Depression is a serious mental and psychological disorder, characterized by a high incidence rate, high disability rate and high recurrence rate. It is a major problem that urgently needs to be solved in the field of global public health. Circadian rhythms regulate various physiological and behavioral processes in the human body. Previous studies have shown that there is a close connection between circadian rhythmicity and depression. Factors such as shift work, jet lag, social jet lag, chronotypes, and light at night exposure are all related to the occurrence and development of depression. An in-depth exploration of the neural mechanisms related to circadian rhythms and depression can help us better understand the relationship between the two. At present, non-pharmacological intervention methods based on circadian rhythm regulation, such as light therapy, sleep deprivation and cognitive behavioral therapy for insomnia have demonstrated clinical value in improving depression. Future research can also focus on the in-depth application of wearable devices, explore diverse and precise intervention methods, conduct in-depth longitudinal studies, and use various brain imaging devices to explore neural mechanisms, etc. providing theoretical basis and practical directions for the early prevention, precise diagnosis and personalized treatment of depression.

Affective and non-affective psychoses exhibit heterogeneous clinical presentation, neurobiological underpinnings, and treatment response. This special issue integrates multimodal findings to examine overlapping and distinct neural substrates in the psychosis spectrum. In this context, longitudinal designs appear essential to observe the developmental trajectory of patients and advance real-world precision psychiatry. Interestingly, gray matter changes in psychotic patients point toward the possibility of differential developmental trajectories in insular subregions between affective and non-affective psychosis. Moreover, white matter abnormalities shared by schizophrenia and bipolar disorder, as revealed by diffusion tensor imaging studies, might indicate common neural mechanisms affecting cognitive and behavioral functions across both conditions. Beyond these neuroimaging findings, stratification approaches based on immune-inflammatory profiles may further characterize biologically distinct subgroups, with immune-neurobiological interactions potentially contributing to illness trajectories. Finally, machine learning techniques, integrating clinical and neuroimaging data in a multimodal approach, emerged as promising tools for predicting critical outcomes, such as suicide, enabling earlier and more targeted interventions. The evidence presented in this special issue underscores the complexity of psychotic disorders and the need for multimodal approaches. Future research will be essential to improve predictive tools and refine biomarker integration.

We reviewed longitudinal magnetic resonance imaging (MRI) studies exploring the brain development of children with attention-deficit/hyperactivity disorder (ADHD). Specifically, we conducted a systematic review of papers published until 9 September 2025 in English on pediatric patients with ADHD. After screening 3385 studies, 32 were selected for review. The age range at baseline for the participants in the review ranged from 4 to 18 years old. Children with ADHD exhibited delays in brain volume and cortical thickness compared to typically developing (TD) children, particularly at baseline, with these differences often persisting over time, with four key trends. First, children with ADHD showed smaller cerebral and cerebellar volumes, with no significant changes in their developmental trajectories. Second, there was a delayed peak in the cortical thickness, surface area, and gyrification observed in regions such as the prefrontal, temporal, and occipital gyri for children with ADHD. Third, the differences in brain volume and cortical thickness between ADHD and TD children diminished with age, particularly in the cerebellar white matter and caudate. Finally, ADHD children showed atypical growth patterns such as contraction of the ventral striatum surface area. A meta-analysis of longitudinal changes in total gray matter volume revealed no significant differences between children with ADHD and TD peers. Due to inconsistencies across studies and methodological challenges in integrating these findings, the results should be interpreted with caution. Selection bias is another concern. Multicenter studies with standardized protocols, long-term follow-ups, considering gender, comorbidities, and medication effects are required to enhance study replicability.

Menopause affects nearly one-third of women's lives and is associated with a wide range of physical and psychological symptoms-including sleep disturbances, mood fluctuations, and reduced quality of life-that represent a significant public health concern. While pharmacological treatments carry well-documented risks, evidence-based non-pharmacological interventions such as Mindfulness-Based Stress Reduction (MBSR) remain understudied in this population, particularly with respect to multiple psychosocial outcomes.

This study aimed to evaluate the effects of a Mindfulness-Based Stress Reduction (MBSR) program on quality of life, life satisfaction, sleep quality, and mental well-being among menopausal women.

A randomized controlled trial with a pretest-posttest control group design.

The study was conducted between February 28 and December 22, 2025, at a primary healthcare center in Türkiye. A total of 84 menopausal women were included (intervention: n = 43; control: n = 41). Data were collected using the Utian Quality of Life Scale, Riverside Life Satisfaction Scale, Pittsburgh Sleep Quality Index, and Warwick-Edinburgh Mental Well-Being Scale. The intervention group participated in an 8-week MBSR program, while the control group received no intervention. Data were analyzed using IBM SPSS Statistics (version 26.0).

