To synthesize the available experimental study evidence to estimate the effects of ketamine on suicide ideation (SI) in high-risk individuals.

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Double-blind randomized controlled trials and open-label studies investigating the safety and effectiveness of ketamine on SI published up to October 2025 were identified. Data were pooled using random-effects meta-analysis. The main outcome was standardized mean difference on SI in high-risk individuals. Secondary outcomes were the percentage of adverse events and the moderator effects.

We identified 21 studies with a total of 927 participants meeting our inclusion criteria. The pooled effect size for the reduction of SI after ketamine treatment was significant and clinically meaningful (large effect size of −1.40, 95% confidence interval: −2.15 to −0.66, P < 0.001, low–quality evidence). Dissociation (38.8%, P = 0.014), nausea (31.6%, P < 0.001), dizziness (24.7%, P = 0.003), headache (22.0%, P = 0.011) and anxiety (15.8%, P < 0.001) were the frequently reported adverse events. Moderator analyses indicated that the effect was higher in younger individuals and those with severe SI.

Our findings highlight the effectiveness of ketamine in reducing SI in high-risk individuals, especially younger individuals and those with severe ideation. Nonetheless, additional research is required to better understand optimal dosing regimens and the potential long-term effects of ketamine treatment.

While mobile gaming addiction (MGA) behavior is increasingly prevalent among children and adolescents, the role of specific emotional-behavioral profiles – particularly their latent patterns – in associating with MGA behavior remains poorly understood. This study aimed to examine these associations and age-related variations.

Data were analyzed from 507,188 participants aged 6–18 years in the Children’s Growth Environment, Lifestyle, and Physical and Mental Health Development Project, conducted in Guangzhou, China, in 2020. Latent class analysis was performed on parent-reported Strengths and Difficulties Questionnaire (SDQ) data to identify subgroups with distinct emotional and behavioral problems. Associations between SDQ dimensions, latent classes, and MGA behavior were examined using logistic regression analysis.

Five latent classes were identified: ‘Low symptom’ (82.2%), ‘Internalizing’ (0.8%), ‘Peer and prosocial issues’ (4.3%), ‘High difficulties’ (5.0%), and ‘Hyperactive’ (7.6%). Compared to the ‘Low symptom’ class, all other latent classes showed significantly higher risks for MGA, with the strongest association observed in the ‘Internalizing’ class (adjusted odds ratio [AOR]: 2.84; 95% confidence interval [95% CI]: 2.67–3.02). Among SDQ subscales, conduct problems presented the highest association (AOR: 2.08; 95% CI: 2.04–2.12), though all SDQ subdimensions were significantly positively correlated with MGA behavior (all p < 0.05). Notably, these associations were consistently stronger in adolescents (aged 13–18 years) than in children (aged 6–12 years).

This study identifies specific SDQ-based risk characteristics for MGA behavior, with adolescents (aged 13–18 years) being the most vulnerable. Future longitudinal studies should verify these associations, and clinicians may prioritize early screening for internalizing and conduct-related difficulties.

To investigate the association of midlife and late-life undiagnosed mood symptoms, especially their comorbidity, with long-term dementia risk among multi-regional and ethnic adults.

The prospective study used data from the UK Biobank (N = 142,670; mean follow-up 11.0 years) and three Asian studies (N = 1,610; mean follow-up 4.4 years). Undiagnosed mood symptoms (manic symptoms, depressive symptoms and comorbidity of depressive and manic symptoms) and diagnosed mood disorders (depression, mania and bipolar disorders) were classified. Plasma levels of 168 metabolites were measured. The association between undiagnosed mood symptoms and 12-year dementia (including subtypes) risk and domain-specific cognitive function was examined. The contribution of metabolites in explaining the association between symptom comorbidity and dementia risk was estimated.

Undiagnosed mood symptoms were prevalent (11.4% in the UK cohort and 31.2% in Asian cohorts) among 1,462 (1.0%) and 74 (19.4%) participants who developed dementia. Comorbidity of undiagnosed mood symptoms was associated with higher dementia risk (sub-distribution hazard ratios = 9.46; 95% confidence interval = 4.07–21.97), especially Alzheimer’s disease, and with worse reasoning ability, poorer numeric memory and metabolic dysfunction. Glucose and total Esterified Cholesterol explained 9.1% of the association between symptom comorbidity and dementia, with most of the contribution being from glucose (6.8%).

