility is the ability to relinquish a coping strategy regarded as ineffective and to devise and implement an alternative one; the concept is based on stress and coping theory. Inhibition is the ability to suppress responses selectively according to a change in the situation, while set-shifting is the process of switching flexibly between task sets, mental sets, or response rules. Inhibition and set-shifting are both executive functions in cognitive mechanisms. We hypothesized that coping flexibility was associated with a lower risk of depression, even when the effects of inhibition and set-shifting were controlled for. In total, 200 Japanese university students (100 women and 100 men) completed questionnaires that measured coping flexibility and depression and performed the Stroop Color and Word Test and the Wisconsin Card Sorting Test, which measured inhibition and set-shifting. We found that greater coping flexibility was associated with a lower risk of depression, even when the effects of inhibition and set-shifting were controlled for. Our findings suggest that, although coping flexibility is conceptually similar to inhibition and set-shifting, its association with depression differs from theirs.

Measurement Invariance in the Center for Epidemiologic Studies-Depression (CES-D) Scale among English-Speaking Whites and Asians.

The Center for Epidemiologic Studies Depression (CES-D) Scale has been widely used to measure depressive symptoms. This study compared the measurement invariances for one-, two-, three-, and four-factor models of the CES-D across English-speaking Whites and Asians: White Americans, White Australians, Indians, Filipinos, and Singaporeans. White Americans and Australians, Indians, Filipinos, and Singaporeans English speakers (782 men and 824 women) whose ages ranged from 20 to 79 years, completed the CES-D. They were recruited from the data pool of the 2013 and 2014 Coping and Health Survey. Confirmatory factor analyses indicated that the original four-factor model showed the best fit, compared to the other models. Mean and covariance structure analyses showed that the factor means of the CES-D subscales among Whites were significantly lower than were those among Asians; the score gap was particularly high between Whites and Indians. Additionally, Indians scored the highest on all subscales of the CES-D compared to all other countries. Overall, CES-D scores among Whites were lower than those among Asians.

Effects of Coping Flexibility in Young Women on Depressive Symptoms during Chronic Pain.

Chronic pain is a worldwide problem that has a high prevalence rate and is often comorbid with depression. Coping flexibility, which is defined as the ability to discontinue an ineffective coping strategy-evaluation coping-and to produce and implement an alternative strategy-adaptive coping-has attracted much interest as an important factor that attenuates pain-induced stress responses, including depression. This study hypothesized that greater coping flexibility would be associated with lower depression in both women with chronic pain and those with menstrual pain. The participants included women with chronic pain (n = 292) and those with menstrual pain (n = 181) who completed questionnaires on pain intensity, pain acceptance, psychological inflexibility, and coping flexibility for chronic pain. The hierarchical multiple regressions revealed that both evaluation coping and adaptive coping predicted depression even after controlling for the effects of pain intensity, pain acceptance, and psychological inflexibility, which are well-known for their association with depression in patients with chronic pain. The hypothesis was supported in our samples. Our findings may contribute to the development of self-management without self-medication using over-the-counter analgesics by acquiring coping flexibility for chronic pain.

Effects of waiting patiently as coping strategy for an interpersonal stressor on depressive symptoms.

Background: Coping behavior is known to moderate the effect of stressors on depressive symptoms. Increased reassessing coping, that is, waiting patiently for an appropriate opportunity to handle a stressful relationship, as coping strategy for interpersonal stressors is associated with lower depressive symptoms. Objectives: We hypothesized that higher reassessing coping would be associated with lower depressive symptoms in individuals with higher coping flexibility. Coping flexibility is the ability to discontinue a coping strategy that produces undesirable outcomes by monitoring and evaluating stressful situations and the effects of coping strategies. Methods: Two studies involving approximately 1,800 college students were conducted, one using a cross-sectional design (n = 281) and another a longitudinal design (n = 1,468). Results: In both studies, hierarchical multiple regression analyses showed that the interaction between reassessing coping and coping flexibility scores was predictive of a significant depressive symptom score. This indicates that higher levels of reassessing coping are associated with lower levels of depressive symptoms when coping flexibility is higher, whereas reassessing coping is not associated with depressive symptoms when coping flexibility is lower. Conclusions: These results were consistent with our hypothesis in both studies.

Examination of the Coping Flexibility Hypothesis Using the Coping Flexibility Scale-Revised.

