Coronary microvascular dysfunction (CMD), a common endotype of angina with non-obstructed coronary arteries (ANOCA), is linked to poor cardiovascular outcomes, and can significantly impact quality of life, mental health, and functional capacity. CMD management strategies focus on symptom control with antianginal therapies, with limited effect and prognostic benefit. While lifestyle changes and risk factor modification are advocated by international guidelines, evidence supporting cardiac rehabilitation for CMD is sparse. It is proposed that MICROFIT-a personalized lifestyle intervention programme, utilizing exercise training and dietary counselling, underpinned by behavioural change techniques, can improve symptoms of angina in patients with CMD. This study aims to examine the feasibility of undertaking a multicenter randomized controlled trial (RCT) of the MICROFIT programme vs. usual care in patients with CMD and explore its effects on symptoms of angina.

Forty participants (aged >18) will be recruited from two centers and randomized 1:1 to receive either MICROFIT intervention plus usual care or usual care only. The primary outcome is feasibility, measured by recruitment and retention, and adherence to the intervention. Participants' and practitioners' experience of the programme will be explored qualitatively. The secondary outcome is change in angina symptoms, to inform the design and power calculations for a future RCT. Other exploratory outcomes include changes to functional capacity (VO_{2 peak}), cardiovascular MRI-derived markers of myocardial perfusion and coronary vascular function, and biomarkers of metabolic syndrome. A sub-study will explore experiences of the ANOCA diagnostic pathway from patient and healthcare professionals' perspective.

Ethics approval was granted by the NHS Health Research Authority Plymouth and Cornwall Research Ethics Committee (reference: 24/SW/0125, 30th October 2024). Study findings will be disseminated via presentations to relevant stakeholders, national and international conferences and open-access peer-reviewed research publications.Clinical Trial Registration: NCT06681896.

The objective of this systematic review was to analyze the effects of physical activity (PA) intervention as an adjuvant strategy to pharmacological treatment in people with treatment-resistant depression (TRD) and non-remitted depression (NRD).

A search strategy was conducted from five databases: PubMed, Cochrane Central Register of Controlled Trials, Scopus, SPORTDiscus, and Web of Science. The Physiotherapy Evidence Database and Oxford's Evidence Levels were used to classify the quality appraisal.

Of the 10777 records, 11 randomized controlled studies met the inclusion criteria. The main outcome for this analysis was the effect of physical activity (PA) or exercise on depressive symptoms in people with TRD and NRD diagnosis. According to the FITT (Frequency, Intensity, Time, and Type) principle, there was some variability in the PA intervention. However, except for one article, all were classified as excellent in terms of quality description.

This review highlights the potential of PA intervention as an adjuvant program to improve various traits in TRD and NRD. The remission of depression seems to be higher after PA intervention, showing improvements in quality of life, sleep quality, executive function, and vitality.

EEG-based neurofeedback (ENF) may be utilised as an intervention for improvement of motor performance in Parkinson's movement impairment. This exploratory study aimed to determine the ability of healthy participants to bidirectionally modulate sensorimotor beta power using ENF in real time and examine learning trends. The protocol trained participants to increase and decrease the amplitude of their individual beta power over C3 using a double-blind sham-controlled and within-subjects design. Fifteen healthy participants completed the study (mean age = 38.9, SD = 14.9, age range = 20-66; nine female and six male). Thirteen participants successfully decreased beta activity, three participants successfully increased it and two participants demonstrated bidirectional control. A Wilcoxon signed-rank test showed that successful EEG control during real ENF was significantly higher than sham ENF when participants received the sham condition first (Z = 3.80, p < 0.001). When participants received the real condition first, the difference in success was not statistically significant (Z = 1.19, p = 0.233), indicating a transfer learning effect from real to sham sessions. ENF performance varied across ENF training based on modulation direction and cognitive variables, including mental strategy, engagement and fatigue. This study showed that initial ENF performance depends critically on how performance is defined and measured. Learning trends between real and sham conditions further suggest that early ENF performance primarily reflects strategy-dependent, effort-based control rather than stable neurophysiological plasticity. These findings highlight the need for a more precise framework for ENF evaluation, one that separates transient modulation, strategic learning and durable physiological adaptation.

Preventive psychiatry requires longitudinal, transdiagnostic data from before adolescence, yet such data are scarce. We propose a nationwide, digital, open cohort in Japan to track mental health trajectories from birth to late adolescence using multi-informant assessments (caregivers and adolescents) within a transdiagnostic, biopsychosocial framework. Diagnosis-open recruitment will combine community-facing dissemination with clinically linked neurodevelopmental enrichment (e.g. autism spectrum disorder and attention-deficit/hyperactivity disorder), addressing underrepresentation of neurodivergent children and adolescents alongside neurotypical peers. An optional saliva sub-cohort will support genetic and epigenetic analyses. This design will characterize risk and protective factors and their developmental timing to inform stage-specific prevention and early intervention.

