Depression is a common mental disorder and a leading cause of disability, affecting approximately 280 million people worldwide. Its pathological mechanisms are closely linked to neurotransmitter homeostasis imbalance and neuroplasticity impairment. We aimed to systematically evaluate the clinical efficacy of virtual reality (VR) training in improving depression and to elucidate its dual-pathway regulatory mechanism involving neurotransmitter-plasticity interactions.

We systematically searched PubMed, Web of Science, CNKI, and ScienceDirect databases from their formation to May 2025 to identify randomised controlled trials (RCTs) assessing VR-based interventions. Given the significant heterogeneity across protocols, we conducted a narrative synthesis in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guidelines rather than a quantitative meta-analysis. We assessed the quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale.

Based on 16 studies, we found that VR training can significantly alleviate depressive symptoms through multimodal sensory stimulation and immersive interactions, as the included RCTs generally reported reductions in depression scale scores. Preliminary evidence from several studies also suggests a positive correlation between clinical efficacy and biomarkers of neural structure recovery and functional network synchronisation. However, due to high heterogeneity in intervention protocols, control group designs, and outcome measures, we were unable to provide a unified estimate of the VR training efficacy.

Evidence suggests that VR training may reverse the pathological cycle of depression through a synergistic dual pathway of neurotransmitter regulation and neuroplasticity enhancement, offering a novel strategy for precision intervention. Future research should optimise VR intervention protocols, explore synergistic effects with traditional therapies, and validate its long-term efficacy and safety in special populations.

PROSPERO: CRD420261300373.

Cancer-related fatigue and reduced health-related quality of life (HRQOL) are common among lymphoma patients undergoing treatment. Exercise may be safe and feasible for individuals with hematological malignancies, with potential benefits in mitigating treatment-related toxicity and enhancing treatment tolerance. This systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on health-related outcomes such as HRQOL, muscle strength, cardiorespiratory fitness (CRF), fatigue, and body composition in this population.

Electronic databases (PubMed, Cochrane Register of Controlled Trials, SCOPUS, and Web of Science) were searched following PRISMA guidelines. This systematic review was registered on PROSPERO (CRD42024497531).

Five studies (N.=118, 68.6±9.04 years) were included. HRQOL components such as physical functioning (95% CI: 2.97, 26.41), body pain (95% CI: 6.26, 17.35), general health (95% CI: 3.20, 29.72), vitality (95% CI: 4.54, 27.09), emotional role functioning (95% CI: 1.43, 69.50), and mental health (95% CI: 14.73, 21.50) and lower limb strength measured by the 30-Second Chair Stand Test (95% CI: 1.11, 3.48) significantly (P<0.05) improved. No significant effects were found for fatigue, handgrip strength, knee extension strength, or cardiorespiratory fitness. The skeletal muscle index significantly decreased (95% CI: -0.5, -0.13; P<0.05), indicating ongoing muscle loss despite exercise interventions.

These findings support the safety and feasibility of exercise for patients with hematological cancers, showing moderate improvements in physical function and HRQOL. However, heterogeneity in study designs and small sample sizes limit the generalizability of the results.

Microglia, the resident immune cells of the central nervous system, exhibit substantial phenotypic and functional diversity shaped by local microenvironmental cues. While advanced in vitro human microglial models exist, the influence of culture dimensionality and cellular context on microglial state composition remains poorly defined. Here, we analyzed single-cell RNA sequencing datasets from human monocyte-derived microglia (MDMi) cultured under two-dimensional (2D) and three-dimensional (3D) monoculture, as well as 3D neural-glial co-culture conditions. Across platforms, four microglial states were identified, including interferon (IFN)-responsive, chemokine-enriched, metabolically active, and proliferative states, with pronounced environment-dependent transcriptional shifts. 2D cultures were dominated by IFN-responsive microglia characterized by elevated IFITM2 and IFITM3 expression, whereas 3D systems supported greater cellular diversity, including expanded metabolic programs and chemokine remodeling. Co-culture further increased proliferative microglia and induced immune-communication signatures involving CCL2/CCL5/CCL7, CSF1, and VEGF/FLT1 pathways. Pseudotime analysis revealed a largely linear trajectory in 2D cultures, but branching differentiation paths in 3D and co-culture systems, consistent with enhanced microglial heterogeneity. Benchmarking against human microglial reference signatures demonstrated broader and stronger overlap in 3D-based models, with homeostatic and disease-associated modules engaged in a context-specific manner. These findings demonstrate that culture architecture is a major determinant of microglial identity and immune responsiveness; and highlight the value of single-cell datasets to uncover previously underappreciated microglial states with relevance to human neuroimmune biology.

Plasma phosphorylated tau at threonine 217 (p-tau217) has shown excellent diagnostic performance for Alzheimer's disease (AD), yet real-world validation and implementation pathways remain limited. This study assessed its clinical applicability and proposed a practical workflow for memory clinics.

