Despite the established clinical effectiveness of electroconvulsive therapy (ECT) in the treatment of bipolar depression, its acceptance is limited by concerns over cognitive adverse effects. Magnetic seizure therapy (MST) has shown promise in treating patients with depression, with fewer cognitive adverse effects. The aim of this pilot study was to assess the clinical efficacy and cognitive adverse effects of MST compared to right unilateral ultrabrief-pulse (RUL-UB) ECT in patients with bipolar depression.

In this double-blind, randomized, parallel-group pilot clinical trial, participants with bipolar depression received either RUL-UB ECT or MST until they achieved remission, dropped out, or received a maximum of 21 treatments. The primary outcomes were 1) clinical remission as assessed with the 24-item Hamilton Rating Scale for Depression and 2) cognitive adverse effects as assessed with the Autobiographical Memory Test (AMT).

Of 55 participants who were randomized, 45 received an adequate trial of treatment, of whom 6/20 (30%) in the ECT group and 5/25 (20%) in the MST group achieved remission. Clinically important worsening in autobiographical memory (≥25% decline in AMT score) occurred in 6/27 (22.2%) participants in the ECT group and 2/28 (7.1%) in the MST group. Secondary clinical outcomes were similar in both groups.

This pilot study demonstrated similar effects on depression symptoms between MST and ECT. MST appeared to have resulted in less worsening of autobiographical memory and was better tolerated, suggesting that it may be a safe clinical application to treat bipolar depression. Given the relatively small sample size of this pilot study, these findings should be considered preliminary.

This study assessed associations of motivation factors and precursor health behaviors with weight loss in the CoachToFit program for adults with mental illness.

This is a secondary analysis of a randomized trial comparing CoachToFit and usual care over 6 months at a Veterans Affairs medical center. Inclusion criteria were body mass index ≥30 kg/m² and diagnosis of major depressive disorder, bipolar disorder, or schizophrenia. Exclusion criteria were history of bariatric surgery or recent psychiatric hospitalization. The sample (N=256) had a mean±SD age of 53.5±13.0 years; 176 (69%) were male, 178 (70%) were White, and 199 (78%) were diagnosed as having major depressive disorder. Participants were assessed at baseline and at 6 months (postintervention) on weight, motivation factors (efficacy for healthy eating and exercise, confidence to improve health, importance assigned to weight loss, and stage of change for weight control), and precursor health behaviors (daily cups of sugary drinks consumed and physical activity days per week and minutes per day). The study assessed the relationships between study group and multiple motivation factors and precursor health behaviors and associations between weight loss and change over time on those factors.

Compared with usual care, CoachToFit significantly improved efficacy for eating healthily, exercising, and making healthy changes. CoachToFit (vs. usual-care) participants reported nearly 1 additional day of physical activity per week and had nearly twice the odds of being in a higher category of exercise minutes.

Physical activity and confidence for health improvement are important factors for weight loss programs among adults with mental illness.

Despite findings that acute exercises can regulate emotions, more specific research is needed to distinguish more efficient exercise types. This paper examines the effects and differences of three acute moderate exercise types on emotion regulation after a social stress event.

A total of 72 college students were randomly assigned into 4 groups: single aerobic group (Gsa), paired aerobic group (Gpa), dynamic stretching group (Gds), and sitting group (Gs) as a control group. Each participant in groups experienced a Trier Social Stress Test (TSST) for social stress induction and a 15-min group intervention. The participants' states on emotions were measured 3 times by the Profile of Mood State (POMS), and their variations were statistically analyzed.

(1) The scores of Stress, POMS Tension and Vigour significantly reduced in all 4 groups. (2) The scores of POMS Anger significantly increased in both Gsa and Gpa, and the score of Total Mood Disturbance (TMD) significantly increased only in the Gpa. (3) The scores of POMS Depression, Confusion and TMD significantly reduced in the Gds, specifically in which POMS Depression reduced more than Gsa or Gpa, and TMD reduced more than Gpa.

The three acute moderate exercise types exhibited no advantage on alleviating the stress and tension of college students after social stress event, whereas the acute dynamic stretching exercise shew better effects on regulating negative emotions, especially on depression than the aerobic exercise.

•High overall openness: Most respondents reported moderate to high willingness to use game-based interventions to improve emotion regulation, mental health, and well-being across diverse countries.•Two distinct user profiles identified: Cluster analysis revealed a high willingness group (43%) and a moderate willingness group (57%), highlighting meaningful heterogeneity in receptivity.•Key predictors of high willingness: Younger age (18-25), male gender, frequent gaming, gaming disorder symptoms, and specific emotion regulation difficulties significantly increased likelihood of high willingness.•Factors associated with lower willingness: Higher impulsivity (low perseverance, high sensation seeking) and emotional unawareness or limited use of regulation strategies were linked to reduced openness.•One of the key findings: Participants showed lower willingness to use game-based interventions preventively than reactively.