From February 2026, approximately 7,000 children and caregivers (up to ~14,000 individuals) will be recruited nationwide from community and clinical settings into a longitudinal online cohort. Eligible participants are caregivers aged ≥ 18 years of children and adolescents aged 0-18 years; adolescents aged 13-18 years will also complete self-reports. Enrollment and annual follow-ups will use a secure web platform integrated with LINE, a widely used communication app in Japan. Validated questionnaires will annually assess mental health and development: caregivers report on all children, and adolescents provide self-reports. The principal repeated transdiagnostic outcome is the caregiver-reported Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score across ages 2-18 years. Adolescent self-reported scores will be analyzed as complementary informant-specific secondary outcomes. Longitudinal mixed-effects models will examine developmental changes and associations with risk and protective factors, with exploratory genetic and epigenetic analyses.

This large longitudinal cohort will generate insights into child and adolescent mental health trajectories in Japan. Following participants from infancy through adolescence will help identify early risk and resilience indicators across traditional diagnoses. Integrating multi-informant surveys with genetic and epigenetic data will clarify how biological, psychological, and social factors interact over time. Nationwide digital recruitment aims to broaden geographic reach and reduce burden; representativeness will be empirically evaluated and findings interpreted cautiously. Results will inform the timing and targets of stage-specific preventive and early interventions in community and clinical settings.

Japan Registry of Clinical Trials (jRCT), jRCT1050250205. Registered on 26 January 2026.

Undergraduate medical sciences students experience substantial psychological distress due to demanding academic workloads and early clinical exposure, increasing their vulnerability to anxiety, depression, and burnout. This systematic review evaluates randomized controlled trials (RCTs) examining psychosocial interventions-including mindfulness-based programs, cognitive-behavioral strategies, acceptance-based therapies, and structured stress-management training-designed to enhance resilience among undergraduate medical sciences students.

A comprehensive search of PubMed, Scopus, ISI Web of Science, ProQuest, Google Scholar, and Semantic Scholar identified studies published between January 2000 and April 2025.

11 RCTs met inclusion criteria. Data extraction included participant characteristics, intervention type and duration, delivery format, and outcome measures. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated using the Cochrane RoB 2 tool.

Across the included trials, psychosocial interventions demonstrated consistent positive effects on resilience, perceived stress, coping flexibility, and psychological well-being. Mindfulness-based programs-ranging from brief sessions to full 8-week MBSR courses-generally reduced distress, though shorter or peer-led formats produced mixed results. Cognitive-behavioral and stress-management interventions improved coping skills, emotional regulation, and self-efficacy. Acceptance and Commitment Therapy enhanced psychological flexibility, and structured resilience curricula such as the Penn Resilience Program yielded significant gains in resilience scores. Variability in intervention design, duration, and measurement tools limited comparability across studies. Overall, psychosocial interventions appear effective in enhancing resilience among undergraduate medical sciences students. Integrating structured, theory-based approaches into medical education may strengthen students' psychological health and academic functioning. Future research should prioritize standardized protocols, culturally sensitive adaptations, and long-term follow-up.

Sleep quality is a multidimensional and inherently subjective construct that plays a fundamental role in physical and mental health. Numerous self-report instruments have been developed to assess subjective sleep quality; however, their cross-cultural validity must be established before use in different linguistic contexts.

The objective was to systematically identify the Arabic-validated sleep quality instruments and to critically evaluate their methodological quality and psychometric properties in accordance with COSMIN standards.

This systematic review was conducted following the PRISMA-COSMIN guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to December 2025. Studies reporting the translation, cross-cultural adaptation, or validation of sleep quality instruments in Arabic were included. Methodological quality was assessed using the COSMIN Risk of Bias checklist. Measurement properties were evaluated according to COSMIN criteria for good measurement properties.

Fifteen validation studies conducted across seven Arab countries and one general Arabic-speaking cohort were included. The Pittsburgh Sleep Quality Index was the most extensively validated instrument (n = 9 studies), demonstrating generally adequate structural validity but heterogeneous internal consistency results across populations. The Sleep Quality Scale (SQS) showed acceptable psychometric performance following structural adaptation. The Single-item SQS and the Jenkins Sleep Scale provided pragmatic, brief alternatives with acceptable construct validity, though limited structural evaluation. In intensive care settings, the Richards-Campbell Sleep Questionnaire and the Freedman Sleep Questionnaire Questionnaire demonstrated satisfactory internal consistency. Across instruments, structural validity and internal consistency were frequently evaluated, whereas measurement error, responsiveness, and cross-cultural measurement invariance were seldom examined.

Multiple sleep quality instruments are available for use in Arabic-speaking populations. However, none demonstrated comprehensive evaluation across all COSMIN-recommended measurement properties. Instrument selection should be guided by both psychometric evidence and conceptual alignment with the intended context of use. Future validation studies should prioritize responsiveness, measurement error estimation, and formal cross-cultural invariance testing to strengthen the evidence base for sleep quality assessment in Arabic contexts.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261328016, Identifier CRD420261328016.

Smoking cessation programs are designed to support individuals in quitting tobacco and improving their health. Psychological factors, including anxiety and depression symptoms, can affect cessation outcomes, emphasizing the need to investigate their influence in public program settings. Objective is to assess how anxiety and depression symptoms influence therapeutic success in a public smoking cessation program and to identify associated clinical and behavioral factors.