Plasma p-tau217, p-tau181, and neurofilament light chain (NfL) were quantified in consecutive patients referred for cognitive assessment. Cerebrospinal fluid (CSF) amyloid beta (Aβ) 42/40 defined amyloid (A) status, and final etiological diagnoses were reached through multidisciplinary consensus integrating clinical, neuropsychological, and metabolic imaging data.

Among 163 patients (mean age 69.3 ± 7.4 years, 52% female), plasma p-tau217 distinguished A+ from A- individuals (area under the curve [AUC] 0.90, 81% sensitivity, 91% specificity). AD patients showed the highest p-tau217 levels, while non-AD neurodegenerative disorders exhibited elevated NfL (p < 0.001). A dual cut-off strategy with 95% sensitivity and specificity could have avoided 65% of lumbar punctures.

Plasma p-tau217 demonstrated robust clinical validity and supports structured integration into routine diagnostic pathways.

Irregular sleep, frequently resulting from night shifts, is associated with various mental health issues. However, the specific associations among these factors remain unclear. This study aimed to investigate the associations of night shift frequency with depressive, anxiety, and comorbid depressive-anxiety symptoms and to estimate the indirect associations through sleep quality and sleep duration.

A cross-sectional study was conducted among nurses in seven hospitals in Zhejiang Province in 2023. A self-administered questionnaire was utilized to collect sociodemographic, work-related, lifestyle, and mental health information. Multivariable logistic regression models were used to examine the associations of night shift frequency, sleep duration, sleep quality, and mental health outcomes. Additionally, we used a mediation analysis to estimate indirect effects through sleep quality and sleep duration.

A total of 2037 nurses were included in the study. Compared to low-frequency night shifts, high-frequency night shifts were significantly associated with higher odds of depressive symptoms (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.20-1.77), anxiety symptoms (OR = 1.29, 95% CI = 1.06-1.58), and comorbid depressive-anxiety symptoms (OR = 1.34, 95% CI = 1.09-1.65). The statistical indirect association via sleep quality accounted for 19.5%, 25.9%, and 19.0% of the total association for depressive, anxiety, and comorbid depressive-anxiety symptoms, respectively. The indirect effect through sleep duration was not statistically significant.

In this cross-sectional study, a higher frequency of night shifts was significantly associated with poorer mental health outcomes among Chinese nurses, with sleep quality serving as a statistical mediator. These findings suggest that optimizing shift scheduling, enhancing institutional support for sleep recovery, and integrating sleep quality monitoring into occupational health policies may be effective strategies to promote nurse well-being. This study provides empirical evidence to inform nursing management practices and health workforce policy.

Personal recovery has been recognized as an important goal in patients with psychotic disorders. It is defined as a deeply personal, unique process of living a satisfying life even with the limitations caused by the illness. Neurocognitive impairments are a core feature of psychotic disorders and proven to be a key determinant of functional outcomes, such as daily- and social functioning, work and independent living. However, the relationship with personal recovery remains unclear. Few studies investigated the relationship, and the findings remains inconclusive. This study explores the relationship between neurocognition and personal recovery, both cross-sectionally and over a year time.

Data from baseline and T1 (one year later) was used from the UP's cohort; this is a longitudinal observational study (n = 366) of schizophrenia spectrum disorder patients. Personal recovery was assessed using the ReQOL and the Individual Recovery Outcomes Counter (I.ROC). Neurocognition was assessed using the BACS (composite score and subdomains). Linear mixed models were used to analyze the association between neurocognition and personal recovery over time.

Global neurocognition and neurocognitive domains (verbal memory, working memory, motor speed, verbal fluency, attention and executive function) were not associated with personal recovery at baseline and after a one-year period. The models controlling for age and sex explained only a small proportion of the variance, adding the PANSS-R significantly improved the explained variance. Additional analyses showed robust finding across different personal recovery measures using the I.ROC. Personal recovery improved with 6.9% between baseline and one year later: the ReQOL improved from 57.6% to 64.5%, the I.ROC improved from 43.9% to 50.8%.

Neurocognition did not predict personal recovery in this study. Patients with and without neurocognitive impairments showed similar levels of personal recovery at baseline and over a one-year time. This finding suggests that personal recovery can be accomplished in the presence of neurocognitive impairments and highlights the importance of addressing both domains independently. Psychotic symptoms are a stronger predictor of personal recovery than neurocognitive impairments. Future research is needed to investigate possible indirect relationships through metacognition.

Post-coronavirus disease 2019 (post-COVID-19) syndrome is associated with persistent impairments in physical fitness and altered body composition, particularly in older adults. The extracellular-to-total body water (ECW/TBW) ratio has been linked to poor outcomes in clinical populations. However, its association with cardiorespiratory fitness (CRF) and muscular fitness (MF) in older adults with post-COVID-19 syndrome remains unclear. This study aimed to examine the associations between ECW/TBW ratio, CRF, MF, and other variables in this population.