This study examined the longitudinal relationship between pain intensity and depressive symptoms among older adults and assessed the buffering effects of social and physical activities. In addition, it explored whether these buffering effects vary by gender and educational attainment.

Using 8 waves (2006-2020) of the Korean Longitudinal Study of Aging, we analyzed a sample of 7,238 older adults aged 65 years and older. Longitudinal fixed-effects models were employed to assess how within-person changes in pain intensity were associated with within-person changes in depressive symptoms. Interaction terms were included to test the buffering effects of informal and formal social activity, as well as physical activity. Stratified analyses were conducted to explore potential heterogeneity by educational attainment and gender.

The fixed-effects models indicated that increases in pain intensity were significantly associated with higher levels of depressive symptoms. Interaction analyses revealed that this positive association was moderated by informal social activity, formal social activity, and physical activity. Specifically, older adults with higher levels of social or physical activity exhibited a weaker association between pain and depressive symptoms than those with lower levels of engagement. No clear differences in moderating effects were observed by education or gender.

These findings highlight that social and physical activities act as key protective factors against the adverse psychological consequences of pain among older adults. Integrative interventions that promote sustained social engagement and physical activity may help mitigate depression risk in this population.

Hypothalamic arginine vasopressin (AVP) and oxytocin (OXT) magnocellular neurons (MCNs), share a developmental lineage. The transcription factors driving specification are yet unknown. Using gene regulatory network analysis on published single-cell RNA-sequencing data of the developing mouse hypothalamus, we identified RORA, EBF3, FOXP1, FOXP2, and BCL11B as candidate transcription factors for differential MCN specification. We modeled developmental gene expression dynamics using computational cell fate mapping, revealing enrichment of EBF3 and BCL11B in the Avp lineage, and FOXP1 and FOXP2 in the Oxt lineage. In silico analysis of Avp and Oxt promoters predicted a binding site for FOXP1 and FOXP2, and an in vitro reporter assay identified regulation on both Avp and Oxt genomic promoters. Finally, heterozygous FOXP1 knockout mice exhibited a significant reduction in AVP and OXT neuron abundance, with OXT neurons disproportionally affected. We conclude that FOXP1 participates in MCN development, while being differentially active in OXT MCNs relative to AVP MCNs.

Metformin is widely used for diabetes, but its effects on bone health are uncertain. This meta-analysis study found that it reduces markers of both bone loss and bone formation. It is still unclear whether this benefits or harms bones long term, highlighting the need for larger, longer clinical studies.

Metformin is a widely used antidiabetic drug that has shown potential effects on bone metabolism. However, its impact on bone turnover markers remains unclear. This systematic review and meta-analysis aimed to assess this effect.

A comprehensive search was conducted across PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases, identifying clinical trials published up to February 04, 2026, that evaluated the effects of metformin on validated bone turnover markers. The quality and risk of bias were assessed using the Modified Jadad Scale, and Cochrane Collaboration's risk of bias tool, respectively. A random-effects meta-analysis was performed to estimate the standardized mean difference (SMD) with a 95% confidence interval.

Fourteen studies met the inclusion criteria, involving diabetic and non-diabetic populations. Metformin significantly reduced both bone resorption, bone formation markers (SMD: -1.28 [95% CI: -2.03, -0.52], I² = 99.33%), and (-0.18 [-0.28, -0.08], I² = 67.78%), respectively. These findings suggest a pattern consistent with reduced bone turnover rather than selective modulation of either bone resorption or bone formation. However, substantial statistical heterogeneity was observed across studies, especially for bone resorption markers, limiting the precision and generalizability of pooled estimates.

Metformin appears to lower overall bone turnover, reducing both bone resorption and bone formation markers. However, given the high heterogeneity across studies and the reliance on surrogate biochemical endpoints rather than fracture or bone mineral density outcomes, the clinical significance of these findings remains uncertain. Larger, long-term trials are needed to determine whether metformin provides real benefits or risks for osteoporosis.