A longitudinal study was conducted from January to April 2025 with 80 participants enrolled in the Smoking Cessation Program of the municipality of Tubarão, Santa Catarina. The Fagerström test for nicotine dependence, Beck Anxiety Inventory, and Beck Depression Inventory were administered at baseline, 30, and 90 days. Data were analyzed using descriptive statistics and association tests (p < 0.05).

The participants showed a cessation rate of 40%; 26.3% of them dropped out, while 33.8% did not quit. The non-quitters were older (58.6±11.4 years) and had a higher tobacco exposure (47.7±25.3 pack years; p < 0.01) than the quitters (49.0±10.2 years; 29.5±18.6 pack years). The mean Fagerström score decreased among the quitters (0.05±0.2 vs. 2.5±1.1; p < 0.001). Higher anxiety at 90 days was associated with cessation failure (10.2 vs. 3.7; p < 0.001), whereas depression showed a similar but nonsignificant trend (p = 0.08).

Anxiety negatively affected cessation success, whereas depression showed a comparable pattern. Older age and greater tobacco exposure were associated with increased vulnerability. Thus, psychological assessments and multidisciplinary support in public cessation programs are essential.

In recent years, research interest in digital biomarkers has grown rapidly, driven by their capacity to enable continuous, objective, and personalized health monitoring. However, comprehensive bibliometric analyses of global research output in this field remain limited. This study aims to systematically evaluate the current status, hotspots, and emerging trends of global digital biomarker research using bibliometric analysis.

On August 11, 2026, we retrieved publications related to digital biomarkers from the Web of Science Core Collection (WoSCC). This study encompassed articles and reviews published from January 1, 2014 to August 11, 2026. Publication years, journals, authors, institutions, countries/regions, cited references, and keywords were systematically analyzed. VOSviewer was employed to conduct co-authorship, co-occurrence, and co-citation analyses and to construct network visualization maps.

We evaluated a total of 1056 publications from 96 countries/regions, of which the United States was the main contributor. Harvard University, King's College London and the Massachusetts General Hospital were the primary research institutions. Among the 7,188 contributing authors, Najafi, Bijan was the most prolific, while Horak, Fay B. was the most frequently cited. Keyword cluster analysis reveals four main research topics: (1) Parkinson's disease and mobility monitoring in older adults, (2) AI-assisted diagnosis, classification, and prediction, (3) remote mental health assessment and passive physiological monitoring, and (4) cognitive dysfunction and neurodegenerative disease assessment.

Digital biomarker research shows the characteristics of continuous expansion and increasingly diversified themes. This bibliometric analysis clarifies major research directions and knowledge structures, supporting digital biomarker development and clinical translation.

Alertness fluctuations and cognitive processing comprise overlapping brain circuits that include frontoparietal, thalamocortical, and sensory pathways. It is unclear how these brain circuits can simultaneously support such disparate but foundational human processes. To develop an integrated framework of consciousness and cognition, it is important to understand how fluctuations in alertness and cognitive processing interact in their shared circuits. In this electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) study, we assessed individuals who fluctuated between alert and drowsy states while engaged in either an active or passive auditory task. We hypothesized that during periods of low alertness, individuals who actively maintain task engagement would recruit additional frontoparietal and sensory processing networks, while thalamocortical dynamics that typically change during sleep onset would remain unaffected. We found that when alertness decreased, passively listening to auditory tones led to increased synchronization primarily in the parietal lobe, whereas actively performing an auditory task resulted in increased long-range frontoparietal synchronization. During decreasing alertness, passive listening (but not active task engagement) was associated with widespread increased synchronization between the thalamus and cortex. In contrast, active task engagement (but not passive listening) led to increased synchronization between the auditory cortex and the rest of the brain. These results suggest the brain's capacity for flexible functional reorganization when alertness levels decline but cognitive processes persist. The brain patterns that support transitions of consciousness at sleep onset also reflect ongoing cognitive task demands.

Major depressive disorder (MDD) commonly co-occurs with obsessive-compulsive disorder (OCD), resulting in greater symptom severity, functional impairment, and suboptimal response to standard pharmacologic and psychotherapeutic interventions. These challenges underscore the need for neuromodulation strategies to target distinct neural networks implicated in mood regulation and compulsivity. This report describes outcomes of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC), and low-frequency (LF) rTMS of the right orbitofrontal cortex (OFC), in a patient with comorbid MDD, OCD, and a left parietal perinatal ischemic infarct. Over the course of treatment, serial psychometric assessments demonstrated progressive reductions in frequency and intensity of depressive symptoms, anxiety, and obsessive-compulsive behaviors, measured via Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). This case adds to the growing body of literature demonstrating efficacy of DLPFC and OFC stimulation for depression and OCD. Further large-scale, blinded, and randomized trials are warranted to examine the efficacy of sequential DLPFC and OFC stimulation for comorbid MDD and OCD compared with single-site DLPFC stimulation.