Comorbidity of undiagnosed mood symptoms was associated with a higher cumulative risk of dementia in the long term. Glucose metabolism could be implicated in the development of mood disorders and dementia. The distinctive pathophysiological mechanism between psychiatric and neurodegenerative disorders warrants further exploration.

As a highly aggressive tumour of the digestive tract, pancreatic cancer has a high mortality rate and poor treatment outcomes. The five-year survival rate for patients with pancreatic cancer is distressingly low, and the recurrence chance remains unacceptably high even with successful treatment. Surgical procedures and chemotherapy are the main treatments of pancreatic cancer, and surgical procedures are the only effective treatment at present. However, these cancer cells can easily develop resistance to chemotherapy agents, which leads to low treatment efficacy and high mortality in pancreatic cancer. Additionally, early diagnosis of pancreatic cancer is challenging due to the absence of obvious symptoms, making surgical intervention unattainable in early stages. However, pancreatic cancer cells show unique changes at genetic and cellular levels, which makes them sensitive to metalrelated cell death or exhibit some characteristics related to metalrelated cell death. These changes and characteristics could be utilized for treatment and diagnosis in pancreatic cancer.

Therefore, our motivation is to explain the potential of metalrelated cell death in treating this aggressive cancer. This review begins by analysing the types of metal-related cell death: ferroptosis, cuproptosis and lysozincrosis. Each form is evaluated based on its unique features and related metabolic pathways.

By examining the key characteristics of metal-related cell death modalities, their primary metabolic patterns and their interactions with pancreatic cancer, our aim is to point the direction to identify potential therapies and treatments.

Our review expands the possibilities for utilizing metal-related cell death and instils hope for its future potential in pancreatic cancer treatment.

Euthymic bipolar disorder (euBD) patients exhibit deficits in neurocognitive and social cognitive functioning compared to healthy controls (HCs). Our prior research has shown that the excitatory/inhibitory (E/I) imbalance in the default mode network (DMN) is linked to executive function in euBD. Neurocognitive impairments are associated with social cognition deficits in individuals with mental disorders. Given this connection, this study posits E/I imbalance within the DMN is associated with social cognition, with executive function as a mediator.

Seventy-five HCs and 49 euBD individuals were recruited. Using the emotion recognition task, Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version (DANVA-2-TW) and cognitive flexibility task, Wisconsin Card Sorting Test (WCST), we assessed emotion recognition and prefrontal function. Proton magnetic resonance spectroscopy (1H-MRS) measured metabolites in the posterior cingulate cortex (PCC) and medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC), quantifying excitatory glutamate+glutamine (Glx) and inhibitory GABA to calculate the E/I ratio.

euBD patients showed poorer emotion recognition (p = 0.020) and poorer cognitive flexibility (fewer WCST categories completed, p = 0.002). A negative association was found between emotion recognition and the E/I ratio in the mPFC/ACC of the BD patients (r = −0.30, p = 0.034), which was significantly mediated by cognitive flexibility (Z = −2.657, p = 0.007).

The BD patients demonstrate deficits in emotion recognition, linked to an altered E/I balance in the prefrontal cortex, and the cognitive flexibility, a key aspect of executive function, mediates the impact of the E/I ratio on emotion recognition accuracy in euBD patients.

Late-onset depression (LOD) is featured by disrupted cognitive performance, which is refractory to conventional treatments and increases the risk of dementia. Aberrant functional connectivity among various brain regions has been reported in LOD, but their abnormal patterns of functional network connectivity remain unclear in LOD.

A total of 82 LOD and 101 healthy older adults (HOA) accepted functional magnetic resonance imaging scanning and a battery of neuropsychological tests. Static functional network connectivity (sFNC) and dynamic functional network connectivity (dFNC) were analyzed using independent component analysis, with dFNC assessed via a sliding window approach. Both sFNC and dFNC contributions were classified using a support vector machine.

LOD exhibited decreased sFNC among the default mode network (DMN), salience network (SN), sensorimotor network (SMN), and language network (LAN), along with reduced dFNC of DMN-SN and SN-SMN. The sFNC of SMN-LAN and dFNC of DMN-SN contributed the most in differentiating LOD and HOA by support vector machine. Additionally, abnormal sFNC of DMN-SN and DMN-SMN both correlated with working memory, with DMN-SMN mediating the relationship between depression and working memory. The dFNC of SN-SMN was associated with depressive severity and multiple domains of cognition, and mediated the impact of depression on memory and semantic function.

This study displayed the abnormal connectivity among DMN, SN, and SMN that involved the relationship between depression and cognition in LOD, which might reveal mutual biomarkers between depression and cognitive decline in LOD.