Rheumatic heart disease (RHD) remains a leading cause of acquired cardiovascular disease in children and adolescents globally, despite dramatic declines in high-income settings. This review synthesises contemporary evidence on the epidemiology, pathogenesis, natural history and diagnosis of rheumatic fever (RF) and RHD in young populations, with a focus on regions with high disease burden.Over recent decades, improvements in socio-economic conditions and access to healthcare have led to marked reductions in RF and RHD across much of Europe, North America and parts of Asia. In contrast, the disease persists at high prevalence in sub-Saharan Africa, South Asia, the Pacific Islands and among Indigenous and marginalised populations within high-income countries. In these settings, RF often occurs at younger ages, disease progression is accelerated and access to timely diagnosis and care is limited, resulting in substantial morbidity and premature mortality.Pathogenetic models continue to support immune-mediated valvular injury following Group A streptococcal infection, with increasing evidence that both pharyngeal and skin infections contribute to disease initiation. However, determinants of individual susceptibility and the mechanisms underlying progression from infection to chronic valvular damage remain incompletely understood. Importantly, recent observational and trial data challenge the traditional linear paradigm in which clinically apparent RF precedes RHD, demonstrating that many children develop early valvular disease without recognised RF episodes.Echocardiography has transformed the diagnosis of RHD, revealing a substantial burden of clinically silent disease and enabling earlier identification along the disease spectrum. Updated World Heart Federation echocardiographic criteria and recent WHO guidelines now support screening in high-risk populations and a staged approach to disease classification. Evidence that secondary antibiotic prophylaxis can prevent progression of early RHD reinforces the importance of early detection.Together, these advances reframe RHD as a preventable chronic disease with a detectable early phase, providing a strong foundation for effective prevention, timely diagnosis and improved outcomes in children and adolescents living in endemic regions.

Tobacco use is a major contributor to the burden of chronic obstructive pulmonary disease (COPD) and other non-communicable diseases in China. People at high risk for COPD who smoke, particularly those with pre-existing chronic conditions, often remain underserved by conventional smoking cessation programmes. Population medicine offers a promising framework for proactively identifying high-burden diseases, managing multimorbidity and prioritising interventions for vulnerable populations.

This protocol describes a stratified, two-arm cluster randomised controlled trial (Population Medicine Multimorbidity Intervention in Xishui County-Smoking) being conducted in Xishui County, a rural area of Guizhou Province, China. A total of 26 townships were stratified by population size and randomly assigned in a 1:1 ratio to receive either a multicomponent intervention or usual care. Eligible participants were individuals aged 35 years or older who smoked and were at high risk for COPD as identified by the COPD Screening Questionnaire. The intervention package integrates multiple components, including a digital smoking cessation programme, digital mental health support, community-based spirometry, tailored chronic disease management, health education and a performance-linked 'pay-for-population' scheme that aligns healthcare worker reimbursement with population health outcomes. Primary outcomes are smoking amount and nicotine dependence and secondary outcomes include COPD-related health outcomes, hypertension, diabetes, health risk behaviours, quality of life, healthcare utilisation and productivity loss. Follow-up occurs at 3, 6 and 12 months.

Ethical approval has been granted by the Peking Union Medical College Ethics Committee (CAMS&PUMC-IEC-2024-042). Informed consent was obtained from all participants prior to enrolment. Results will be shared through peer-reviewed publication and (inter)national conference presentations.

NCT06458205.

This study aimed to investigate the associations between visceral obesity indices and the risk of mild cognitive impairment (MCI) in patients with diabetes and to identify the most valuable visceral obesity index to develop a risk assessment nomogram.

We explored the relationship between visceral obesity indices and MCI risk in patients with diabetes and developed a nomogram utilising a cohort of 1080 patients from Nanjing Drum Tower Hospital. MCI was diagnosed according to the criteria recommended by the National Institute on Aging-Alzheimer's Association Workgroup. Logistic regression models were used to identify factors independently associated with MCI in the cohort. Furthermore, the nomogram was externally validated by a multicenter retrospective cohort (Cohort 2) and a prospective cohort with a follow-up period of up to 10 years (Cohort 3).

We identified a positive but non-linear dose-response relationship between visceral obesity indices and the risk of MCI in patients with diabetes. Compared with a body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP) and Chinese visceral adiposity index (CVAI), body roundness index (BRI) exhibited superior discriminative ability (AUC: 0.734, 95% CI: 0.703-0.764). The nomogram constructed from BRI, age, education and haemoglobin A1c (HbA1c) achieved an optimal AUC of 0.804 (95% CI: 0.777-0.830) in the internal validation cohort. The model exhibited consistent performance across external validations, yielding a discriminative AUC of 0.756 (95% CI: 0.722-0.790) in Cohort 2 and a 10-year predictive AUC of 0.762 (95% CI: 0.727-0.797) in Cohort 3.

Higher visceral obesity indices were associated with an increased risk of MCI in patients with diabetes. Assessment of visceral obesity may help identify patients with diabetes who are at a high risk of MCI.