Compared with the control group, participants in the MBSR group demonstrated significant improvements in quality of life, life satisfaction, and mental well-being, along with significant reductions in sleep disturbances (p < 0.001). Within-group analyses showed significant improvements across all outcomes in the intervention group (p < 0.001), whereas no significant changes were observed in the control group (p > 0.05).

The MBSR program was associated with improvements in psychosocial well-being and sleep quality among menopausal women. These findings suggest that MBSR may be a beneficial non-pharmacological approach for managing menopausal symptoms.

Labor migration constitutes a critical component of Sri Lanka's economic framework, yet it necessitates complex family reorganizations in which older grandparents frequently assume primary child-rearing responsibilities. This study investigates the lived experiences of these caregivers within transnational households, evaluating the nature of their caregiving roles, the impact on their physical and mental wellbeing, and the availability of support networks.

Utilizing a cross-sectional design, primary data were collected from 166 grandparents aged 60 and above from all nine provinces of Sri Lanka, using a non-probability purposive sampling approach and a standardized face-to-face questionnaire combining closed- and open-ended items. Data were analyzed using descriptive statistics, with open-ended responses examined through reflexive thematic analysis.

Caregivers often undertake the total substitution of parental duties, with care arrangements typically spanning 1 to 5 years. While a portion of respondents expressed emotional fulfillment and a sense of cultural duty, the study uncovers a prevalent burden of stress and physical deterioration. Nearly half of participants reported high to very high stress levels, compounded by a significant incidence of chronic non-communicable diseases, such as hypertension and diabetes, which disproportionately affect female caregivers. Over a quarter of caregivers reported receiving no assistance, relying entirely on their own resilience or limited informal networks.

Grandparental care appears to function as an important mechanism sustaining the flow of remittances and national economic stability, but it exerts a severe, often invisible toll on the older population. Recommendations emphasize the urgent need for policy interventions, including integrated geriatric healthcare, community-based psychosocial support, and targeted financial assistance to safeguard the wellbeing of these essential caregivers.

Metabolic disorders, including obesity, type 2 diabetes, metabolic dysfunction-associated fatty liver disease (MAFLD), anemia, and insulin resistance, are increasingly prevalent and represent a major contributor to cardiovascular morbidity and mortality. Emerging evidence indicates that these conditions are associated with prolongation of the corrected QT (QTc) interval, a well-established marker of ventricular arrhythmias and sudden cardiac death. Individuals with metabolic disorders have a significantly higher risk of life-threatening arrhythmias, even in the absence of known cardiovascular disease. Insulin resistance, a central component of cardiometabolic dysfunction, has also been linked to QT interval prolongation. Despite this growing body of evidence, QTc monitoring is not currently included in routine clinical guidelines for the management of metabolic disorders. Electrocardiography (ECG) is a low-cost and widely accessible diagnostic tool that enables early identification of high-risk individuals and supports timely preventive interventions. Routine implementation of baseline and annual ECG-based QTc monitoring has the potential to reduce sudden cardiac death, improve cardiovascular risk stratification, and decrease healthcare costs associated with acute cardiac events. This policy brief advocates for the adoption of a national QTc monitoring strategy as a scalable and cost-effective approach to improving cardiovascular outcomes in patients with metabolic disorders.

Herpes simplex virus type 1 encephalitis is a neurologic emergency that can present with focal language deficits before the diagnosis becomes clinically apparent. We present an 82-year-old man with diabetes mellitus, hypertension, and hyperlipidemia who developed acute confusion and expressive aphasia after an emergency department visit the previous day for fever, chills, fatigue, sore throat, dizziness, and abdominal discomfort. On arrival for the aphasia presentation, the temperature was 100.3°F, and there were no motor or sensory deficits. Computed tomography of the head, computed tomography angiography of the head and neck, and computed tomography perfusion showed no hemorrhage, large vessel occlusion, or perfusion abnormality. Magnetic resonance imaging of the brain on day 2 showed a focal left temporal lobe abnormality with fluid-attenuated inversion recovery and gradient recalled echo signal change and slight restricted diffusion, without abnormal enhancement. Empiric intravenous acyclovir and broad-spectrum antibiotics were started after magnetic resonance imaging raised concern for encephalitis. Cerebrospinal fluid showed white blood cells 159 cells/µL, 100% lymphocytes, protein 218 mg/dL, glucose 63 mg/dL, and herpes simplex virus type 1 polymerase chain reaction positivity. Electroencephalogram showed diffuse slowing with independent bitemporal sharp waves, at times periodic, without electrographic seizures. His course was complicated by hypotonic hyponatremia, concerning for syndrome of inappropriate antidiuretic hormone secretion, although urine osmolality and urine sodium did not result. Herpes simplex virus type 1 encephalitis should be considered early in older adults with acute aphasia, confusion, recent febrile symptoms, negative vascular imaging, and temporal lobe magnetic resonance imaging abnormalities.