A cross-sectional study was conducted in 71 older adults with post-COVID-19 syndrome. Hydration status and body composition were assessed using bioelectrical impedance analysis (BIA). CRF was evaluated by cardiopulmonary exercise testing (CPET; peak oxygen uptake, VO₂peak), and MF was assessed using isokinetic and functional performance tests. Associations between ECW/TBW ratio, fitness outcomes, and other variables were analyzed through multi-variate linear regression models adjusted for age and sex. Results: Higher ECW/TBW ratio was significantly associated with lower VO₂peak (β = -0.010, p = 0.048) and greater comorbidity burden (β = 0.003, p = 0.002). No significant associations were observed between ECW/TBW ratio and MF variables (p > 0.05).

The ECW/TBW ratio is independently associated with comorbidity burden and CRF, but not with MF, in older adults with post-COVID-19 syndrome. The Charlson Comorbidity Index emerged as the strongest determinant of ECW/TBW ratio. These findings highlight the potential relevance of integrating hydration monitoring and CRF assessment into rehabilitation strategies, and support further investigation of their role in the clinical management of older adults with post-COVID-19 syndrome.

The rapid growth of digital mental health tools offers accessible support to a growing global population with mental health needs. However, concerns remain regarding their safety, efficacy, and overall quality, particularly for tools used outside formal healthcare settings. Limited regulation and non-specific quality frameworks exacerbate these issues, often overlooking key elements such as user experience and evidence-based practice.

This study aimed to develop a comprehensive and pragmatic quality assurance framework for digital mental health tools, tailored to the needs of UK stakeholders.

A sequential mixed-methods design informed the development of the framework. Participants included mental health service users, academic and clinical professionals, and digital health experts. Survey data (N = 309) were analysed descriptively to identify stakeholder priorities across three core domains: user experience, data, and evidence. These findings were enriched by qualitative data from focus groups (N = 101), analysed thematically using a deductive approach to refine and extend the framework.

Intuitive, accessible, user-centred design, strong data privacy and security measures, and robust evidence were identified as essential to quality assessment. These findings informed the development of MTAQ, which includes key domains and a structured process for evaluating tool quality.

The MTAQ framework is among the first quality assurance frameworks specifically designed for digital mental health tools. By integrating research evidence with lived experience, clinical, academic, technical, and commercial input, this offers a user-informed, practical standard to guide the development, assessment, and improvement of digital mental health technologies.

Depressed patients with comorbid metabolic disorders have poorer quality of life and prognosis. Pharmacological interventions carries risks of liver and kidney toxicity, which highlights the need for safer non-pharmacological alternatives. Experimental data suggest that light exposure modulates cortisol secretion, thereby influencing metabolic outcomes in depression. We hypothesized that bright light therapy may ameliorate metabolic disturbances by modulating cortisol secretion.

In this randomized controlled trial, hospitalized patients with depression were assigned to receive either bright light therapy (BLT) or dim-light control condition. The pre-specified primary endpoint was the change in fasting blood glucose (FBG) and cortisol rhythm indices from baseline to post-treatment. Secondary endpoints included changes in other glycolipid parameters, and scores on the Hamilton Depression (HAMD) and Anxiety (HAMA) scales. Treatment effects were evaluated using linear mixed-effects models with baseline adjustment.

After the 2-week intervention, the BLT group showed a significant reduction in fasting blood glucose (95% CI: 0.280 to 0.600; p < 0.001) and cortisol mesor (95% CI: -2.677 to -0.064; p = 0.040) compared to the control group. Within the BLT group, the change in FBG was positively associated with the change in cortisol mesor after adjusting for covariates (β = 0.053, 95% CI: 0.016 to 0.122, p = 0.036).

The findings of this study support a potential mechanism whereby BLT modulates cortisol rhythmicity, which in turn may contribute to improved glycemic control, pointing to its potential therapeutic benefit for addressing metabolic disturbances in depression.

https://www.chictr.org.cn/bin/project/edit?pid=260569, identifier ChiCTR2500097364.

This study aimed to examine the prevalence and temporal trends of SUDs among psychiatric inpatients, investigate the factors predicting involuntary hospitalization, and assess the impact of SUDs and involuntary admission on pharmacological treatment practices.

A retrospective cross-sectional analysis was conducted using medical records of all psychiatric inpatients (n = 5,887) admitted to the general psychiatric wards of a regional training and research hospital between 2019 and 2023. Descriptive statistics, logistic regression, linear regression, and seemingly unrelated regression (SUR) analyses were employed to evaluate clinical predictors and treatment trends.

The prevalence of SUD was 27.5% (n = 1,619), with mixed substance use being the most common pattern (76.1%). In the logistic regression model, substance use, male sex, and later years of admission were associated with a higher likelihood of involuntary hospitalization, whereas bipolar affective disorder was associated with a lower likelihood. Treatment trends showed an overall increase in atypical antipsychotics, depot antipsychotics, clozapine, and electroconvulsive therapy (ECT); compared with non-users, patients with SUD showed lower use of typical antipsychotics, mood stabilizers, clozapine, and ECT.

This large-scale study demonstrates that SUDs are a strong predictor of involuntary psychiatric hospitalization and significantly influence pharmacological treatment patterns. The increasing trend of compulsory admissions, particularly among male patients with SUD, underscores the urgent need for clearer legal and ethical frameworks, as well as the expansion of community-based mental health services in Türkiye.