Coping flexibility, as defined by the dual-process theory, refers to one's ability to relinquish a coping strategy recognized as ineffective-abandonment-and to devise and implement an alternative and more effective strategy-re-coping. The coping flexibility hypothesis (CFH) dictates that richer coping flexibility produces more adaptive outcomes caused by stress responses, such as reduced psychological and physical dysfunction. We tested the reliability and validity of the Coping Flexibility Scale-Revised (CFS-R) and the CFH using the CFS-R, which was developed to measure coping flexibility. In total, we performed three studies involving 6,752 participants. Study 1 provided the psychometric properties of the CFS-R and tested this factorial structure by a confirmatory factor analysis. Study 2 estimated the validity of the CFS-R by examining the associations between its three subscales and variables that were conceptually similar to them. Study 3 tested the CFH using a longitudinal design after controlling for the effects of typical coping strategies and other types of coping flexibility. Overall, the CFH was supported by the use of the CFS-R, and the findings in Studies 2 and 3 showed that it had acceptable validity and reliability. Our findings implied that abandonment and re-coping can predict reduced depressive symptoms more than other types of theoretical framings for coping flexibility. Additionally, a meta-analysis of the Cronbach's alphas for all samples in this study (k = 9, N = 6,752) showed that they were 0.87 (95% CI [0.87, 0.88]) for abandonment, 0.92 (95% CI [0.91, 0.92]) for re-coping, and 0.86 (95% CI [0.85, 0.87]) for meta-coping.

Effect of Psychological Inflexibility on Depressive Symptoms and Sleep Disturbance among Japanese Young Women with Chronic Pain.

BACKGROUND: Psychological inflexibility based on an acceptance and commitment therapy model is theoretically well-established as a process to exacerbate psychological distress, such as depressive symptoms and sleep disturbance. This study aimed to examine the associations of psychological inflexibility with depressive symptoms and sleep distribution. We hypothesized that psychological inflexibility would be associated with higher levels of depressive symptoms and sleep disturbance in women with chronic pain. METHODS: Female college students in Japan answered a questionnaire on pain status, treatment, and psychological inflexibility as measured by the Acceptance and Action Questionnaire-Ⅱ before answering questionnaires on depressive symptoms and sleep disturbance eight months after. RESULTS: Women with chronic pain (n = 320) reported more severe depressive symptoms and sleep disturbances compared to women without chronic pain (n = 90). Hierarchical multiple regressions revealed that psychological inflexibility predicted higher levels of depressive symptoms and sleep disturbance, independent of the pain intensity, whether they consulted a doctor or used pain medication. CONCLUSION: Based on our findings self-management interventions aimed at reducing psychological inflexibility should be developed for individuals who are experiencing chronic pain.

Effects of coping flexibility on cardiovascular reactivity to task difficulty.

OBJECTIVE: Coping flexibility refers to an individual's ability to effectively modify his or her coping behavior to better fit the nature of each stressful situation they encounter. More flexible coping is believed to produce more adaptive psychological functioning and physical health. METHODS: We examined the relationship between coping flexibility and cardiovascular reactivity (CVR) to psychological stress. Challenging tasks of two difficulty levels were presented to 24 men and 24 women aged 18 to 24years. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure were measured. RESULTS: Change scores (from baseline to reactivity) for SBP and HR responses in the difficult task were higher than those in the easy task and were negatively correlated with coping flexibility during the difficult task but not the easy one. CONCLUSIONS: The findings suggest that more flexible coping is associated with reduced CVR to a difficult task.

Effects of Flexibility in Coping with Menstrual Pain on Depressive Symptoms.

Coping flexibility refers to the ability to discontinue an ineffective coping strategy and replace it with a more effective alternative. The coping flexibility hypothesis (CFH) predicts that more flexible coping will produce more adaptive outcomes. This study tested CFH validity among young Japanese women with menstrual pain. A total of 186 college students, who reported menstrual pain as being the most frequent pain they suffered over the past year, completed questionnaires related to coping flexibility and strategies for dealing with menstrual pain. Additionally, they reported on later depressive symptoms experienced during menstruation. A hierarchical multiple regression analysis showed that menstrual pain coping flexibility was significantly associated with reduced depressive symptoms during menstruation, even after controlling for the effects of menstrual pain intensity and coping strategies. Thus, the CFH was supported by the data obtained from menstrual pain sufferers in college.

Relationship between coping flexibility and the risk of depression in Indian adults.

According to the dual-process theory of coping flexibility, coping flexibility is the ability to discontinue an ineffective coping strategy and produce and implement an alternative coping strategy. In order to test the coping flexibility hypothesis, which posits that flexible coping produces adaptive outcomes, the relationship between coping flexibility and the risk of depression was examined in the context of Indian adults. Participants (150 men and 150 women) answered questionnaires measuring coping flexibility and depressive symptoms. The risk of depression was assessed using a Patient Health Questionnaire-9 score of 10 and a Center for Epidemiologic Studies' Depression Scale score of 16 as cut-off points. Logistic regression analyses of the score cut-off points revealed that higher levels of coping flexibility were associated with lower risks of depression, after controlling for the effects of gender, age, and marital status. Overall, the coping flexibility hypothesis was supported in this Indian adult sample. These findings might contribute to preventing recurrent depression and to attenuating depressive symptoms.