Immune checkpoint inhibitor (ICI) therapy for colorectal cancer (CRC) can be accompanied by endocrine adverse events, yet the comparative risk across commonly used regimens remains unclear. We therefore conducted a network meta-analysis of randomized controlled trials in CRC published up to November 22, 2025, estimating risk ratios (RRs) with 95% confidence intervals (CIs) and assessing risk of bias. Six RCTs were included. Relative to conventional therapy, ICI-based regimens were associated with a higher thyroid-related toxicity burden. Pembrolizumab and ICI+tyrosine kinase inhibitor (TKI) significantly increased the risk of hypothyroidism, whereas hyperthyroidism was significantly higher with ICI+TKI and ICI plus chemotherapy plus an anti-angiogenic antibody (ICI+Chem+Antiangio-Ab). Grade 1-2 adverse events were consistently increased across ICI-based treatments. For thyroiditis, diabetes mellitus, adrenal insufficiency, and grade 3-4 adverse events, effect estimates were imprecise with wide 95% CIs; nevertheless, SUCRA rankings tended to place ICI+TKI toward the higher-risk end for thyroiditis and diabetes. These findings indicate that ICI-containing strategies in CRC increase risks of endocrine adverse events-particularly for thyroid dysfunction-supporting the need for proactive endocrine monitoring and standardized management, while highlighting the limited precision of current evidence for rarer endpoints and severe toxicity.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42023469312, identifier CRD42023469312.

Diabetic foot (DF) represents a serious complication associated with type 2 diabetes mellitus (T2DM), characterized by elevated rates of morbidity and mortality, alongside substantial healthcare expenditures. Early detection and intervention are essential for enhancing patient prognosis. The objective of this research is to establish a nomogram model for predicting diabetic foot (DF) risk in type 2 diabetes (T2DM).

We conducted a retrospective analysis of 450 individuals with T2DM. Patients were divided into training and validation sets in a 7:3 ratio randomly. We utilized the least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression to determine independent risk factors. The performance of the nomogram was evaluated through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Six independent factors were incorporated into the nomogram: diabetic peripheral neuropathy (DPN), coronary heart disease (CHD), serum albumin (ALB) levels, high-density lipoprotein cholesterol levels (HDLC), fasting blood glucose levels (FBG), and the neutrophil percentage-to-hemoglobin ratio (NPHR). This model demonstrated impressive discrimination, achieving an area under the curve (AUC) of 0.945 (95% confidence interval (CI) [0.9226-0.968]) in the training cohort and 0.941 (95% CI [0.9021-0.9789]) in the validation cohort, while the calibration curves illustrated a positive alignment between predictions and the observed data. Additionally, the DCA revealed clinical benefits.

This nomogram enables individualized risk stratification, guiding clinicians to prioritize high-risk patients for preventive care, thereby reducing diabetes-related complications and optimizing resource utilization.

Evaluate the effectiveness and safety of adding metformin to insulin (M+I) versus insulin alone for pregnant women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM), focusing on stillbirth as the primary outcome.

PubMed, Embase, and Cochrane Central were searched. No date limits. Last search: January 2025.

Randomized clinical trials including women with T2DM or GDM were eligible. Trials restricted to type 1 diabetes were excluded.

Two reviewers extracted maternal and neonatal outcomes and assessed risk of bias with the Cochrane RoB 2 tool. Evidence certainty was graded using GRADE. Data were pooled with random-effects models and reported as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals.

Nine RCTs (2,420 women) were included, most with GDM and some with T2DM. Moderate-quality evidence indicated reduced stillbirth risk with M+I (6 RCTs, 2,196 participants; RR 0.36, 95% CI 0.14-0.90; NNT 111). Low-quality evidence suggested lower risks of gestational hypertension (4 RCTs; RR 0.68, 95% CI 0.48-0.97) and neonatal hypoglycemia (7 RCTs; RR 0.49, 95% CI 0.30-0.80). No significant differences were found for cesarean section, preterm delivery, or other neonatal outcomes. Heterogeneity, baseline imbalances, and small samples limited certainty.

M+I may reduce stillbirth and some adverse outcomes compared with insulin alone, but most evidence remains low certainty. Further high-quality RCTs are needed.Registered in PROSPERO: CRD42024617330.