Antimicrobial resistance (AMR) is a global health crisis exacerbated by policies like China’s Volume-Based Procurement (VBP), which may inadvertently increase antimicrobial overuse. This study evaluates a clinical pharmacist-led Antimicrobial Stewardship (AMS) program with prospective audit for special-restricted antimicrobials under VBP.

A retrospective quasi-experimental interrupted time-series analysis compared pre-intervention (2022) and post-intervention (2023–2024) data at Tongji Hospital, a tertiary hospital in Wuhan, China. Key metrics included Antimicrobial Use Density (AUD), prescription rationality, antimicrobial costs, and multidrug-resistant infection rates.

The intervention significantly improved prescription appropriateness for special-restricted antimicrobials (80.24% vs. 93.83%, P < 0.005) and reduced AUD (47.87 vs. 34.25, P < 0.001). Total antimicrobial costs decreased by 41.26%, with a reduction in the incidence of multidrug-resistant infections from 0.084% to 0.062% (P < 0.05). Carbapenem use correlated with CRKP isolation rates (R = 0.62, P < 0.05). Clinical pharmacists rejected 10.24% of prescriptions, all accepted by physicians.

Pharmacist-led prospective audits optimize antimicrobial use under VBP, mitigate resistance risks, and reduce costs, while acknowledging that concurrent infection control measures may have contributed to these trends. This model may inform similar interventions in other institutions, particularly those in resource-limited settings.

Psychomotor disturbance (PmD) is prevalent in major depressive disorder (MDD), with neural substrates implicated in disrupted motor circuits and the interaction to non-motor cortex. Our objective is to explore the functional connectivity pattern underlying PmD using functional magnetic resonance imaging (fMRI).

A total of 150 patients with MDD and 91 healthy controls (HCs) were included in this study. The patients were categorized into psychomotor (pMDD, n = 107) and non-psychomotor (npMDD, n = 43) groups based on the Hamilton Depression Rating Scale. Seed-based connectivity (SBC) analysis was conducted using predefined somatomotor and cerebellar network (SMN and CN) coordinates as seeds, to assess group differences and symptom correlations. Subsequently, we correlated the group-contrast SBC map with existing neurotransmitter maps to explore the neurochemical basis.

In pMDD patients compared to HC, we observed decreased connectivity, especially between the SMN and frontal cortex, within the bilateral SMN, and between the CN and right precentral cortex. Meanwhile, connectivity increased between the SMN and the middle cingulate cortex and between the CN and left precentral cortex in pMDD relative to npMDD and HC. Connectivity between the SMN and angular gyrus was positively correlated with the severity of PmD. Additionally, the aberrant SBC patterns in pMDD were linked to the distribution of dopamine D1 and D2 receptors.

This study provides insights into the aberrant connectivity within the motor circuits and its interactions with non-motor regions in PmD. It also suggests a potential role for dopaminergic dysregulation in the connectivity abnormalities associated with PmD.

Although guidelines recommend targeted vitamin D testing for high-risk populations, testing has increased globally. Limited studies have examined real-world testing patterns and their relationship with deficiency outcomes. This study investigates trends, demographic determinants and deficiency outcomes associated with voluntary vitamin D testing among Taiwanese adults.

A retrospective cohort study analysing electronic medical records to assess vitamin D testing trends, demographic predictors of deficiency and status changes following consecutive tests within 2 years. Vitamin D status was classified based on serum 25-hydroxyvitamin D levels as deficient (< 20 ng/ml), insufficient (20–29·9 ng/ml) or sufficient (≥ 30 ng/ml).

A tertiary medical centre in Taiwan.

Between 2013 and 2022, 13 381 outpatients underwent voluntary vitamin D testing. After excluding those aged < 18 years, with advanced renal disease, osteomalacia, rickets or hyperparathyroidism, 8383 were included in the final analysis.

Testing increased sharply after 2019. Although women underwent twice as many tests, men had a higher deficiency prevalence (56·94 % v. 53·01 %). Adults aged 18–34 years had the highest prevalence (67·81 %). Obstetrics and Gynecology specialists ordered the most tests, particularly for female infertility, with 65·73 % of patients deficient. Among those with repeat tests, deficiency prevalence decreased from 59.32 % to 43·25 %.

The increase in voluntary vitamin D testing with demographic disparities highlights the importance of understanding testing behaviours and public health implications. Improved vitamin D status at follow-up suggests potential benefits in identifying high-risk individuals and emphasises the need for further research to evaluate outcomes and guide prevention strategies.